Prostate Cancer, Exams, and Treatments

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Introduction

Prostate cancer is the most common cancer found in men in the USA. About 218,890 new cases of prostate cancer were diagnosed in 2007. For a few decades, prostate cancer had been the 2nd leading cause of cancer-related death in men with nearly 30,000 deaths per year. However, prostate cancer related mortality is decreasing over the last 5 years and it is estimated that prostate cancer is now the 3rd leading cause of cancer-related deaths in men.

The prostate is a gland (found only in men) below the urinary bladder. A normal prostate is about the size of a walnut. As a man ages, his prostate slowly grows because of the hormone testosterone. This is called prostate hyperplasia and is not cancer. Prostate cancer occurs when prostate cells change and begin to grow out of control.

Early prostate cancer is confined to the prostate gland. Untreated, it can spread to other parts of the body. The good news is that a simple exam can often detect the cancer before it spreads. For this reason, prostate exams are extremely important for men who are considered to be at risk.

Screening

Treated in its earliest stages, prostate cancer can be cured. Early detection through regular prostate exams is essential. The entire exam takes less than 5 minutes. It consists of a Prostate Specific Antigen (PSA) blood test and a digital rectal exam (DRE).  

PSA is a substance made by the normal prostate gland. Elevated or rising PSA levels may be a signal that there is something wrong with the prostate. Cancer is not the only cause for elevated PSA levels. Infection, recent sexual activity, and benign prostate hyperplasia can all affect the PSA level. Your physician will evaluate and track your level of PSA and the rate at which the level changes over time. A “normal” but quickly rising PSA level may suggest a need for further study.

The DRE is a physical prostate exam that checks for abnormalities on the surface of the prostate. Prostate cancer may appear as a “nodule” or an unusually firm texture of the gland. Sometimes prostate cancer is apparent only upon a rectal prostate exam, even when the PSA test is normal. This is no time for men to be squeamish! Both PSA and DRE are recommended for adequate cancer screening.

Who Should be Screened?

Screening has significantly increased the number of cancers diagnosed at an early, and usually curable, stage. Men who are elderly and/or in poor health, need not undergo prostate cancer exams because there may be little or no benefit to finding the prostate cancer at an early stage in these men. However, men over the age of 50 (or age 40 for African-American men or those with a family history) should be offered or recommended to undergo yearly prostate exams using PSA and DRE. Since the advent of screening with PSA test in 1987, there has been a 4-fold decrease in men with advanced prostate cancer which had already spread at the time of diagnosis.

Risk factors for prostate cancer include family history, high fat diet, smoking and ethnicity. African-American men have a 60% higher incidence rate of prostate cancer than Caucasian men. They are more likely to get this disease at a younger age and often have more aggressive cancer, making regular exams even more important.

Treatment

The detection of prostate cancer through prostate exams while it is still localized (hasn’t spread past the prostate), combined with improvements in technology and our understanding of prostate cancer, means the chances for recovery have improved significantly. Today, men with newly diagnosed prostate cancer, who have an expected life span of at least ten years, have a number of options for treatment with high likelihood of cure. These include surgery to remove the cancerous prostate or delivering radiation therapy (either external or with radioactive seed implant) to the prostate, sometimes with hormonal therapy.

DaVinci Robotic Surgery

The most recent advance in the management of localized prostate cancer is the robotic-assisted, laparoscopic prostatectomy (surgical removal of part of the prostate gland). The laparoscopic instruments are attached to the robotic arms of the DaVinci robotic system at the bedside. The surgeon controls the movements of the robotic arms from a remote console while visualizing the surgical field through a 3-D camera.

Instead of a larger incision needed for a standard operation, there a four small, keyhole like incisions. The blood loss during robotic-assisted procedure is reduced significantly to about one-sixth of what is noted with standard open surgery. The precision of movements and improved visualization of the surgical field allows for preservation of vital structures and reduces the risk of potential side effects such as impotence or urinary dysfunction. Also, the time to full recovery may be reduced by one half for most patients.

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