Prostate Cancer

Two tests are commonly used to help detect prostate cancer:

• One is the digital rectal exam (DRE), in which a doctor examines the prostate through the rectum to find hard or lumpy areas known as nodules.
• The other is a blood test used to detect a substance made by the prostate called “prostate-specific antigen” (PSA). Elevated PSA readings can be a sign of prostate cancer.

Neither of these initial tests for prostate cancer is perfect. Many men with a mildly elevated PSA do not have prostate cancer, and men with prostate cancer may have normal PSA levels. Also, the digital rectal exam does not detect all prostate cancers. The most comprehensive way to detect prostate cancer is to use both the PSA test and DRE.

If your doctor is concerned about the results of your PSA test or DRE, additional tests may be recommended. Prostate cancer can only be definitively diagnosed by performing a biopsy, in which a small sample of your prostate tissue is removed and examined under a microscope to identify abnormal cancer cells. Arkansas Urology performs these biopsies in our Little Rock office procedure area with the assistance of anesthesia sedation.

If you are going to have a biopsy — which is the definitive way prostate cancer is diagnosed — be sure to request a micro-ultrasound targeted biopsy. This will allow your urologist at Arkansas Urology to benefit from a powerful tool to visualize your prostate, differentiate areas of suspicion, and then to target those areas with their biopsies.

Prostate cancer treatment depends on several factors, including:

• How advanced the cancer is
• Your health and other medical conditions
• Your age and life expectancy
• The potential side effects of treatment

Initially, prostate cancer can be treated with active surveillance, hormone therapy, radiation therapy, chemotherapy or surgery:

• Active surveillance is often the preferred treatment for men who have slow-growing cancers or limited life expectancy due to age or medical conditions. This involves regular checkups and monitoring of cancer growth. Active treatment may be recommended if symptoms worsen.
• Hormone therapy aims to control prostate cancer by limiting the supply of hormones that cancer cells need to grow, particularly testosterone. It is typically used in more advanced cases of prostate cancer.
• Radiation therapy is usually used for patients whose cancer is confined to the immediate prostate area, but it can also be used in advanced cases to control pain. It can be delivered from outside the body or by implanting radioactive beads or other material inside the prostate. Radiation works by damaging tumor cells that divide quickly.
• Brachytherapy is a type of internal radiation in which radioactive material in the form of “seeds” is placed into or near a tumor in the prostate gland. With this procedure, high doses of radiation can be delivered to the immediate area of the tumor, minimizing damage to nearby tissues. The procedure takes less than an hour and generally does not require an overnight hospital stay. The seeds are placed using thin needles inserted through the perineum, guided by ultrasound. They emit radiation for several weeks and continue to stay in place, causing no harm to surrounding tissues. Brachytherapy is not recommended for large or advanced tumors, but is extremely advantageous for men with smaller tumors. The procedure is less invasive, takes less time, is less costly and has fewer side effects than external radiation or surgery. More than 90 percent of patients continue to be disease-free five years after the procedure.
• Chemotherapy uses drugs to slow or reverse the spread of prostate cancer in advanced cases. The drugs are injected into the bloodstream and poison the rapidly dividing cancer cells. However, the drugs also affect healthy, dividing cells in the blood, intestine and hair. Common side effects include nausea, hair loss and anemia, which may be helped with other medications.
• Intensity-modulated radiation therapy (IMRT) is an advanced method of high-precision radiotherapy that uses computer-controlled X-ray accelerators to deliver precise radiation doses to a malignant tumor or specific areas within the tumor. IMRT is more precise and controlled than other forms of radiation. IMRT also allows higher radiation doses to be focused on specific regions within the tumor while minimizing the dose to surrounding healthy tissue.
• Surgery is typically performed when tumors are still confined inside the prostate during early stages of prostate cancer. Surgery is intended to remove all cancerous tissue and cure the cancer. Surgical options include the following:
  • Open radical prostatectomy is a major surgical procedure to remove the entire prostate, along with both seminal vesicles and other surrounding tissues, including a section of the urethra and part of the sphincter muscle. Radical prostatectomy is a recommended treatment option for patients whose cancer is localized, or confined to the prostate, and for younger patients who have a high-grade tumor.
  • Radical prostatectomy is a procedure that takes two to four hours to perform and requires at least a three-day hospital stay. Patients must wear a catheter for 10-21 days following surgery. Certain risks and complications are involved with prostatectomy, including bleeding, infection or cardiopulmonary problems. More serious problems can include urinary incontinence, stool incontinence and impotence. In fact, most patients experience some level of incontinence following the procedure that improves over time. Impotence was once inevitable following prostatectomy, but today that risk may be reduced with nerve-sparing surgical techniques.
• Da Vinci Robotic surgery uses small laparoscopic instruments that are inserted through small incisions in the abdomen to dissect and remove the cancerous prostate gland. This procedure is less painful and requires a shorter period of recovery than radical prostatectomy but achieves the same level of cancer control. The typical hospital stay is 36 hours with a recovery period of two to three weeks, compared with a 72-hour hospital stay and six- to eight-week recovery period with radical prostatectomy.Da Vinci Robotic surgery is a minimally invasive procedure that requires four or five small incisions at or below the navel. Because of the amazing clarity the da Vinci system provides, the surgeon can identify the muscles that control continence and the nerves involved with sexual function and reduce side effects such as urinary incontinence and sexual dysfunction.
• Cryosurgery is less invasive than traditional surgery, involving only a small incision or insertion through the skin, and uses liquid argon gas to destroy cancerous tissue. For years, cryosurgery has been used to treat skin cancers. Now, physicians are using the procedure in cancer treatment of the liver, prostate, pancreas and kidney. Researchers have determined that cryosurgery is a good alternative to surgery or radiation therapy, both of which often have severe side effects. Because physicians can focus on a limited treatment area, destruction of nearby tissue is reduced. This minimizes pain, bleeding and other complications of surgery. Cryosurgery also requires shorter recovery time and is typically an outpatient procedure. Cryosurgery is especially good for men who cannot have traditional surgery due to their age or other medical problems. The procedure is also a good alternative for those patients who have had unsuccessful radiation therapy.The cryosurgery process works by using argon gas to freeze and destroy cancerous cells. Argon gas is circulated through a hollow instrument called a cryoprobe, which is placed inside the tumor. A ball of ice crystals forms around the probe, freezing nearby cells. Ultrasound is used to guide the cryoprobe and monitor the freezing of the cells, thus limiting damage to nearby healthy tissue. After cryosurgery, the frozen tissue thaws and is naturally absorbed by the body.
• Provenge
• SpaceOAR Hyrdogel
• Xofigo
• If prostate cancer progresses, there are more aggressive treatments that can be offered. These include immunotherapy with Provenge, oral medications and advanced radiation treatment with Xofigo.