Prostate Cancer

OVERVIEW

Like breast cancer in women, the diagnosis of prostate cancer is one of the most devastating cancer diagnoses for men. Not only is there the fear of the disease itself, but also the possibility for damage to bowel or bladder control, or sexual function as a consequence of treatment. Fortunately, this is changing as treatment becomes more targeted and less toxic. Prostate cancer is the most common malignancy to afflict men. Approximately 180,000 new cases of prostate cancer are diagnosed annually. About 40,000 men die of prostate cancer each year. Early detection is the key to improved outcomes and survival. Earlier detection also increases the potential treatment options available to the individual. Prostate cancer screening, although controversial, enhances the ability to detect prostate cancer early. Screening may be especially important for those men who are at higher risk, as compared with the general population, for developing prostate carcinoma

Because the only way to improve cure rates of prostrate cancer is through early detection. Every man over fifty years of age should  have an annual rectal examination and a PSA (Prostate Specific Antigen) blood test. This painless test is capable of detecting prostrate cancer years before it is large enough to cause symptoms—at a time when it is usually most curable. Men with prostate cancer in their family are at higher risk and should begin screening earlier. African American men have the highest incidence rate of prostate cancer
 

RISK FACTORS 

Risk factors include age (higher vs. lower), family history of prostate cancer, race, dietary and environmental exposures, and the existence of precancerous findings at the time of prostate biopsy.

If prostate cancer is suspected, a biopsy is necessary to confirm the diagnosis and also to assign a “Gleason Sum.” This is a numeric score of the aggressiveness of the cancer which ranges from 2-10. Once prostate cancer is detected, scans are usually done to determine how far the disease has spread beyond the prostate.

DIAGNOSIS AND STAGING 

Once a diagnosis of prostate cancer is established, various parameters need to be assessed to determine which treatment options are appropriate. These parameters include age of patient, other complicating medical problems, degree of differentiation (Gleason score), and stage of the tumor (see table below). Additional tests, such as a CT scan or bone scan, may be needed for staging. As the PSA, Gleason score and/or the size of the tumor in the prostate increases, the higher the risk of microscopic cancer spread outside the prostate into the surrounding tissues, the lymph nodes in the pelvis, or through the bloodsteam into the bones.
 

(Click here to see the STAGES of Prostate Cancer)

The picture at the top demonstrates a 3-D conformal plan to treat the prostate with radiation beams. The green colorwash shows the six intersecting beams superimposed on a cross section of the pelvis. The red area where the beams overlap is the prostate. This spreads the dose out over normal tissue sparing it somewhat from radiation effects. However, the most accurate way to treat the prostate and spare normal tissue is to actually implant radiation within the prostate using radioactive seeds. This is called brachytherapy.
 

Treatment of prostate cancer is highly tailored and will depend on many factors including:

• The age and health of the patient

• The size of the prostate

• The size of the tumor and its Gleason Sum

• The presence or absence of disease outside of the gland

Your doctor will discuss all of these issues with you. Possible treatment alternatives include

o      Observation—Usually for older men with tumors of low aggressiveness, or in patients who are not healthy enough to tolerate more aggressive treatments. As prostate cancers usually grow very slowly, this "watchful waiting" may be all that is needed for many years.

o      Surgery to remove the prostate gland is usually recommended in younger men who are in good health. A Radical Prostatectomy is surgical removal of the prostate, and, often removal of some pelvic lymph nodes. Because it is associated with all the possible complications of major surgery, it is not generally recommended in older men. The use of Robotic Assisted surgery is making this operation safer and more widely useful.  
 
o      Total Androgen Blockade.  Hormone shots or pills, or removal of the testicles stops the action of the male hormone testosterone. Hormone treatments could be a treatment given alone, after surgery, or in combination with radiation therapy depending on stage, Gleason score, or PSA. Possible side effects include impotence, hot flashes, osteoporosis, and loss of muscle mass. 

o      Radiation Beam treatments require sophisticated treatment planning computers and equally sophisticated radiation treatment delivery equipment. Using IMRT techniques, we can deliver of high doses of radiation to the prostate by creating radiation beams that conform to the shape of the prostate. This minimizes radiation dose to surrounding normal structures, decreasing the risk of long term side effects. This treatment may also play a role after surgery, depending on surgical findings, and in some circumstances can be used in combination with seed implants (brachytherapy). Long term risks include bowel dysfunction in approximately 20-30% of patients with 3% experiencing severe bowel complications, severe urinary dysfunction in 8%, complications requiring surgery in less than 1%, urinary incontinence in less than 2%, 33-50% reported risk of impotency. 


o      Implantation of radioactive seeds is the placement of several dozen radioactive "seeds” directly into the prostate to give a high, localized dose of radiation. The seeds are delivered through needles with the patient under anesthesia. An ultrasound probe in the rectum guides the placement of each seed into the correct spot. This is typically a more useful option in those patients falling into the favorable category. Long term side effects are similar to Radiation Beam Treatments, but also may include a small risk of infection or bleeding from the needle sticks.

o      Cryotherapy (freezing) is very new and its role is still not well defined. While it is generally felt that this is still an investigational treatment, and not ready for widespread use as initial curative therapy, we do have several urologists with cryotherapy experience. It may also be of more value as treatment for cancer which regrows after radiation. But again, extensive experience with cryosurgery is lacking.

Robotic Assisted Surgery: Here at St. Josephs Hospital we're using the Da Vinci robotic system to perform radical prostatectomies for prostate cancer. This state-of-the-art machine allows our surgeons to operate on the prostate through small holes in the abdomen. This is key to doing a nerve sparing prostatectomy in order to preserve post-operation potency and, it allows for a faster return to continence. Patients recover faster with shorter hospital stays. To learn more about Robotic Assisted Prostate Surgery, and to meet one of our surgeons,

click here: www.DrMastandrea.com

   Call or click for a free informational CD about Prostate Seed  Implants. 
 (813) 870-4160

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