Prostate cancer is the second-leading cause of cancer deaths among men in the United States. Yet, when detected in its early stages, prostate cancer can be effectively treated and cured.
At Austin Urology Institute, we are proud to offer the latest in evaluation, treatment and management of prostate cancer. This can range from active surveillance (observation) of low grade cancers, to the latest minimally invasive da Vinci Robotic Prostatectomy to completely remove more aggressive cancers.
The prostate is a small, walnut-sized gland in men. It is located below the bladder and surrounds the upper portion of the urethra (where urine exits). The function of the prostate is to secrete fluids that make up part of the semen. The prostate may be a source of many health problems in men, the most common being benign prostatic hyperplasia (BPH), prostatitis (infection of the prostate), and cancer.
Prostate cancer is an important health problem in the United States due to its high significance. It is different from most cancers in that a percentage of men, particularly older men with a shorter life expectancy, may have a silent form of this cancer, meaning it will not cause symptoms or progress beyond the prostate gland during their lifetime. Sometimes this cancer can be small, slow growing and present limited risk to the patient. Other times, it can progress rapidly. Clinically important prostate cancers can be defined as those that threaten the well-being or life span of a man.
What causes prostate cancer is a subject of intensive research. It is likely that prostate cancer occurs due to many reasons. Predominately a disease of elderly men, the diagnosis of prostate cancer is rare before age 40 but increases dramatically thereafter.
The intake of other certain dietary factors may also reduce the risk of developing prostate cancer. Such substances include lycopene and fish oil. Lycopene is an antioxidant that may protect cells from becoming cancerous.
The easiest thing you can do to detect prostate cancer and catch it early, is be diligent about getting screened. Screening involves a blood test called a PSA and prostate exam (also known as a digital rectal exam). This can be done by your primary care physician or a urologist.
The following guidelines are per AUA (American Urological Association) recommendations:
If your doctor feels that a screening test was suspicious, he or she may check your PSA more frequently until it is stable.
Why is there a debate about screening?
There is questioning among healthcare professionals regarding the over-diagnosis and overtreatment of prostate cancer. However, screening to see if cancer is present is still important. If the doctor suspects cancer, then he may decide to proceed with a prostate biopsy. We recognize that not all patients need to be treated if they have prostate cancer. For example, an elderly patient (>age 80) with a small amount of prostate cancer may not necessarily be affected by the cancer due to its slow growing nature. In certain patient populations, treatment may lead to more harm than good. Each patient has a different story, and while we recommend routine screening, further diagnosis and treatment is at the doctor’s discretion based on each individual case.
There are usually no symptoms associated with prostate cancer, especially in the early stages of the disease. If symptoms do occur, they include urinary problems, pelvic pain, blood in the semen or urine, and bone pain. Again, it is rare to have these symptoms unless the prostate cancer is very advanced and/or has spread to the body.
Currently, digital rectal examination (DRE) and prostate specific antigen (PSA) are used for prostate cancer detection. The American Urological Association recommends that healthy men ages 55-70 should have prostate cancer screening with a DRE and PSA test every two years. Men with risk factors such as family history or African-American ethnicity should be screened yearly, starting at an earlier age. We recommend continual screening for men over the age of 70 if life expectancy is greater than 10 years.
These are minor issues that will resolve in one-two days. If you experience fever (greater than 101.4 F), chills, nausea, or vomiting, immediately call our office or go to the emergency room.
Dr. Shaw is proud to be amongst the first surgeons in the Central Texas area to offer da Vinci Robotic Prostatectomy. Trained at Tulane in New Orleans in 2000, he has been performing the Robotic-Assisted Prostatectomy procedures in Austin since 2004. A radical robotic prostatectomy is done to remove the entire prostate and seminal vesicles. For patients with prostate cancer confined to the prostate, the chance of cure with surgery alone at 10 years (with an undetectable PSA) is more than 90 percent. Most patients are able to leave the hospital within 48 hours with five small incisions no bigger than a dime, and minimal pain. Although the incidence of operative complications with radical prostatectomy is quite low, the primary postoperative side effects are urinary incontinence and erectile dysfunction.
The surgery itself is an inpatient procedure, about two-three hours long, and requires at least 24 to 48 hours in the hospital afterwards. It is performed under general anesthesia, so you will be asleep through the whole procedure. With the advent of robotics, we perform the surgery with smaller incisions and quicker recovery. The robot is controlled by the surgeon from about 10 feet away. The fine movements of the robotic arms allow the surgery to be performed at an optimal level. The prostate is removed, along with nearby structures called the seminal vesicles. We do our best to preserve nerves around the prostate; however, this depends on the extent and location of the cancer. The urethra is then re-anastomosed to the bladder, and the incisions are closed. The prostate and seminal vesicles are sent to pathology to be analyzed, and we will review that report with you at your follow up visit.
Before the surgery:
Some things to expect after surgery:
At Austin Urology Institute, we utilize a comprehensive prostate cancer program to ensure that our patients and family are well educated in the Laparoscopic Robotic da Vinci Prostatectomy Care Pathway to ensure optimum expectations and outcomes.
Radiation therapy is appropriate for the primary treatment of localized prostate cancer, and secondary treatment for cancer recurring within the region of the prostate. These therapies are typically reserved for patients who are not candidates for surgery, or who do not wish to have surgery. Radiation is performed by a radiation oncologist, and involves a number of sessions depending on the type of radiation you choose.
Once radiation is done for the prostate, surgical removal of the prostate becomes very difficult, and is not usually offered as a treatment option. However, it can be used if prostate cancer recurs after surgery. Side effects of radiation are similar to those of surgery and include erectile dysfunction and urinary leakage.
Prostate cancer is often a slowly progressive disease. Tumor (grade, volume, PSA, stage) and patient (age and comorbidities) measures can be used to identify men at lower risk of disease progression during intermediate periods of follow-up. For men with lower risk cancer or for those for whom avoidance of sexual, urinary, and/or bowel complications are a primary consideration, active surveillance may also be considered. Surveillance includes close follow-up of PSA levels, DREs (digital rectal exams), and prostate biopsies if necessary. Certain hormonal medications that decrease testosterone can also be used to help keep the prostate cancer from growing.
After surgical prostate cancer treatment, we closely monitor your PSA levels to ensure that there is no recurrence of cancer. An ultrasensitive PSA is checked every six months for two years, then annually afterwards if there is no evidence of recurrence.
What if my cancer recurs?
If cancer recurs after surgical removal of the prostate, radiation or medical treatment may be advised. Radiation treatment involves EBRT (external beam radiation) and brachytherapy, described above. This is appropriate for patients who have not had prior radiation to the prostate. Medical treatment includes the use of hormonal therapies that are made to reduce levels of testosterone. In a patient with residual prostate cancer, excess testosterone may fuel the cancer and cause it to grow. Medical therapy is appropriate for either patients who have had either surgery or radiation of the prostate.
There is controversy about true prevention. The best thing you can do is follow the screening guidelines, and maintain your health through diet and exercise. As clinical studies, which found that supplements such as vitamin E and selenium do not prevent prostate cancer, point out – there is no current short-cut that can replace a healthy lifestyle.
When caught early and treated, patients with prostate cancer have a high chance of being cancer free after surgery. This will depend on the grade and extent of the cancer, as well as the patient’s other medical problems. While prostate cancer is considered a slow-growing cancer, it is still important to follow-up and have proper screening done.
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