BASIC FACTS
Prostate cancer refers to a malignant tumor that arises from the lining of the small tubules of the prostate gland (also called Adenocarcinoma). There are other types of tumors that can be found in the prostate but they are very rare. In the U.S. there are about 230,000 men that are diagnosed with prostate cancer each year and about 30,000 men die of prostate cancer annually. It is the most common non skin cancer malignancy and second most common cause of cancer death in men. A man is diagnosed with prostate cancer every 3 minutes and a man dies of prostate cancer every 17 minutes.

DIAGNOSIS
Prostate cancer is initially suspected if there is abnormal rectal examination or an elevation of a blood test called Prostate Specific Antigen (PSA). The next step is a biopsy of the prostate using an ultrasound placed in the rectum. Several small samples are obtained from various regions of the prostate gland.

Gleason Score
If prostate cancer is noted on the biopsy, then the aggressiveness of the tumor is graded on a scale called the Gleason Score. The score ranges from 2 to 10 but scores less than 5 are very rarely used. The higher the number, the more aggressive the cancer tends to be. Most patients have a score of 6 or 7.

Stage
The stage of prostate cancer refers to extension of the cancer outside the prostate gland or possible spread to other body parts. Based on the Gleason score, PSA values and physical exam your doctor may recommend further testing. If the various factors seem favorable no further testing is required because the chance of spread is low and the early stage is very likely. If the clinical factors are worrisome, such as high Gleason score or very high PSA, then there is a more significant risk of spread and radiological testing is warranted. The two most common areas of spread are pelvic lymph nodes and bone. A CT scan of the abdomen and pelvis and a special imaging study called a bone scan are the most common tests utilized. Clearly if these tests are normal that is a good sign, however small microscopic areas of spread may be impossible to detect.

TREATMENT
We hope you find this information helpful, however it should not be used in the treatment of any specific patient. Please consult your doctor.

Watchful Waiting
Prostate cancer tends to progress slowly. In fact, many patients will eventually die of something other than prostate cancer. If a patient has an early stage disease with favorable parameters and has a life expectancy less that 10-15 years, then watchful waiting may be an option. The benefits are that the patient avoids any of the risks and side effects of the various treatments. However, the patient is at risk of the disease growing and spreading.

Hormone therapy
Prostate cancer needs the male hormone testosterone for growth. The testosterone level can be greatly reduced with medical therapy or surgical removal of the testicles. Hormone therapy is usually used for advanced stages of prostate cancer when cure is not possible. In early state disease, it can be used on a short term basis to compliment other therapies, such as radiation therapy

Cryo-therapy
This form of therapy uses small probes to freeze the prostate gland, which causes cancer cell death. The new versions have reduced some of the earlier problems seen with damage to the urethra and sexual function.

Radiation therapy
High energy radiation can be focused on the prostate gland. Cancer cells are sensitive to this form of radiation. This results in the death of cancer cells. Radiation can be delivered either through multiple brief treatments of external beams of radiation or through the placement of many radioactive “seeds” directly into the prostate gland. Radiation therapy is usually well tolerated. Some men develop bladder or rectal injury which is usually mild or moderate. The problems can include urinary problems, rectal pain and gradual loss of sexual function.

Surgery
The surgical treatment of prostate cancer is Radical Prostatectomy. This involves the removal of the entire prostate and two small appendages called the Seminal Vesicles. The bladder is then sutured back to the urethra in order to re-establish the urinary tract. Sometimes the local lymph nodes will be removed based on the likelihood of lymph node spread.

Traditionally this was performed through an incision from the bellybutton to the pelvic bone (Radical Retro-pubic Prostatectomy) or through an incision between the rectum to the scrotum (Radical Perineal Prostatectomy). However, with advancement of modern techniques such as small telescopes and long instruments, the procedure can be performed through several small incisions. This procedure is called a Laparoscopic Radical Prostatectomy. With this technique the patients have less pain and recover quicker. Also there is significantly less blood loss. The surgical outcomes are not compromised and may even be better due to the magnified view. Surgical robots can be helpful in performing this procedure. After any form of radical prostatectomy, the patients may have difficulty with urinary control. This is usually temporary and over 90% of men regain good urinary control in the months following surgery. Better understanding of basic anatomy allows us to perform the surgery without damaging the nerves that are responsible for erections. By sparing the nerves the risk of impotency is reduced. This is referred to as a “Nerve Sparing” radical prostatectomy. Most men who have good sexual function are a candidate for nerve sparing.