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March 14, 2006 > Advances in Prostate Cancer Treatment

Advances in Prostate Cancer Treatment

According to the American Cancer Society, nearly one out of every five American men will develop prostate cancer during his lifetime. Prostate cancer is the second-most common cancer in American men, trailing only skin cancer.

While these statistics are cause for concern, there is a bright side -- except for skin cancer, prostate cancer is the most easily diagnosed and treated cancer among men. Plus, the advances in prostate cancer treatments can provide better results in preserving erectile function, which is a common side effect of treatment.

Early diagnosis and treatment are crucial, so Washington Hospital urologist Dr. Richard Bevan-Thomas encourages regular prostate cancer screenings. "In general, the risk of prostate cancer increases with age, so men should have a prostate evaluation every year from the age of 50 on," he explains. "For men at greater risk -- such as African Americans and those with a family history of prostate cancer -- we recommend annual screenings beginning at age 40 to 45. There also is evidence that obese men may be at greater risk."

Bevan-Thomas and his partner Dr. John Heine will conduct a special Health & Wellness seminar on advances in prostate cancer treatment and maintaining potency on Tuesday, March 21 from 6 to 8 p.m. The seminar will be held in the Conrad E. Anderson, M.D. Auditorium, Rooms A & B, in the Washington West Building located at 2500 Mowry Avenue in Fremont. For more information, or to register to attend, please call (800) 963-7070.

The prostate, a gland found only in men, is normally about the size of a walnut. Located under the bladder, the prostate surrounds the upper part of the urethra. Prostate cancer is a malignant tumor that develops from cells at that site.

Early prostate cancer generally causes no symptoms. A few men may experience more frequent urination or difficulty urinating, but that can also be a symptom of an enlarged prostate. Advanced cancer symptoms can include impotence, blood in the urine, and bone pain in the pelvis, spine, hips or ribs. "Most prostate cancers grow slowly, but others can spread quickly, including to the lymphatic system and the bones," Bevan-Thomas notes.

"Most early prostate cancer can be detected by a digital rectal exam or DRE and a blood test to measure the level of PSA -- prostate specific antigen, a protein made by prostate cells," says Bevan-Thomas. "With the DRE, the physician can feel whether there is any swelling or nodules. The higher the level of PSA, the more likely it is there is cancer present. The standard PSA level that might indicate cancer is 4.0, but that is currently subject to debate, with many physicians believing a lower level warrants concern. For example, if we have a patient in a high-risk category who has a PSA level of only 2.6, we would either consider an immediate biopsy or monitor him closely every six months to see if his PSA level increases rapidly. As prostate cancer grows, it releases PSA more rapidly."

If either the PSA or DRE is abnormal, an ultrasound study is indicated. "The ultrasound canít diagnose cancer, but it may suggest the presence of cancer," Bevan-Thomas explains. "A biopsy is really the only way to diagnose prostate cancer. Using ultrasound-guided needle biopsies, we usually take 10 to 12 samples of cells from the location of abnormalities or areas of the prostate where cancer most commonly occurs."

When a diagnosis of prostate cancer is confirmed, the question becomes how to treat it. "Watchful waiting," which involves closely monitoring the cancer without using any treatment, may be an option -- particularly for those over age 75 who have a less-aggressive cancer and may have other major health problems.

"Treatment depends not only on whether the cancer is localized or widespread, but also on the patientís age and medical condition," Bevan-Thomas says. "Hormone therapy to suppress production of testosterone and shrink the tumors or slow their growth might be recommended for older men who are not good candidates for surgery or radiation, especially if a bone scan indicates metastasis to the bones. Radiation -- either the implantation of radioactive Ďseeds,í known as brachytherapy, or external beam radiation therapy -- may be more appropriate in some cases. Also, cryoablation can be used in some instances to freeze parts or all of the prostate."

For many patients, surgery to remove the prostate is the most effective. "In addition to open surgery, we also can perform laparoscopic surgery with small incisions," Bevan-Thomas notes. "A newer procedure, called the da Vinci prostatectomy, employs robotic technology that enables the surgeon to manipulate laparoscopic instruments more precisely and may result in less damage to the nerves responsible for erectile function."

Each treatment option has potential side effects, notes Heine. "Brachytherapy generally results in a lower incidence of incontinence or impotence than surgery, although surgeons often attempt a nerve-sparing approach that doesnít impede erectile function," he says. "When we evaluate various treatments, we take into consideration the patientís assessment of how important it is to maintain potency. An 85-year-old may not consider it as important as a man in his mid-50s.

"We also analyze patientsí erectile function both before and after treatment for prostate cancer," Heine adds. "There are a variety of medications available today to enhance potency, including Viagra, Cialis and Levitra. These medications -- which should not be used by men with heart disease or other serious medical conditions -- donít usually work immediately, but they can be effective several months after surgery. It also may be possible to restore function with direct injection therapy or external mechanical devices."

Heine emphasizes that patients need to be active participants in treatment decisions. "Each man is different," he explains. "Itís important to seek different medical opinions and work with your physician to tailor a treatment and rehabilitation program that fits your particular circumstances."

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