A Team Approach to Care

Prostate Cancer

With over 3,000 prostate surgeries performed to date, the urological leaders at Comprehensive Urology have over 125 years of collective experience in treating prostate cancer and all of its symptoms.

Comprehensive Urology is an industry leader in providing cutting-edge, minimally invasive treatment for prostate cancer with compassion and an individualized approach for each patient. If you’ve been diagnosed with prostate cancer, or have a family history of the disease, it’s important to know your treatment options and to have a general understanding of what’s involved during the treatment process.

We hope that this information serves as a good starting point in regards to prostate cancer treatment. Please continue reading to learn more about this disease and the numerous therapies that our board-certified urologists use to treat it.

Approximately one in nine men will receive a prostate diagnosis during his lifetime, according to the American Cancer Society (ACS). Prostate cancer is also more prominent in older men and African-American men than others, and the condition is very rarely diagnosed before the age of 40.

What is Prostate Cancer? 

Prostate cancer normally starts in the gland cells and is called adenocarcinoma. This type of cancer is considered to be a slow, progressive disease that is not as easily detected compared to other forms of cancer. Prostate cancer starts with microscopic alterations in the shape and size of the prostate gland cells, which is referred to as prostatic intraepithelial neoplasia (PIN).

Nearly all prostate cancers are adenocarcinomas that develop from the gland cells.

Most prostate cancers grow slowly, but some have been shown to quickly grow and spread. Also, prostate cancer often shows no symptoms until it spreads. With an early-st
prostate cancer diagnosis, men are better equipped than ever before to fully treat this condition.

4 Risk Factors for Prostate Cancer
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When diagnosed early, prostate cancer is one of the most treatable and even curable forms of cancer. Though there are a variety of prostate cancer risk factors, the cancer is usually slow-growing, and the causes of the disease are multifactorial and can include the following.

1. Age

Prostate cancer is rare in young men, but after age 45 to 50 the risk progressively increases. 60% of prostate cancer diagnoses are in men 65 or older, and the average age of a prostate cancer patient is 66 years old. However, other factors could cause prostate cancer to develop earlier, and these causes are listed below

2. Genetic Link

Men with a family history of prostate cancer have double the risk of developing the disease. The risk is even higher for men with several affected relatives, particularly if their relatives were young at the time of diagnosis. Scientists have identified several inherited genes that seem to increase risk, but they probably account for only a small fraction of cases. Genetic testing for these genes is not yet available.

3. Ethnicity

Ethnic origin also plays a part in the development of prostate cancer: men of African heritage seem to be at highest risk, and men of Far Eastern descent the lowest. Men who are at higher risk (family history or African origin) are screened at an earlier age in order to find the cancer at its earliest stages when the potential for cure is the highest. At Comprehensive Urology, we recommend that African American men be screened at the age of 40, regardless of their family history of prostate cancer.

4. Diet
Maintaining a healthy diet is an important step when it comes to reducing your risk of prostate cancer. There have been studies linking prostate cancer to a high animal fat and red meat diet, and it may be possible to reduce the risk of developing cancer by cutting down on dairy foods, red meats, and other foods rich with saturated fats.

Exposure to certain agricultural pesticides may be associated with an increased risk of prostate cancer. There is also a weak association between prostate cancer and cadmium exposure. Additionally, some studies have linked a previous history of prostate infection to a higher risk of developing cancer.

Prostate Cancer Screening Tests

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It is possible to detect the early signs of prostate carcinoma from the convenience of the Prostate Cancer Specialists of Los Angeles’ office with the following tests:

Prostate-Specific Antigen Blood Test

Prostate-specific antigen is a protein that is released by the prostate gland in minuscule amounts into the bloodstream. In some cases, the prostate can release excess levels of PSA, whether due to a prostatic benign hyperplasia, cancer, or other complication. The PSA test is used to detect the level of prostate-specific antigens in a man’s blood to determine if a further screening is necessary or whether to take an active surveillance approach.

Digital Rectal Exam

The doctor simply inserts a lubricated and gloved finger into the lower part of the rectum to feel whether there are any lumps or abnormalities on the prostate. An experienced urologist can evaluate the shape, size, and texture of the prostate to identify whether the patient is more likely to have prostate cancer or a benign condition.

Transrectal Ultrasound (TRUS)

In the event of abnormal results found in a DRE or PSA test, an additional conservative method for screening may be used involving a transrectal ultrasound. A small probe is lubricated and inserted into the rectum where it will emit sound waves and pick up the echoes and transmit the date into black and white computer images. The procedure takes no more than 10 minutes and does not cause any pain. The black and white images can be used to evaluate whether further diagnostic tests should be conducted.

