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Adenocarcinoma of the prostate is the clinical term for cancerous tumor of the prostate. Prostate cancer confined to the gland is usually curable. According to the American Cancer Society (ACS), prostate cancer is the most common type of cancer in men in the United States. The ACS estimates that about 192,280 new cases will be diagnosed in 2009 and about 27,360 men die of the disease. Prostate cancer is the second leading cause of cancer death in men, exceeded only by lung cancer. Prostate cancer occurs in 1 out of 6 men, with reports of diagnosed cases rising rapidly in recent years and mortality rates declining, likely due to increased screening.
Dr. Cornell in the operating room. Treatment for prostate cancer depends on the stage of the disease at diagnosis and the patient's age and overall health. Elderly patients with early stage cancer or co-existing illness may be treated conservatively. The different treatment options I provide include:
The prostate biopsy procedure is the main method used to diagnose prostate cancer. In obtaining a biopsy, your physician performs a surgical procedure using a very thin needle to remove small pieces of prostate tissue from your prostate gland. The tissue collected by the needle is then sent to our diagnostic laboratory for microscopic examination - to evaluate your prostate health - with a particular focus on identifying the potential presence of cancer cells. The pathologist performs the microscopic evaluation. If cancer cells are discovered, the pathologist can assist us in determining the stage and extent of the disease process. Ultimately, our goal is to form a unique plan for your future treatment needs.
Until recently, detecting cancer in your histological specimen (prostate biopsy) was limited to what could physically be seen when looking at the specimen under a microscope. Because a biopsy is only a 1%-2% representation of the overall volume of the prostate gland, and because cancer can present as a small lesion anywhere in the prostate, a common fear is that the biopsy needle may miss a cancerous lesion - leaving behind a hidden (occult) tumor that could possibly evolve into a worsening problem. There is new technology - a test called ConfirmMDx - that addresses this fear. Results of the initial biopsy usually take about a week, and the ConfirmMDx test usually return in an additional 1 to 2 weeks, mainly because the test is only utilized if cancer is not seen under the microscope.
The new test offers valuable information because it extends our detection abilities so we can locate cancer beyond the point of the histological specimen - by millimeters or centimeters from each core (biopsy zone in the prostate) - giving us the ability to project our detection capabilities across almost the entire organ. It does this by detecting a field effect of epigenetic signatures that are unique to prostate cancer (hypermethylation in CaP - specific genes RASSF1, APC, and/or GSTP1). If these signatures are not detected, it gives us the added assurance that your prostate is free of cancer (at least a 90% negative predictive value with this assay). Conversely, if a field effect is detected, these signals will give us valuable information to use in a focused re-biopsy: potentially giving us a timely advantage and greatly improving our chances to find, characterize, and develop a specific plan to deal with prostate cancer if, again, it exists.
Two types of radiation therapy are used to treat prostate cancer: brachytherapy and external radiation therapy (XRT).
This treatment involves implanting tiny radioactive capsules (called "seeds") into the cancerous prostate. The seeds emit radiation that kills cancerous tumor cells. Men with small tumors confined to the prostate (stage T1 or T2) and those with only moderate prostate enlargement are candidates for brachytherapy. The procedure is performed on an out-patient basis and takes 45-60 minutes. Brachytherapy patients usually resume routine activity within a day or so. For those who additionally have obstructive voiding symptoms, transurethral resection of the prostate (TURP) surrounding the urethra may be performed before brachytherapy is initiated.
XRT is recommended as an alternative to surgery for cure of disease confined to the prostate. XRT is usually given on an outpatient basis for 6-8 weeks. High energy x-rays are projected into the prostate tissue from a machine outside the body. The radiation destroys cancer cells and shrinks the tumor.
Hormonal therapy for prostate cancer involves the use of medication to block production of testosterone, which prostate cancer cells use to grow. Drugs used for hormonal therapy include Lupron®, Zoladex®, Casodex®, Vantas®, Eulexin®, and Viadur®.
Radical retropubic prostatectomy is the "gold standard" treatment for localized prostate cancer. Radical prostatectomy is the surgical removal of the prostate and surrounding tissues, including the seminal vesicles and pelvic lymph nodes.
Good candidates for prostate cancer surgery have one or more of the following characteristics:
Radical retropubic prostatectomy involves an incision in the lower abdomen. This gives the surgeon access to the prostate, seminal vesicles, and the pelvic lymph nodes. Based on findings intraoperatively and the tumor volume anticipated from the number of positive biopsy cores done before surgery, every attempt is made to save the cavernosal nerves to the penis (nerves providing erection/potency). This maneuver adds little time or complexity to the case and can be offered by most recently trained urologists today, including myself.
Robot-assisted prostatectomy is a minimally invasive, robotic-assisted surgical procedure that removes the cancerous prostate gland.
Typically, patients remain in the hospital for 2 days after surgery and are catheterized for 7 days postoperatively.
The 10 year survival rate after radical prostatectomy ranges from 75% to 97% for
patients with well and moderately differentiated cancer and 60% to 86% for patients
with poorly differentiated cancer.
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American Urological Association Foundation