The exact causes of prostate cancer are not known. However, there are some things that have been proven to be linked to prostate cancer. You are at a higher risk for prostate cancer if:
You are African-American
- You are over 50 years of age
- You have one or more first-degree relatives (father or brother) who have had prostate cancer
- You eat large amounts of red meat
Symptoms of Prostate Cancer:
In the early stages of prostate cancer, there usually are no symptoms. If symptoms do occur, they can include:
- Difficulty starting or holding back urine
- The need to urinate often, especially at night
- Weak or interrupted urine flow
- Pain or burning during urination
- Difficulty with having an erection
- Painful ejaculation
- Blood in the urine or semen
- Pain or stiffness in the lower back, hips, pelvis or upper thighs
Since the prostate surrounds your urethra, any change in your prostate can cause problems with urination and ejaculation. These symptoms can also be caused by other diseases or disorders which are not cancerous, but only your urologists determine their cause.
Detection of Prostate Cancer:
Because prostate cancer often has no symptoms, the American Urology Association (AUA) recommends than men talk to their doctors about screening starting at age 40. Prostate cancer screening consists of 2 simple and quick tests:
PSA is a protein produced by the prostate and normally very small amounts are released into your bloodstream. When prostate cancer is present, excess amounts of PSA are released. This can easily be detected in your blood with a simple blood test. Your PSA can also be elevated by other prostate problems, such as infection or an enlarged prostate. A small amount of prostate cancers, mainly the aggressive kind, do not produce much PSA but present as a nodule on the prostate therefore a digital rectal exam is also recommended by urologists.
- Digital Rectal Exam (DRE) Test
In this test, your physician will insert a gloved, lubricated finger into your rectum and press on your prostate. This will allow him or her to feel for any irregularities in the size, shape or texture of your prostate. Lumps on the prostate may indicate cancer.
Diagnosis of Prostate Cancer:
If your screening tests show signs of a possible problem, your doctor will likely refer you to an urologist. The urologist may recommend a prostate biopsy. Using a local anesthetic and ultrasound guidance, the urologist will insert a tiny needle into the prostate and remove a small amount of cells for laboratory testing.
If cancer is detected, additional testing such as a bone scan or a CT ultrasound may be recommended. Once prostate cancer has been diagnosed, the urologist will stage the disease to determine the extent of the cancer (i.e., the “T” stage) and whether it has spread beyond the prostate gland to the surrounding tissues. The T stage is divided into the following categories:
T1: Doctor is unable to feel the tumor or see it with imaging (e.g., Transrectal ultrasound)
T1a: Cancer is found incidentally during a transurethral resection (TURP) for benign prostatic enlargement. Cancer is present in less than 5% of the tissue removed and is low grade (Gleason < 6).
T1b: Cancer is found after TURP but is present in more than 5% of the tissue removed or is of a higher grade (Gleason > 6)
T1c: Cancer is found by needle biopsy that was done because of an elevated PSA
T2: Doctor can feel the tumor when a digital rectal exam (DRE) is performed but the tumor still appears to be confined to the prostate
T2a: Cancer is found in one half or less of only one side (left or right) of the prostate
T2b: Cancer is found in more than half of only one side (left or right) of the prostate
T2c: Cancer is found in both sides of the prostate
T3: Cancer has begun to spread outside the prostate and may involve the seminal vesicles
T3a: Cancer extends outside the prostate but not to the seminal vesicles
T3b: Cancer has spread to the seminal vesicles
T4: Cancer has spread to adjacent organs, such as the urethral sphincter, rectum and/or wall of the pelvis
You will also be given a “Gleason Score” which grades the surrounding tissue and helps the urologist predict how the cancer may progress.
Treatments for Prostate Cancer
The earlier prostate cancer is detected, the more treatment options will be available to you. Based on the prostate cancer grade and stage, your age, overall health status and personal lifestyle, your urologist will discuss treatment options with you.
Treatment Options Include:
Watchful waiting or active surveillance: Men in the early stages of cancer, with slow growing disease or those with advanced age or serious diseases may be advised to monitor the prostate cancer rather than actively treat it.