Other health conditions, such as obesity, can contribute to higher than average PSA levels, therefore, it is important to get screened by an expert urologist with extensive experience evaluating cancer screening tests. There are numerous factors that must be taken into account when conducting reliable prostate cancer screening tests and the Prostate Cancer Specialists of Los Angeles provide comprehensive care to ensure that each patient receives the personalized screening and treatment he needs.

Depending on the results of the various prostate cancer screening tests, the urologist may schedule a procedure called a prostate biopsy. The procedure involves taking small samples of the gland tissue with a thin hollow needle.

Diagnosing Prostate Cancer

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Sometimes, our physician will order additional diagnostic exams to help determine if prostate cancer is limited to the prostate or if it has spread. These tests may include a bone scan, CT scan, MRI, and/or lymph node biopsy. These tests are usually performed when there is a suspicion of aggressive or advanced disease (e.g., a PSA score greater than 10 or bone pain).

Prostate Mapping

Prostate mapping involves the use of specific tests to help men understand the risks associated with prostate cancer. It is also used to help men determine if they have prostate cancer. If prostate cancer is discovered, additional testing is used to evaluate the cancer’s precise location, number of tumors, and grade.

With prostate mapping, a urologist uses MRI and/or transperineal template-guided biopsy testing. This helps a urologist provide an accurate prostate cancer diagnosis.

Prostate Biopsy

During a prostate biopsy, a urologist inserts a needle into the wall of a patient’s rectum. A urologist next extracts prostate cells for testing and collects samples from multiple parts of the prostate. Then, a urologist sends the prostate tissue samples to a laboratory, where they are reviewed under a microscope.

Prostate biopsy results are generally available within a few days. If a urologist identifies prostate cancer, he or she will provide a patient with a Gleason score based on the aggressiveness of cancer.

MRI Fusion Biopsy

The board certified and award-winning team of prostate cancer specialists at Comprehensive Urology uses an enhanced imaging and diagnostic technique known as MRI fusion biopsy. Because tumors are not always detectable on ultrasound exams alone, MRI (magnetic resonance imaging) screenings can provide more detailed results.

An MRI fusion biopsy goes a step further than a regular prostate cancer test. It merges the images and data from an ultrasound and MRI images to offer urologists a more precise, accurate view of the prostate and the size, location, and severity of the tumor(s).

Prostate Cancer Grading & Staging

If cancerous cells are found, a pathologist at Comprehensive Urology will use a grading system – called Gleason grading – to help describe how aggressive the cancer is.

The pathologist will evaluate the two largest areas of cancer and will give each section a grade from 1 (least aggressive) to 5 (most aggressive).

When these two numbers are added together, it represents the total “Gleason score” of the cancer. A higher score signifies a more aggressive cancer. Depending on each individual’s score, the urologists at Comprehensive Urology will develop a personalized treatment approach that’s unique to your cancer’s grade, stage, and more.

Staging of Prostate Cancer

In order to determine how much cancer is present, how fast the cancer is growing, and to determine if the cancer is still localized to the prostate (early stage) or if it has spread beyond the prostate (late stage), our physicians will use the following clinical information:
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  • The findings noted on the rectal examination,
  • The Gleason grade of the cancer
  • How much tumor is present in the biopsy specimen,
  • How many different areas of the prostate had detectable cancer cells,
  • The PSA value, and
  • The size of the prostate

Treatment Options
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Comprehensive Urology offers a variety of treatment methods for prostate cancer. Like other forms of the cancer, prostate cancer treatment is determined by a few factors, including the grade and stage of the disease, a patient’s age, and more. Once your cancer has been diagnosed and studied, our specialists will determine a specific treatment plan that’s unique to you and your lifestyle.

Patients with prostate cancer can benefit from the following treatments. Each treatment option is beneficial to certain individuals, as there is no “one size fits all” approach to prostate cancer treatments. However, the prostate cancer specialists at Comprehensive Urology in Los Angeles can help you choose a treatment plan that is specifically tailored to you and your condition.

Treatments for female urinary incontinence include:

 

Active Surveillance: Involves monitoring prostate cancer symptoms over an extended period of time. With active surveillance, a prostate cancer patient will receive a clinical assessment of symptoms, monitor the prostate with rectal examinations and PSA testing, use prostate imaging, and perform prostate biopsies at regular intervals.

Robotic Prostate Cancer Surgery: Requires the use of the da Vinci® robotic surgical machine to remove malignant or enlarged prostate tissue. Robotic prostate cancer surgery is minimally invasive and enables a surgeon to use small, precise instruments to treat patients.

High-Intensity Focused Ultrasound (HIFU): Uses high-frequency ultrasound waves to heat and destroy cancer cells within the prostate. HIFU targets cancerous tissue and ensures tissue outside the focal point remains intact.

