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Prostate Cancer Evaluation and Treatment Options

Howard B. Abromowitz, MD, FACS

Prostate Cancer Evaluation and Treatment Options

The prostate is a sex organ similar to the size and shape of a walnut and is located between the bladder and the urethra.
Prostate Cancer is a malignant disease that develops from cells from prostate tissue and is generally known as adenocarcinoma of the prostate.

Prostate cancer is the most common non-skin cancer diagnosed in men. It is also the number two cause of cancer death in men in the US. Lung cancer is the number one cause of cancer deaths.  Roughly 230,000 new cases of prostate cancer are diagnosed each year in the US; approximately one-in-six men will be diagnosed during his lifetime.

The key to treating cancer has always been early diagnosis. The difficulty with prostate cancer is that when a man becomes symptomatic (fatigue, weight loss, voiding symptoms, bone pain) it is generally advanced and not curable. Therefore, primary care physicians must be involved in the process of early diagnosis. Screening considerations include risks factors such as: age, family history, ethnic background, and symptoms.

Typically, a patient is referred to a urologist because the patient has one or all of these indicators; an elevated PSA (Prostate Specific Antigen), an abnormal prostate exam during routine physical or related symptoms.

The urologist‘s evaluation will most likely will include a prostate ultrasound and biopsy. This procedure is usually preformed in the office under local anesthesia and is normally well tolerated. Potential side effects include; blood in the urine or rectum which generally clears quickly, bloody ejaculation with sexual activity that can last up to one month and fever and chills, which can be related to an infection. Infection is uncommon but can be very serious and requires IV antibiotics. Prostate tissue is then sent to our in-house pathology lab for analysis. Using the latest biomarkers and tests our expert pathologists provide fast, accurate results.

If the biopsy demonstrates adenocarcinoma of the prostate, then evaluation will continue. Many factors are considered prior to proceeding. Patients’ age, overall health status and Gleason score (the aggressiveness of the cancer) are of primary concern when proceeding with further evaluation.

Next steps in the evaluation process may consist of CT scan, bone scan and PET scan. Not everyone will need every test, sometimes very little imaging evaluation is necessary.

At this point the cancer stage is determined and treatment options are discussed.

Prostate Cancer treatment options depend on a few important factors:
o How localized is the cancer?
o How far has it spread?
o How is the patient’s overall health?
o What are the benefits and the potential side effects of the treatment

Treatment options:

  • Active Surveillance: For some men with early disease or very slow growing disease.  No intervention or delayed intervention is an option.  This generally requires regular follow up with blood test, rectal exams and possibly biopsies.  Active surveillance is also an option for those who have other serious health conditions or advanced age.

 

  •  Radiation Therapy: This uses radioactive high-powered energy to kill cancer cells in a very controlled and focused manner. Radiation therapy can be delivered by either using external beam radiation therapy or brachytherapy (placing radioactive seeds internally inside the prostate). Side effects of radiation therapy can include fatigue, painful urination, and frequent urination; rectal symptoms such as loose stools and rectal bleeding, as well as, erectile dysfunction. It is generally well tolerated and symptoms can usually be managed with medications.

 

  •  Surgery: Radical Prostatectomy includes removing the entire prostate, surrounding tissues and seminal vesicles. Lymph nodes are also often removed.  The surgery can be done though an open incision,laprascopically or done with the aid of the daVinci robot. The majority of surgical cases today use the robotic method.  Side effects of surgery include the risks of urinary incontinence as well as erectile dysfunction. The other general risk of anesthesia and surgery are also included.

 

  • Cryosurgery: Involves freezing tissue to kill cancer cells. This technique uses ultrasound guidance to place probes into the prostate directly and with use of very cold gas thru the probes the prostate tissue is frozen to the point of cell destruction. This is an excellent treatment but does carry some increased side effects. These include voiding issues secondary to scar formation in the urethra, high potential for erectile dysfunction and potential rectal injury.  It can be used as primary treatment as well as salvage treatment for men who have failed radiation therapy.

 

  • Hormone Therapy: This is used to decrease the male production of testosterone. Prostate cancer cells require testosterone to help them grow. By blocking this source of fuel the cancer cells will die or grow slower. They can also make cancer cells more sensitive to radiation therapy.   Hormonal Therapy can be administered many ways; with LH-RH agonists that prevent the testicles from producing testosterone, medications that block testosterone from reaching cancer cells; as well as, surgery to remove the testicles (orchiectomy).   Hormone Therapy is used in men with early disease as adjuvant therapy or in men with advanced disease to reduce the cancer burden and slow the cancer progress. Hormones alone will not cure prostate cancer but it can significantly reduce the cancer progression.   Side effects of hormonal therapy include; erectile dysfunction, hot flashes, decreased sexual desire, weight loss and loss of bone mass.

 

  • Chemotherapy: uses drugs to kill cancer cells directly and is administered either intravenous or orally.   Chemotherapy is used in men with advanced disease and often is used in combination with other treatments.

 

  • Immunotherapy (sipuleucel-T/Provenge): in this treatment the patient’s own cells are harvested and then genetically engineered in a lab to fight prostate cancer and then injected back to the patient through an IV.   This treatment is used for advanced disease.

 

As you can see the process is very involved and each case is very unique and must be evaluated as its own individual case. At Dayton Physicians we have experts who have treated thousands of patients with our team approach. We want to help you make appropriate and well-informed decisions.

We’re here for you; we have the capability to meet all of your needs while helping you get through this very difficult and confusing time.

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