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It is news that no man wants to hear: a prostate cancer diagnosis. For Terry Gross, it marked the start of a challenging journey to determine his next steps. The options ran the spectrum: from monitoring the cancer without treatment, known as active surveillance, to surgery. Only after genetic testing and leading-edge care through The Mark R. Neaman Center for Personalized Medicine did Gross get the information needed to make the right decision for him.
The 57-year-old from Evanston first learned of the health threat when a routine physical found he had an enlarged prostate. A prostate-specific antigen (PSA) blood test followed. The PSA test, which can be used to screen for prostate cancer, tracked rising levels in Gross’ PSA score. It warranted further clinical investigation.
NorthShore’s John and Carol Walter Center for Urological Health offers patients a Prostate Health Index (PHI) assessment. This comprehensive testing, performed by NorthShore’s advanced pathology laboratory, measures several biomarkers in the blood to better pinpoint a patient’s risk of having cancer and, more important, an aggressive form of prostate cancer. Gross’ PHI results confirmed he was at an increased risk and should have a biopsy of the gland.
While the biopsy did confirm cancer, the results still left questions as to whether surgery would be the best option. Of the 12 tissue samples taken during the biopsy, only one showed cancer, and Gross’ Gleason score—a measurement of potential aggressiveness of the disease—was low.
Armed with conflicting test results and no clear path to treatment, Gross turned to Urologist and Surgeon Brian Helfand, MD, PhD, and the care team at the Walter Center. Dr. Helfand, who holds an academic appointment at the University of Chicago Pritzker School of Medicine, also has specialized research expertise in identifying genetic markers for prostate cancer.
In consultation with Gross and his family, Dr. Helfand recommended that Gross undergo genetic testing through the Neaman Center for Personalized Medicine, seeking to identify a possible BRCA gene mutation. Although BRCA mutations are often linked to breast cancer in women, research studies led by NorthShore physician-scientists have found that they also can be an indicator of aggressive forms of prostate cancer.
“We’re making great progress in our research into the potential impact for carriers of these genetic mutations, and that’s helping to guide our treatment plans,” explained Dr. Helfand.
Gross also had other risk factors in his family’s health history. His mother had breast cancer, his father suffered from pancreatic cancer and Gross himself previously fought off lymphoma.
DNA testing at NorthShore confirmed that Gross had a mutation in the BRCA2 gene. Armed with that definitive information, Gross consulted further with his caregivers and his wife, ultimately deciding to have his prostate surgically removed.
“Initially, I was in denial about this and wasn’t sure I wanted to do it,” recalled Gross. “My wife was really worried and upset about the cancer diagnosis, much more than me. But Dr. Helfand was great with us. He was really balanced in his approach and wasn’t trying to sway me either way.”
Dr. Helfand performed the procedure just before Labor Day last year with advanced robotassisted laparoscopic surgery, using tiny incisions to minimize nerve damage. Gross expressed thanks to be at a place like NorthShore, where the personalized medicine approach is valued. The genetic information helped him not only decide on his course of treatment, but better grasp the unique risks he faced. As the father of two daughters in their 20s, Gross also felt a strong obligation to share his genetic finding with them and other members of his family.
“This is a very emotional topic for me,” noted Gross. “I’ve encouraged my family to be tested for their genetic risk for cancer so that they can make better-informed healthcare decisions going forward. NorthShore has these tools, and we should take advantage of them.”
“It’s gratifying to be at a place like NorthShore that’s on the leading edge of real-time implementation of personalized medicine,” added Dr. Helfand. “Many health systems have ideas about using genetics to guide a patient’s care, but at NorthShore we’re putting these findings into action.”