PROSTATE CANCER

What It Is
Cancer of the prostate — a small, walnut-sized gland that helps to produce semen in the male reproductive system — develops when abnormal cells grow out of control and form a malignant tumor. Prostate cancer is typically very slow-growing, but when it becomes aggressive and spreads beyond the prostate, the disease is more likely to cause fatality.

Sixty-five percent of cases occur in men 65 and older. The older a man becomes, the more likely he is to develop prostate cancer. African American males are more than 50 percent more likely to have prostate cancer than Caucasians and 2.5 times more likely to die from the disease. Men with a brother or father diagnosed with prostate cancer are twice as likely to develop prostate cancer, and four times more likely if their relative was diagnosed before the age of 60. Large consumption of fatty foods, particularly red meat, is also believed to increase one’s risk.

Symptoms
Urinary problems (need to urinate frequently, particularly at night, difficulties stopping and/or starting urine flow, weak flow, burning during urination), difficulty having an erection, painful ejaculation, blood in urine or semen, pain or stiffness in lower pack, hips, or upper thighs.

Detection
Detection proves challenging as symptoms are rare during the early stages of the disease. They become more noticeable as the cancer becomes more advanced. However, for 85 percent of prostate cancer cases diagnosed during the early stages and with early detection, the survival rate is nearly 100 percent. Detection typically occurs during a digital rectal exam, which is recommended for all men after age 50 and for African-Americans and those with a family history after age 40. A PSA blood test is also an effective detection method and is recommended for males over 50.

Standard Treatments
Surgery
The choices for nerve-sparing radical prostectomy to remove the prostate are either standard open surgery or robotic surgery. Dr. Alan Wein, chief of urology at Penn, prefers the classic approach. “Otherwise,” he says, “the surgeon can’t change what he’s doing based on feel because there is no feel.” His other objection is that data on robotics is only four to six years old: “We won’t know the full efficacy until the data is eight to ten years old.”

Nevertheless, the trend is heavily toward robotics because it cuts the hospital stay in half (two days to one), there is less blood loss, and the smaller incision hastens recovery time by two and a half weeks. Presbyterian urologic surgeon Dr. David Lee particularly likes that his field of vision is magnified 10 times and he can see the prostate on his monitor in 3D. A note of caution comes from Cooper Hospital urologist Dr. Raul Parra, who does six to eight robotic surgeries weekly: “Experience is crucial. There is a learning curve of a least 150 to 200 procedures, and a solid grounding in open surgery is a prerequisite on the rare chance the robot fails.”

Radiation therapy
Rather than remove the prostate gland, radiation aims to eradicate only the cancerous areas in a series of daily treatments over several weeks. “Radiation equals the best nerve-sparing surgery for encapsulated tumors,” says Dr. Eric Horwitz, acting chairman of radiation oncology at Fox Chase, “but it’s better for bigger cancers that have broken through the skin of the gland.” There are several new procedures designed to do this. They include:

Intensity Modulated Radiation Therapy (IMRT)
This option uses computerized 3D images of the patient’s prostate and surrounding organs to control and direct the x-ray beam. Because of the precision, higher doses of radiation can be used with less risk of side effects. Fox Chase was the first in the area to have this machine, and in 2007 they got the latest model, called the Calypso Beam. Dr. Horowitz calls this “a GPS for the prostate. It tracks real-time movement during radiation to assure the exactness of the beam.”

Proton Beam Therapy
Penn will be one of the few places in the country to offer this when its machine arrives in early 2009. This very new concept bombards the tumor with protons instead of x-rays.

Brachytherapy
Better known as radioactive seed implants (pictured above), this places rice-size seeds into the prostate, where they emit radiation to the tumor over a period of about 10 months until they lose their power. The technique has been around for a long time, but improved ultrasound imaging technology assures more accurate seed placement. It’s most effective for early stage cancer.

HIFU
Jefferson is currently participating in a clinical trial to examine this minimally invasive way to treat early-stage prostate cancer. A probe shoots an intense ultrasound beam to the prostate to destroy the cancer. “Normally this is a one-time ‘Star Wars’ treatment, but it can be repeated,” says Jefferson urologist Dr. Leonard Gomella, who thinks this technology is very promising. While it’s considered experimental in the U.S., it’s popular in Europe and Canada.

Living With Prostate Cancer
Hearing the diagnosis can be terrifying for any man and his family. But Philadelphia has a wealth of resources that’ll help you do everything from treat it fast and effectively to help connect you with others that can lend a hand for support.