Surgery: A radical prostatectomy is a surgical procedure which removes the cancerous prostate gland. The high skilled and experienced urologists of Georgia Urology utilize the most advanced techniques to reduce side effects and surgical complications. One such technique is the state of the art, da Vinci robotic surgical system which many of our urologists at hospitals throughout metro Atlanta to perform a radical prostatectomy. Robotic assisted prostatectomy allows precise surgical removal of the prostate while preserving important structures for urinary control and sexual function.
Radiation therapy: High energy rays or particles of radiation are used to kill cancer cells either by external beam or internal implantation (brachytherapy).
Brachytherapy: An outpatient procedure, performed while the patient is under anesthesia, in which tiny, radioactive seeds are placed inside the prostate gland, using ultrasound, to attack the cancer.
Cryosurgery: During an outpatient procedure while the patient is under anesthesia, thin needles which produce very cold sub-zero temperatures are inserted into the prostate gland using ultrasound. Freezing destroys the prostate gland and cancerous tissue. Cryotherapy can be repeated and used as a secondary treatment when other treatments fail.
Hormone therapy: Used in certain cases to reduce the levels of male hormones in the body which can make the prostate cancer shrink or grow more slowly.
Chemotherapy: Used in the case of advanced disease or if the cancer is not responding to other therapy.
Immunotherapy: is a treatment that is designed to help the immune system (the body’s natural defense) fight disease. The immune system is made up of imune cells found in the body. These cells work as the body’s natural defense against all types of illness, including prostate cancer. PROVENGE is the only FDA- approved treatment that uses the body’s immune system to fight prostate cancer.
HIFU, or high intensity focused ultrasound, is a non-invasive treatment performed under anesthesia. The procedure offers drastically reduced side effects, such as erectile dysfunction and incontinence, and the same efficacy rates as traditional, more invasive prostate treatment options. HIFU is a one to three-hour non-surgical, outpatient procedure performed while the patient is under light sedation.
During the procedure, a high intensity focused ultrasound energy or sound waves raise the temperature to destroy the targeted prostate cancer cells without harming surrounding tissue. Unlike radiation, HIFU uses clean (also known as non-ionizing) energy so that the procedure can be repeated, if necessary without damaging healthy tissue. HIFU usually allows for a more rapid recovery: no overnight hospitalization, and a return to work duty with in a few days.
Georgia Urology’s medical director, Dr. Vahan Kassabian, is Atlanta’s leader in HIFU treatment. With years of experience performing the procedure, he has been recognized as the area’s foremost physician in this field of treatment.
Advanced Prostate Cancer
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Advanced prostate cancer is when the cancer spreads to areas outside of the prostate gland, such as bones, lymph nodes, or nearby tissue. While there is currently no cure for Advanced Prostate Cancer, different treatments can vastly expand length of life and mitigate symptoms.
Georgia Urology’s Dr. Vahan Kassabian is a leader in the field of advanced prostate cancer treatment and research. A study, conducted by Dr. Kassabian and his Georgia Urology colleagues –Drs. Jeffrey Proctor, Jerry Yuan, Allen Futral, and Ronald Anglade– explores the impact of a specific type of genomic testing, which assesses tumor biology for those facing advanced prostate cancer.
You can learn more about their findings through these informative documents, presented at urologic conferences nationwide:
Prostate cancer patients with recurrent prostate cancer which has spread to the bones now have a new tool to treat their disease. A new drug called Xofigo has shown significant activity against the hard to treat bone lesions that can occur with the disease.
Approximately one-third of patients diagnosed with prostate cancer will have the more aggressive type, usually treated by surgery or radiation therapy. Unfortunately, the cancer can sometimes recur and can prove difficult to treat, especially when it attacks the bones. It has traditionally been difficult to treat disease in the bones, especially when it is widespread. Enter Xofigo, a radioactive treatment which targets areas of bone disease but leaves uninvolved bone alone. The result is targeted destruction of metastatic disease without the typical side effects of more traditional chemotherapies.
