Prostate Cancer Services

Prostate Cancer Services

Facts About Prostate Cancer

The American Cancer Society estimates that in 2018:

  • 164,690 men will be diagnosed with prostate cancer in the United States
  • 29,430 men in the United States will die from prostate cancer

More than 60% of prostate cancers are diagnosed in men over 65

Prostate cancer is the second leading cause of cancer death in American men behind lung cancer

Approximately 1 in 9 men will be diagnosed with prostate cancer during their lifetime  

 

Risk Factors For Prostate Cancer

Incidence of prostate cancer increases with age.

  • Median age at diagnosis in Caucasian males is 71.
  • African-American men have the highest incidence of prostate cancer in the world.
  • Heredity accounts for 5 to 10 percent of cases.

 

Screening For Prostate Cancer

According to the American Cancer Society, men aged 50 or older should be offered a digital rectal exam (DRE) and a PSA blood test. However, it is a good idea to visit your doctor earlier to establish a baseline PSA level so you can monitor changes. 

  • Prostate specific antigen (PSA) is a valuable marker for prostate cancer although BPH or infection may also cause a rise in PSA.
  • Normal range is 0-4, however, a PSA above 3 in men younger than 60 may be considered abnormal.
  • African-American men and men with a family history of prostate cancer should be examined beginning at an earlier age.

 

Diagnosing Prostate Cancer

Prostate cancer is most often diagnosed through a blood test measuring the amount of prostate specific antigens (PSA) in the body. However, signs and symptoms of prostate cancer can include:

  • Changes in urinary flow: Frequency, urgency, hesitancy.
  • Frequent nighttime urination.
  • Painful urination.
  • Blood in urine.

Other conditions that may cause these symptoms include an enlarged prostate (benign prostatic hypertrophy or BPH) or infection.

 

Treatments for Prostate Cancer

The treatment of prostate cancer depends on the size, location and whether the cancer has spread, along with the man’s overall health. If the prostate cancer is identified at an early stage and is growing slowly, the physician may recommend active surveillance i.e. close monitoring of the cancer with active treatment only beginning when the cancer shows signs of spreading or causing pain or blockage to the urinary tract. In that case, treatment options include surgery and/or radiation therapy.

 

Surgical Options for Treating Prostate Cancer

Surgery is a common choice to try to cure prostate cancer if it has not spread outside the prostate gland. The main type of surgery for prostate cancer is a Radical Prostatectomy in which the entire prostate gland is removed plus some of the surrounding tissue, including the seminal vesicles. A radical prostatectomy can be done in different ways. 

 

Open Approaches to Radical Prostatectomy:

The surgeon operates through a long incision to remove the prostate and nearby tissue. This approach is used less often than in the past.

  • Radical Retropubic Prostatectomy: The surgeon makes an incision in the lower abdomen from the belly button to the pubic bone. The prostate is removed and nearby lymph nodes if there is a reasonable chance that the cancer might have spread.
  • Radical Perineal Prostatectomy: The surgeon makes an incision between the anus and scrotum. This approach is used less frequently because it is more likely to lead to erection problems and nearby lymph nodes cannot be removed. However, this approach takes less time than a Radical Retropubic Prostatectomy and may result in less pain and an easier recovery.

 

Laparoscopic Approaches to Radical Prostatectomy

Laparoscopic approaches use several smaller incisions and long surgical tools to remove the prostate. The surgeon either holds the tools directly or uses a control panel to move robotic arms that hold the tools. This approach to Radical Prostatectomy has become more common in recent years.

  • For a Laparoscopic Radical Prostatectomy (LRP), the surgeon inserts several long instruments (one of which includes a video camera to see inside the body) through several small incisions to remove the prostate. LPR has advantages over Open Radical Prostatectomy including less blood loss, less pain, shorter hospital stays and faster recovery time.
  • An LPR can also be done using a robotic system and the procedure is known as Robotic Prostatectomy. The surgeon sits at a control panel in the operating room and moves robotic arms to operate through several small incisions in the abdomen. The robotic system may provide more precision and maneuverability than standard LRP. The most important factor in either type of laparoscopic surgery is the surgeon’s experience and skill.

 

Radiation Therapy Options for Treating Prostate Cancer

After a diagnosis of prostate cancer has been established with a biopsy, the patient should discuss the treatment options with a radiation oncologist and a urologist. Radiation therapy treatment options to cure prostate cancer include:

  • External beam radiotherapy.
  • Prostate brachytherapy.

 

External Beam Radiation Therapy

External beam radiation therapy involves a series of daily outpatient treatments to accurately deliver radiation to the prostate. There are two principal methods for delivering external beam radiation.

  • 3-dimensional conformal radiotherapy (3D-CRT) combines multiple radiation treatment fields to deliver precise doses of radiation to the prostate. Tailoring each of the radiation beams to accurately focus on the patient's tumor allows coverage of the prostate cancer while at the same time keeping radiation away from nearby organs such as the bladder or rectum.  
  • Intensity modulated radiation therapy (IMRT) is the most recent advance in the delivery of radiation. IMRT improves on 3D-CRT by modifying the intensity of the radiation within each of the radiation beams. This technique allows more precise adjustment of radiation doses to the tissues within the target area, potentially allowing an increased radiation dose to the prostate and reduced doses to nearby normal tissues. Higher doses to the prostate translate into a greater chance for cure, while lower doses to surrounding organs mean fewer side effects.

Both types of external beam radiotherapy are acceptable treatment; IMRT offers advantages for some but not all prostate cancer patients. With either type of therapy, painless radiation treatments are delivered in a series of daily sessions, each under half-hour in duration, Monday through Friday, for seven to ten weeks overall.

Potential side effects, including fatigue, increased frequency or discomfort of urination, and loose stools, typically resolve within a few weeks after completing treatments. Impotence is also a potential side effect of any treatment for prostate cancer. However, many patients who receive radiation therapy for prostate cancer are able to maintain sexual function. 

 

Prostate Brachytherapy

Prostate brachytherapy, better known as a seed implant, is often done in the operating room.

There are two methods of delivering internal radiation for prostate cancer:

  • Permanent seed implants.
  • High-dose rate temporary seed implants.

These treatments are designed to deliver a very high dose of radiation to the tumor by inserting radioactive seeds directly into the prostate gland under ultrasound guidance while the patient is under anesthesia. Isotopes of iodine or palladium are most commonly used. The seeds are approximately four millimeters long and less than a millimeter in diameter. In certain situations, both prostate brachytherapy and external radiation may be recommended to combat the tumor.

The side effects from seed implants are similar to those experienced with external beam radiotherapy. Patients usually experience urinary frequency and discomfort in urination. These effects may be lessened with medication and usually dissipate over the course of three to six months.

 

Medical Oncology Options for Treating Prostate Cancer

For men with a larger tumor or cancer that is more likely to return, hormone therapy, or androgen deprivation therapy (ADT), may be given before surgery or radiation therapy may be given after surgery. Several months of ADT may also be combined with radiation therapy. ADT is the main treatment option for men with metastatic prostate cancer, but radiation therapy or chemotherapy may be recommended. Prostate cancer that no longer responds to ADT is called castration-resistant prostate cancer. It may be treated with chemotherapy, immunotherapy, or other newer treatment options.