Advances in prostate cancer diagnosis and treatment Dr Nick Mehan

Host: Michelle Odayan (My Health Academy) Guest Expert: Dr. Nicholas Mehan (Urological Surgeon specializing in prostate cancer, robotic surgery, and laser ablation)

Episode Summary

Dr. Nicholas Mehan provides an overview of how prostate cancer care has evolved over the past two decades. The discussion covers the shift away from broad PSA screening toward targeted early detection, modern diagnostic tools (mpMRI and transperineal biopsy), updated Australian clinical guidelines (PCFA & RACGP Red Book), and harm-minimizing treatments like focal laser ablation and robotic surgery.

Key Discussion Topics & Highlights

The PSA Screening Dilemma & Historical ContextPre-PSA Era: Before blood testing in the 1990s, prostate cancer was typically detected at late, metastatic stages with high mortality.Overdiagnosis & Overtreatment: The introduction of PSA testing increased early detection but led to 20–40% overdiagnosis of indolent, low-risk cancers, subjecting many men to aggressive treatments that caused incontinence and erectile dysfunction.Guideline Re-evaluation: Confusion following the 2012 US Preventive Services Task Force (USPSTF) recommendation against PSA testing led to long-term trial analyses that confirmed the value of targeted early detection.Diagnostic Breakthroughs (The Past 10 Years)Multiparametric MRI (mpMRI): Used as a triage tool before biopsy. Federally funded in Australia since 2018, allowing ~50% of low-risk men to safely avoid biopsy altogether.Transperineal (TP) Biopsy: Replaced transrectal (TRUS) biopsies, reducing post-procedure sepsis risk from up to 2–5% down to ~1 in 1,000.Active Surveillance: Standard of care for low-risk (Grade Group 1) disease, with ~90% of eligible Australian men choosing monitoring over immediate surgery or radiation.Updated Clinical Guidelines (PCFA & RACGP 10th Edition Red Book)Risk-Based Approach: Recommends baseline PSA testing from age 45–49 for high-risk men (family history, BRCA2 gene mutation, Black ancestry).Routine Testing: Recommended every 2 years for well-informed men aged 50–69 (with re-testing triggered at PSA > 3.0).Digital Rectal Exam (DRE): No longer recommended for routine screening in asymptomatic men.Treatment Innovations & Harm MinimizationFocal Therapy (Organ Preservation): Targets the MRI-visible "index lesion" while preserving surrounding prostate tissue, resulting in 0% incontinence and low erectile dysfunction rates. Dr. Mehan highlights Nepean Hospital’s ProFocal laser ablation trial, which a