Unfortunately, 1 out of every 9 men will develop prostate cancer during their lifetime. Prostate cancer is the most common malignancy in men and, fortunately, one of the most treatable malignancies if detected at an early stage. If prostate cancer is diagnosed early, before it has spread outside of the prostate, it can be cured in the large majority of cases. If men receive a prostate specific antigen (PSA) blood test and regular digital rectal examinations (DRE) of the prostate by a physician, prostate cancer can be diagnosed at an early stage in most instances.
In recent years, PSA testing has become somewhat controversial in regard to the appropriate normal range for PSA and to the question of whether a low PSA definitively indicates the absence of prostate cancer. (See the American Cancer Society guidelines for prostate cancer screening.) Urologists at the Maryland Prostate Center counsel patients on the intricacies and uncertainties regarding PSA testing. PSA values are adjusted for a patient's age and in some instances, when necessary, the PSA is compared to the prostate size to determine the likelihood of prostate cancer and give the patient enough information to decide whether he should consider undergoing a prostate biopsy. PSA testing is not "cookbook medicine". It requires use of both "art and science" and urologists at the Maryland Prostate Center use these approaches when counseling patients.
If prostate cancer is diagnosed early, before it has spread outside of the prostate, it can be cured most of the time. Treatment options include prostate removal radical prostatectomy, which can now be performed laparoscopically with robotic assistance) and radiation treatments (brachytherapy [seeds] and external beam radiation, IMRT).
Radical prostatectomy can be performed with open surgery, a laparoscopic approach or using robotic assistance. Cure rates after radical prostatectomy in early stage prostate cancer are excellent. The side effect risks include urinary incontinence, erectile dysfunction, and infertility. The risks of incontinence and erectile dysfunction can be minimized with meticulous surgical technique and with technique modifications to minimize/avoid injury to the nerves responsible for erections.
In many men, radiation therapy is an excellent choice to treat localized prostate cancer. Long term results with brachytherapy (prostate seeding) show consistent cure rates. Men with more aggressive or more advanced prostate cancer can benefit from a combination of external beam radiation and brachytherapy. Cancer control rates with combination radiation therapy are superior to those with either treatment alone in men with extensive/aggressive prostate cancer. Radiation therapy is done in conjunction with the Department of Radiation Oncology at the University Of Maryland School Of Medicine.
In some patients who have previously undergone radiation therapy for prostate cancer who have recurrent or residual prostate cancer, cryosurgery (prostate freezing) is a good treatment option. This technique is done without an incision and lowers prostate temperature low enough to cause destruction of the cancer cells. There have been many recent advances in this technology, increasing its effectiveness and decreasing risks/side effects.
Hormonal therapy is a treatment which lowers testosterone levels on a temporary or permanent basis. In many men undergoing radiation, hormonal therapy in conjunction with the radiation treatment(s) can increase the effectiveness of the radiation. In some instances, men with metastatic or extensive cancer are treated with hormonal therapy as their primary treatment.
A man with prostate cancer needs to be carefully evaluated and counseled before he can decide which treatment option for prostate cancer is best for him. In many instances, particularly if the cancer has been diagnosed early, more than one treatment option are available to a man and the staff at MPC will counsel a man and his family on the pros and cons of each treatment option.
Older men or men with significant health problems other than prostate cancer are often best managed expectantly with watchful waiting. Although this is puzzling to many patients with prostate cancer, the rationale for this approach is that an older patient with health problems is more at risk for side effects with treatment and, because of his relative limited life expectancy, his prostate cancer may not progress rapidly enough to bother him. Discussion of this issue is a judgment call on the part of both the urologist and the patient. Counseling by family members and physicians is helpful, but the patient must make the final decision regarding this issue.
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