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Prostate Cancer

The prostate is a small walnut-shaped gland in males that produces seminal fluid, the fluid that nourishes and transports sperm. Prostate cancer is one of the most common types of cancer in men, affecting about one in six men in the United States.

The diagnosis of prostate cancer is made after performing a needle prostate biopsy (TRUS BX).  A prostate biopsy is indicated in men with an abnormal PSA level or an abnormal digital rectal exam (nodule detected on the surface of the prostate).  Needle biopsy confirms the presence or absence of cancerous prostate cells.  If prostate cancer has been detected the patient will undergo further testing to determine if the cancer is its early stages (organ confined) or advanced stages (metastatic).  Treatment options vary depending on the stage of the cancer.

Treatment Options

Radical Prostatectomy.  This refers to the complete removal of the prostate gland.  It is indicated for healthy men who are suspected to have organ-confined prostate cancer.  Radical prostatectomy has the best long term data in terms of cancer control and cure rates.  With the advent of nerve-sparing procedures, the chance of post-operative erectile dysfunction is greatly decreased.  Chances of incontinence are also significantly reduced with the latest nerve sparing technique.  A retropubic radical prostatectomy is performed through a lower abdomen incision.  Robotic radical prostatectomy is performed via 5 small incisions.  (Link to robotic surgery.doc) The entire prostate is removed and nerves are spared.  A catheter is left in place for 7-14 days.  Generally a 2 day hospital stay is required.  Radical prostatectomy is a very well tolerated surgery and indicated for healthy men under the age of 70.

Radioactive Seed Implantation (Brachytherapy).  This treatment modality is indicated for men with organ confined disease, moderate to low grade cancer and medium to small prostate glands.  Larger prostate glands can be shrunk with medications in preparation for this procedure.  During this procedure 40-100 rice sized radioactive pellets are placed throughout the prostate under general anesthesia.  The surgery takes approximately one hour and most patients are discharged home the same day without a catheter.  The radioactive pellets continue to emit radiation and kill prostate cancer cells over the next few months.

External Beam Radiation therapy (EBRT).  This treatment is indicated for men with organ confined disease or with slightly higher grade cancer without metastasis.  It is often used in combination with brachytherapy (seed implants) to achieve higher cure rates.  External beam radiation delivers high dose x-ray radiation to the prostate to kill the cancerous cells.  It is generally performed 5 days a week for 8 weeks.  Each radiation treatment takes 10 minutes.  No anesthesia is required and there is no pain involved.  Side effects are generally mild and usually disappear after treatment is complete.  Long term results are fairly comparable to radical prostatectomy.

Urological Surgical Associates – a division of Premier Urology group – provides state-of-the-art Tomotherapy®.  TomoTherapy® is an all in one machine that brings greater accuracy to the treatment of prostate cancer.  It provides unparalleled precision minimizing damage to the surrounding healthy tissue.  It utilizes state of the art 360º helical radiation combined with CT imaging guidance.  TomoTherapy® treatments are completely painless, more effective and a more efficient radiation process

Hormone Therapy.  This treatment can be used alone in patients with advanced stages of prostate cancer or in combination with either EBRT or Seed implantation to achieve better cure rates.  It can also be used to shrink the size of prostate glands prior to other therapies.  Hormone therapy stops the production of testosterone in your body.  Testosterone is known to stimulate the growth of prostate cancer cells.  The hormones, known as luteinizing hormone-releasing hormone (LH-RH) agonists, chemically block the production of testosterone and retard the growth of cancer cells. The hormones do not kill the prostate cancer cells only slow their growth.  They are administered as injections every 1,3,4 or 6 months.

Chemotherapy.  This treatment modality is reserved for men with advanced prostate cancer who are not responding to hormone therapy or have developed a resistance to hormone therapy.  This therapy is usually administered under the supervision of an oncologist.

Active Surveillance.  Active surveillances is also known as watchful waiting or deferred therapy.  With the advent of PSA more and more men are being diagnosed with very early, low grade prostate cancers.  Since some of these cancers will never progress to clinically significant cancers some men opt for watchful waiting or very close observation.  Typically these men are seen in the office at least every 3 months.  Regular follow-up blood tests, rectal exams and possibly repeat biopsies may be performed to monitor progression of the cancer.