Expanded Diagnostic and Treatment Options Needed to Overcome Stage Migration of Prostate Cancer
By BECKY GILLETTE
Urologist Robbie Hurtt says flawed USPTF data on testing created problem
Prostate cancer is one of the most common cancer diagnoses, affecting an estimated 1 in 9 men in America, primarily occurring in men 65 and older, and in African Americans. Some people may be less concerned about a diagnosis of prostate cancer today because for most, it is slow growing and not fatal. But it is still the second leading cause of cancer deaths in men.
Robbie Hurtt, MD, a urologist based at the Arkansas Urology Conway clinic, said while there are certainly slow-growing prostate cancers, there are also fast-growing, aggressive prostate cancers that tend to metastasize, ending men's lives earlier than expected.
"And as one would expect, there are many prostate cancers in between," said Hurtt. "We now have more tools available than ever to help us differentiate these different tumor behaviors. While a simple blood test called a PSA (prostate specific antigen) and digital rectal exam (DRE) can help identify patients at risk for prostate cancer, the diagnostic capabilities available to us now far exceed PSA and DRE alone."
Hurtt said he can't think of another area of urology that is evolving as fast as prostate cancer. This applies to men who have yet to be diagnosed to those with advanced, metastatic prostate cancer.
"The diagnostic capabilities and therapeutic treatments continue to expand year-to-year which is exciting for us as urologists and great for our patients dealing with this malignancy," Hurtt said.
The PSA test for prostate cancer has been controversial in recent years. But Hurtt said the PSA test is still an extremely useful part of identifying men at risk for prostate cancer, as well as a way of following patients who have been treated for prostate cancer to rule out recurrence of the disease.
"PSA's reputation, so to speak, took a hit in 2012 when the U.S. Preventive Task Force (USPTF) recommended against PSA screening," Hurtt said. "While no prostate cancer expert sat on the panel which made the recommendation, the results have changed practice patterns in our country. The recommendation against the PSA test is contradicted the American Urologic Association (AUA) and experts in the field of urology and prostate cancer. We felt the data the USPTF used to make their recommendations was flawed. Fortunately, they eventually agreed and removed their prior recommendation against PSA."
The USPTF position now is that the decision about PSA screening should be between the patient and their physician.
"PSA certainly has its limitations, and we know that," Hurtt said. "We can augment PSA's shortcoming with molecular testing, MRI and other cutting-edge options now available. The AUA guidelines state men aged 40-70 years old with risk factors for prostate cancer such as family history or African American descent should consider prostate cancer screening, and average risk men should consider screening from age 55-70."
The recommendation against PSA may have backfired. Since the initial USPTF recommendation in 2012 against PSA, a stage migration has been seen in prostate cancer.
"This means more patients are coming to the urologist in 2019 with higher stage, metastatic prostate cancer than 10 years ago," Hurtt said. "Metastatic prostate cancer is incurable. Why has this happened? We have better and more treatment options now than ever. This stage migration has occurred due to less PSA screening. While USPTF removed their recommendation against PSA screening, practice patterns take time to change."
Hurtt strongly encourages any healthcare provider throughout the state who is not talking to their male patients about prostate cancer have that conversation.
"We would be happy to have a discussion with any of those patients, as well," he said. "An elevated PSA does not guarantee that a patient needs a biopsy or will have treatment, but it starts a dialogue and a closer follow-up to ensure we aren't missing these patients at high risk for morbidity and mortality from prostate cancer."
Arkansas Urology is in the process of building a state-of-the-art facility in Conway. Hurtt said they are hopeful to be in that space by the end of the year.
"As leaders in the state in urologic care, this investment in Conway is a big step forward for our patients in Faulkner County and beyond," he said.
Hurtt grew up in Salem, a small town in North Arkansas near Mountain Home, and was valedictorian of Salem High School in 2004. He graduated summa cum laude with a degree in biology from the University of Arkansas, Fayetteville, in 2008. He received his Medical Degree from the University of Arkansas for Medical Sciences in 2012, and did a general surgery internship followed by a urology residency at the University of Mississippi Medical Center in Jackson, finishing up in 2017. He has been employed by Arkansas Urology, the largest urology practice in the state, since 2017.
Hurtt was selected for the Prostate Cancer Academy, Denver, CO, in September 2016, and received the T Leon Howard Imaging Conference presentation award from The Southeast Section of the American Urologic Association in 2016. He received the 2009-2012 Robert L Kerr Medical Student Scholarship, and the 2004-2008 Chancellor's Scholarship and Governor's Distinguished Scholarship from UAMS. He has done a number of podium presentations and published research papers including: A pilot study of telemedicine for post-operative urologic care in children. Stephen Canon, Hurtt et al. Journal of Telemedicine and Telecare, October 2014.
Hurtt and his wife, Megan, are very passionate about adopting and foster care.
"My wife is intimately involved with many organizations related to this (The Call, Soaring Wings, Little Rock Angels), and she is a CASA (court appointed special advocate) for a foster child in Faulkner County," he said. "We are also very involved in our church, New Life Church."
In July, the couple went back to Peru for about 3 weeks for medical and outreach missions in the Amazon. They are also diehard Razorback fans.
"We enjoy going to games there, and we have also become fans of our local colleges in Conway since moving there," Hurtt said.
From the age of 10, he has had an interest in old cars and has restored multiple muscle cars.
"It was working on old cars and 'diagnosing' their 'diseases' that sparked my interest in medicine," he said. "I also think that's really what drew me to surgery. Tools, albeit more expensive, such as high definition endoscopes, robots, and scalpels, seemed like a natural fit for me given my experience with working with other simpler tools on cars over the years."