Dr. William Oh on How Precision Medicine and Early Detection Transform Outcomes in Prostate Cancer Care

Precision Medicine Podcast

In part one of a two-part series on prostate cancer, the Precision Medicine Podcast addresses critical challenges as well as new advancements in prostate cancer, the second leading cause of cancer-related deaths in men. Host, Karan Cushman, is joined by Dr. William Oh, Director of Precision Medicine at Yale Cancer Center and Chair of the American Cancer Society National Prostate Cancer Roundtable. Together, they shed light on the complexities of prostate cancer and how early screening can address rising incidence rates and persistent disparities, particularly among African American men. Subscribe to get Part 2 delivered straight to your inbox.

Prostate cancer currently affects one in eight men in the US, with African American men facing a one-in-six risk and 70% higher incidence rate than White men. These disparities extend to earlier onset and more aggressive disease presentations. Globally, the disease is the most frequently diagnosed cancer in 112 countries and a leading cause of cancer-related deaths in 48 countries. The incidence of prostate cancer has been rising steadily. There has been a 3% annual increase in cases and a 5% annual rise in advanced prostate cancer diagnoses since 2014. Throughout the series, Dr. Oh discusses the role precision medicine can play in addressing these trends by tailoring prevention, diagnosis and treatment strategies to individual patient profiles.

Karan and Dr. Oh begin the conversation by highlighting critical advances in prostate cancer care, including the development of over a dozen FDA-approved drugs in recent decades. Listeners will learn of the systemic barriers that often prevent men from accessing these treatments, resulting in just half of men with advanced prostate cancer receiving standard-of-care therapies—a fact that underscores the need to improve access and equity in treatment. Dr. Oh chairs the American Cancer Society National Prostate Cancer Roundtable, which aims to address these gaps by uniting diverse stakeholders—from patient advocacy groups to scientific organizations—to improve outcomes through collaborative efforts.

The discussion also explores the role of environmental and epigenetic factors in prostate cancer risk. Dr. Oh discusses how stress, socioeconomic disparities, and toxic exposures, such as those experienced by 9/11 first responders, may alter DNA and increase cancer risk. He compares these findings to the higher incidence of prostate cancer among African American men who live in environments that exacerbate health disparities. Dr. Oh emphasizes the importance of identifying and mitigating these risks to improve outcomes.

Screening is a key topic throughout the conversation, and Dr. Oh discusses the challenges of early detection and the controversies surrounding PSA (prostate-specific antigen) screening. While current guidelines recommend baseline PSA testing for most men between the ages of 50 to 55, new evidence supports earlier screening for high-risk populations, particularly African American men who should begin testing between ages 40 and 45. This shift toward earlier detection is critical for addressing aggressive cancers before they progress to advanced stages.

Dr. Oh goes on to explain the importance of genetic testing, which reveals up to 10% of advanced prostate cancer cases involve BRCA or other DNA repair mutations. Recognizing these mutations early can inform targeted treatments like PARP inhibitors, yet Dr. Oh notes that many patients are not tested, underscoring the need for better implementation of precision diagnostics. By linking genetic data to clinical outcomes, precision medicine can help tailor treatments to the unique needs of each patient.

The episode concludes with a call to action for improved education and collaboration. Dr. Oh emphasizes the need for patients to discuss family history and risk factors with their doctors and for primary care physicians to prioritize early conversations about prostate health. He advocates for a comprehensive approach that combines education, technology and multidisciplinary care to close gaps in prostate cancer treatment and ensure that advances in precision medicine benefit all populations, especially those at highest risk.

Stay tuned for Part 2 with Dr. Oh coming out in late December 2024.