The treatment is simple. After a careful evaluation to decide if the patient is eligible for treatment, the patient comes to the office for injection. Simple blood work is performed to make sure the patients blood levels for hemoglobin and platelets are acceptable. After a quick IV is placed, it’s time for the injection. The injection is completely painless and takes less than two minutes. The IV is removed and the patient goes home. With almost no side effects, the drug is extremely well tolerated. Injections are performed once a month for six injections total.
Use of the drug, along with other therapies, has been shown to increase survival for these patients. It also has been shown to significantly decrease the pain associated with the metastatic disease to the bone, which can be difficult to treat clinically. Bone marrow suppression, with associated low white cell counts, is not a significant problem.
Georgia Urology has offered the therapy for patients for over two years, treating approximately 21 patients with 102 doses administered. No significant complications have occurred. Since it is a radioactive drug, there are some minor precautions for the first few days after treatment, but there are no restrictions on contact with other people, including children.
The treatment of prostate cancer is undergoing many exciting changes. In the future, the treatment algorithm will include earlier intervention for these patients, along with dual chemotherapy treatments while being treated with Xofigo.
PROVENGE® (sipuleucel-T) is now available for the treatment of certain types of advanced prostate cancer at Georgia Urology.
PROVENGE® (sipuleucel-T) is a breakthrough treatment option for asymptomatic or minimally symptomatic metastatic castrate resistant (hormone refractory) advanced prostate cancer.
PROVENGE is the only FDA-approved treatment that uses the body’s own immune system to fight the disease. This type of treatment is called autologous cellular immunotherapy, which means it is designed to use the patient’s own immune system to fight prostate cancer. A person’s immune system is made up of immune cells found in their own blood. These cells work as the body’s natural defense against all types of illness, including prostate cancer.
Since PROVENGE is an immunotherapy, each dose is made just for each patient.The personalized dose of PROVENGE consists of the patient’s own immune cells that have been trained to seek and attack prostate cancer cells.By stimulating the natural ability of immune cells already in their blood, PROVENGE may elp patients live longer.
For additional information about PROVENGE, visit www.PROVENGE.COM
Indication and Important Safety Information:
PROVENGE® (sipuleucel-T) is approved by the FDA as an autologous cellular immunotherapy for the treatment of asymptomatic or minimally symptomatic metastatic castrate resistant (hormone refractory) prostate cancer. PROVENGE is made from a patient’s own immune cells. The patient’s cells will be collected at a cell collection center approximately 3 days before each scheduled infusion of PROVENGE. There can be risks associated with the cell collection process, which patients should discuss with their doctor before deciding to begin treatment with PROVENGE.PROVENGE can cause serious reactions. In controlled clinical trials for the treatment of prostate cancer, serious reactions reported in patients in the PROVENGE group include reactions resulting from the infusion of the drug, which occurred within 1 day of infusion, and strokes. Severe infusion reactions included chills, fever, fatigue, weakness, breathing problems (shortness of breath, decreased oxygen level, and wheezing), dizziness, headache, high blood pressure, muscle ache, nausea, and vomiting. Tell your doctor right away if you have breathing problems, chest pains, racing heart or irregular heartbeats, dizziness, nausea, or vomiting after getting PROVENGE because any of these may be signs of heart or lung problems. The most common side effects reported with PROVENGE are chills, fatigue, fever, back pain, nausea, joint ache, and headache. These are not all the possible side effects of PROVENGE treatment. For more information, talk with your doctor.
For more information on PROVENGE, please see the Full Prescribing Information at www.PROVENGE.com or call Dendreon ON Call at 1-877-336-3736.
Physicians at Georgia Urology participated in the original clinical trials for PROVENGE. As a Urology practice, we have received extensive national recognition and have extensive experience in advanced prostate cancer therapies.
Early detection and advancements in treatments continue to improve the quality of life overall cure rates and for prostate cancer survivors. Georgia Urology is passionate about prostate cancer awareness and is involved with prostate cancer education throughout metro Atlanta. Call today to schedule an appointment to speak with an experienced physician at Georgia Urology.