The prostate is a gland that sits below the bladder and surrounds the urethra. The prostate makes semen.
Prostate cancer is one of the most common malignancies occurring in men. It is more common in men with a family history of the disease and in African-Americans. It is often curable when detected early. Survival rates decrease if the cancer has metastasized or spread beyond the prostate.
Most men have no symptoms of prostate cancer. However, symptoms may include:
- Frequent urination
- A weak stream
- Difficulty starting or stopping the stream
- Blood in the urine
- Burning upon urination
- Pain in the back, hips or upper thighs.
How is prostate cancer detected?
Prostate cancer is detected by either an elevated PSA test or an abnormal digital rectal exam. A digital rectal exam is a physical examination of the prostate to detect nodules or other abnormalities. Other diagnostic tests may include an ultrasound and urinalysis. A biopsy, or microscopic examination of tissue, is the only way to confirm cancer. Once diagnosed, a CT and/or bone scan may be necessary.
How is prostate cancer treated?
Treatment for prostate cancer depends upon the stage of the disease and the overall health and age of the patient.
Common treatments include:
Active surveillance or watchful waiting. Monitoring the patient without taking invasive treatment. Often used in older men whose prostate cancer is in early stage and is slow growing, and on those men whose risks of treatment outweigh the potential benefits.
Cryosurgery. An outpatient procedure that uses extreme cold to destroy cancer cells in the prostate. Involves insertion of multiple, hollow tubes into the prostate via ultrasound guidance. Once the probes are in position, a super-chilled liquid circulates to create a “spherical” freeze zone and destroy the cancer. Meant for men with localized cancer; can be performed in men who were previously treated with radiation.
South County Urological was one of the first urology practices in St. Louis to use cryosurgery for prostate cancer. Our physicains have been performing prostate cryosurgery since 1993. Today, it is sometimes called ‘focal cryosurgery’ or a ‘prostate lumpectomy.’
Hormone therapy. Used to suppress testosterone, the male hormone, which is believed to spur tumor growth. Usually prescribed after the cancer has spread beyond the prostate, or in conjunction with other treatment options.
- External beam. Use of high-powered x-rays to destroy or damage cancer cells so they cannot multiply. Typically used on men whose cancer has not spread beyond the prostate.
- Intensity Modulated Radiation Therapy (IMRT). A special type of radiation therapy where the beams conform to the shape of the prostate. Because IMRT is more site-specific, radiation dosage can be increased to the tumor while sparing nearby normal tissue.
- Brachytherapy (seed implant therapy). An outpatient procedure that involves the insertion of radioactive pellets or seeds into the prostate through hollow needles.
Up to 50 or more rice-sized seeds are inserted. The radiation diminishes over time; the seeds stay in the prostate. Meant for localized prostate cancer.
Prostatectomy. Surgical removal of the prostate. When possible, the nerves responsible for erections are spared. Sometimes it may be necessary to remove the lymph nodes that drain the prostate. For decades, the open nerve-sparing radical retropubic prostatectomy has been the standard treatment for prostate cancer.
Surgical approaches to prostate removal include:
- Open radical retropubic prostatectomy (RRP)
- Laparoscopic prostatectomy
- Robotic-assisted laparoscopic prostatectomy
All three techniques may have the following side effects: blood loss, erectile dysfunction (ED), and urinary incontinence. Patients should discuss with their urologists which option is best in his case.
Open radical retropubic prostatectomy (RRP). Removal of the entire prostate through an “open” incision from below the bellybutton to the pubic bone. This usually requires a one or two-night hospital stay and several weeks to recover. Surgeons use special magnifying glasses to perform this surgery.
Laparoscopic prostatectomy. A less invasive approach. A tiny camera inserted into the patient transfers two-dimensional views of the prostate to a video screen. The urologist uses the views to navigate, and remove the prostate with long hand-held instruments through small incisions. Although its cancer-cure rate is equal to the open prostatectomy, the laparoscopic approach can provide a quicker recovery. This approach is rarely performed in the era of robotic-assisted laparoscopic prostatectomy.
Robotic-assisted laparoscopic prostatectomy. A minimally invasive approach that provides the benefits of a laparoscopic and open prostatectomy. Uses 3-D imaging to help the urologist better visualize the surgical field, and robotic technology for greater maneuverability and precision. The prostate is removed through small surgical incisions while preserving nearby nerves. Its cancer cure rates are equal to the open prostatectomy. However, blood loss may be less and patients may have a quicker recovery with a robotic-assisted prostatectomy. Not all urologists are trained in this technique, and not all medical centers are equipped to provide this service. The da Vinci prostatectomy is a robotic-assisted procedure.