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Prostate cancer options: waiting, surgery and more
The detection and treatment of prostate cancer is getting high tech.
New sophisticated screenings, better tests for evaluating biopsied tissue and use of MRI-ultrasound
fusion to accurately map prostate cancer are the latest advancements in detecting and treating the
disease.
These are the things that are new and exciting, said Dr. Dipen Parekh, professor and chairman of
the department of urology and director of robotic surgery at the University of Miami Miller School of
Medicine. If you do get a diagnosis of prostate cancer, if you seek out treatment with the right
people, and you are in the right hands, you should expect an excellent future course.
In addition, robotic-assisted laparoscopic prostatetectomy continues to advance as a surgical tool,
along with radiation therapy or brachytherapy, which uses radioactive seeds to kill cancer cells. Still
others undergo a radical prostatectomy, the removal of a cancerous prostate and its surrounding
tissue.
Pre- and post-surgical pelvic floor physical therapy, a series of exercises under the guidance of a
therapist, can also strengthen pelvic areas to end incontinence, said Louise Gleason, a physical
therapist with South Miami Hospitals Pelvic Floor Center.
And, for those for whom prostate cancer has become too advanced and who are not candidates for
surgery, Provenge, a restorative treatment of cellular immunotherapy, made from a patients own
immune cells, can stimulate a patients immune system to identify and target prostate cancer cells,
thus prolonging life, said Dr. Michael Cusnir, an oncologist at Mount Sinai Medical Center in Miami
Beach, Fla.
GUIDELINES
Guidelines for screenings of the prostate, a walnut-sized portion of a mans reproductive system that
wraps around the urethra, the tube that carries urine out of the body, have changed since May 2013.
Instead of every man over 40 getting a PSA (prostate-specific antigen blood test), now its more
focused on screening for patients with a high risk for prostate cancer, those who have a family
history, or who are African American, said Parekh.
MRI-ultrasound fusion, adopted early by the University of Miamis Sylvester Comprehensive Cancer
Center, can result in more accurate prostate biopsies than ultrasound alone or digital rectal exams.
The American Cancer Society recommends that at age 50, men who are at an average risk of prostate
cancer have a discussion about the risks and potential benefits of a screening with their doctor.
The screening discussion can start at 45 for men at higher risk of developing prostate cancer, which,
according to the American Cancer Society, will impact one out of seven men in the United States -
though only one out of 36 will die from the disease. Most older men who have been diagnosed with
prostate cancer will die from other causes before succumbing to the cancer.
At-risk men would include African Americans, who have a higher instance of prostate cancer
compared with their white and Hispanic counterparts, or men who have an immediate relative such
as a father, brother or son who was diagnosed with prostate cancer before age 65.
Those who have had more than one immediate relative with the disease at an early age should begin
discussions with their doctors even earlier, at age 40.
Prostate cancer is the second most common cause of cancer death in men, behind lung cancer and
ahead of colon cancer.
About 233,000 new cases of prostate cancer will be diagnosed nationwide in 2014, and 29,480 men
will eventually die from it, according to the American Cancer Society. The upshot: More than 2.5
million men in the United States who have been diagnosed with prostate cancer at some point - the
average age at the time of diagnosis is 66 - are still alive. Active surveillance, or monitoring the
disease with doctor and patient working in tandem, can also improve quality of life.
Robotic surgery, guided by infrared vision, is a preferred treatment because blood loss is minimized
as is the risk of damaging blood vessels and nerve bundles that are responsible for blood flow to the
penis that allows a man to achieve an erection. The image-guided surgery is also less traumatic.
Most patients go home within a day or two with a catheter, for about a week, to help drain the
bladder until the sutures heal. Normal continence resumes for 95 percent of patients within the first
six months.
PHYSICAL THERAPY
For patients who need help dealing with issues of incontinence, which can occur before or after
prostate cancer surgery, or from an enlarged prostate as a man gets older, therapeutic exercises can
be a remedy.
The Pelvic Floor Center at South Miami Hospital focuses on a ring of bones that includes the sacrum
at the bottom of the spinal column and the pelvic bone on either side. At the base of that bone
structure lie muscles that hang like a hammock from the tailbone to the pubic bone, supporting the
pelvis. These muscles are voluntarily controlled, like the biceps or triceps, and are used to control the
passage of waste from the body.
I gear my physical therapy toward the muscles and bones of the pelvis to see if we can help patients
restore that function after whatever procedure they have, Gleason said. When these muscles are
weak, or not working properly, they cant close that urethra to hold that urine back and thats where I
come in. I assign people exercises based on the strength they already have so as to maximize their
improvement, she said.
In general, it takes about a month before a patient will see real strengthening, Gleason said.
Typical sessions run once a week for about six to eight weeks with home exercises suggested
afterward. A simple exercise might go like this: Recline on the floor with knees bent, a hand on the
belly, another on a leg. Tighten up around the anal area as if holding back gas. Release and repeat.
The first goal is to isolate the pelvic floor and be able to recognize when they are using it, Gleason
said. From there, you can begin to exercise because you are using the correct muscle.
Still other therapies can utilize electrodes placed on the skin to measure activity in the muscles to
train the muscles to contract and strengthen. If the incontinence or sexual dysfunction is muscular
related, these exercise combinations can be effective, Gleason said.
IMMUNOTHERAPY
In some cases, prostate cancer has advanced beyond surgical solutions. Provenge, a therapeutic class
of cellular immunotherapies, is not curative. But this non-surgical alternative to prostate cancer
treatment can improve the survival rate of patients for months or years.
Patients cells are collected, infused with an antigen that helps activate the patients T-cells to help
fight the cancer cells, and then placed back into the patients body intravenously.
Almost like a blood transfusion, explains Mount Sinais Cusnir. We almost train the patients own
immune system to recognize the cancer cells and fight them on their own.
The process is repeated three times in two-week intervals.
Were still looking for a big change, Cusnir said about the treatment of prostate cancer, but at
least we keep improving survival.