September is Prostrate Cancer Awareness Month: Be Proactive, Get Screened!
There’s no doubt prostate cancer is a serious health concern in the United States. The American Cancer Society estimates that one of every six men will get prostate cancer during his lifetime.
Because early prostate cancer generally causes no symptoms, regular prostate screenings are important. Most early prostate cancer can be detected by a digital rectal exam (DRE) and a blood test to measure the level of prostate specific antigen (PSA), a protein made by prostate cells. With the DRE, the physician can feel whether there is any swelling, nodules or lumps in the prostate. The higher the level of PSA, the more likely it is that there is cancer present.
The American Urological Association (AUA) now recommends getting a baseline PSA screening along with a DRE at age 40, with follow-up screenings at intervals determined by the patient and his physician.
In most cases, the recommendations are for every man to have a PSA and DRE every year after age 50. For certain men, however, the AUA recommends annual screenings beginning at age 40, including those who are African American and those who have a first-degree relative (father or brother) who has had prostate cancer.
"If the patient’s PSA is high and remains elevated, or the DRE indicates there might be a problem, a biopsy would be needed to determine if cancer is present," explains Dr. Mark Saleh, a urologist at Washington Hospital. "If the biopsy samples come back positive for cancer, we would have to determine how aggressive the cancer is, as well as whether or not it has spread outside the prostate."
Treatment options for prostate cancer generally depend on how aggressive the tumor is and the patient’s personal preference. Age is also a factor, since prostate cancer in men under age 65 tends to be more aggressive than tumors in older men.
"For older men and for younger men who have low-grade, early stage tumors, the most likely recommendation would be active surveillance – also called ‘watchful waiting’ – which entails more frequent regular screenings and repeated biopsies as indicated," says Dr. Saleh. "Hormone therapy to stop the production of testosterone, which promotes cancer growth, might also be considered. Hormone therapy does not cure the cancer, but it can put the cancer in temporary remission and relieve symptoms. Hormone therapy also can be used in combination with radiation therapy to improve outcomes."
Radiation therapy for more aggressive prostate cancers could be in the form of external beam radiation therapy or brachytherapy – the implantation of radioactive "seeds" into the prostate. For many patients, surgery to remove the prostate is the most effective treatment.
"Surgery for prostate cancer could be a traditional open prostatectomy," Dr. Saleh notes. "Laparoscopic surgery, with smaller incisions than open surgery, provides a less-invasive option that results in less pain and a faster recovery. In addition, at Washington Hospital we are using the da Vinci robotic surgical system that allows us to perform the operation laparoscopically with a magnified 3-D view of the surgical site, giving the surgeon better visualization. The tips of the robotic instruments have a greater range of motion than even the human hand, providing us with greater flexibility to maneuver in very small spaces.
"In the right surgeon’s hands, the results of laparoscopic surgery – with or without robotics – can be as good as open surgery, without the lengthy recovery time," he adds. "Current surgical techniques allow us to preserve the nerves necessary for erectile function and maintaining urinary continence in the majority of patients."
Learn More About the Benefits of Minimally Invasive Prostate Surgery
Robotic-assisted surgery has proved to be very effective in urologic procedures, such as prostate removal. To learn more about the procedures performed at Washington Hospital’s Institute for Minimally Invasive and Robotic Surgery, visit www.whhs.com/roboticsurgery. To search for a local urologist near you, visit www.whhs.com/physicians