MRI Brachytherapy: Involves the placement of radioactive seed implants into the prostate gland to help localize radiation treatment to the prostate and minimize the effects to the surrounding structures (bladder and rectum).

Cryotherapy: Requires freezing the prostate with liquid nitrogen. Cryotherapy is commonly used to address the recurrence of prostate cancer after radiation treatment has failed.

Hormonal Therapy: Helps reduce a man’s supply of testosterone, the hormone that makes prostate cancer cells grow quickly. Hormonal therapy targets cancer that has spread beyond the prostate gland.

Intensity-Modulated Radiation Therapy (IMRT)/MRI TrueBeam Therapy: Targets and administers radiation to prostate cancer cells with unparalleled accuracy and precision. IMRT usually takes about eight-and-a-half weeks to administer.

URINARY INCONTINENCE

FAQ

What is prostate cancer?
Prostate cancer normally starts in the gland cells and is called adenocarcinoma. This type of cancer is considered to be a slow, progressive disease that is not as easily detected compared to other forms of cancer. Prostate cancer starts with microscopic alterations in the shape and size of the prostate gland cells, which is referred to as prostatic intraepithelial neoplasia (PIN).
What causes prostate cancer?
To this day, the specific causes of prostate cancer are not certain. However, there are many contributing factors to the illness, including age, ethnic background, lifestyle choices, medications, family history, and more.
What are the signs and symptoms of prostate cancer?

Like many forms of cancer, prostate cancer can sometimes be asymptomatic (presenting no obvious symptoms) in the early stages, when diagnosis and treatment has the highest likelihood of success. Knowing what to look out for and learning about personal risk factors should be a priority. Some of the most common symptoms can include:

  • Frequent need to urinate, especially at night
  • Problems with starting urination or holding back urine
  • Weak or interrupted urine flow
  • Pain or burning during urination
  • Difficulty with erection
  • Painful ejaculation
  • Blood in urine or semen
  • Frequent pain or stiffness in lower back, upper thighs, or hips

While the presence of any or a combination of symptoms does not necessarily indicate prostate cancer, men experiencing any symptoms should consult with a urologist as soon as possible.

When should I seek a second opinion?
It is never too late or too early to seek a second opinion.
What is the screening process?

The award-winning team of specialists at Comprehensive Urology has the most advanced and reliable diagnostic imaging tools and equipment available. Screening and testing will vary from patient to patient, but diagnostic testing can include:

  • Rectal exam
  • Blood test
  • Prostate ultrasound
  • MRI fusion biopsy
  • Perfusion dynamic MRI of the prostate
Is this condition preventable?
While it may not be possible to predict or avoid the onset of cancer in all cases, there is no question that taking a proactive approach to nutrition and fitness, including a healthy diet and physically active lifestyle, can have a positive impact on overall health and well-being. Managing stress and anxiety is another important factor in maintaining a healthy lifestyle.
What are some prostate cancer treatment options?

Treatment for prostate cancer will vary from patient to patient and depend on many factors, such as the stage and grade of the cancer. Treatment options at Comprehensive Urology include:

  • Active surveillance
  • Radiation therapy
  • Minimally invasive robotic surgery
  • HIFU
  • And more
How do I know what the best treatment option is for my case?

Every patient and diagnosis is different and therefore there is no “one size fits all” treatment approach for prostate cancer. The expert urologists at Comprehensive Urology in Los Angeles work with each patient to arrive at the best treatment plan available for every case on an individual basis.

What is the prostate?

The prostate is an exocrine gland (glands that secrete outside the body e.g. prostate gland and sweat glands) of the male reproductive system and is located underneath the bladder.

What is the prostate’s normal function?

The prostate is comprised of thousands of tiny glands that produce fluid. This fluid forms part of the semen and primarily protects and nourish the sperm. When a male has an orgasm, the fluid is secreted into the urethra and leaves the body through the penis. The muscle fibers in the prostate gland also function to control urine, or continence, by contracting and releasing the flow of urine through the urethra.

How is prostate cancer classified?

Classifying the right stage of cancer is extremely important. Not only will it help the doctor more clearly define the prognosis, it will help select the right form of therapy to use as well. The most common system for prostate cancer classification is summarized below:

  • TNM (Tumor/Nodes/Metastases) is the most common system for determining the stage of prostate cancer used today. This system closely evaluates the size of the tumor, the number of lymph nodes and the presence of metastases.
  • Computer tomography is used to determine if the prostate cancer has spread inside the pelvis.
  • Bone scans are used to find out of the cancer has spread to the bones.
  • Endorectal coil magnetic resonance imaging can evaluate the prostatic capsule and seminal vesicles.
  • The Gleason System, or score, is used to evaluate the biopsy samples under a microscope. If a pathologist detects cancer tissue, the tumor is then graded on a scale of 2 to 10. The higher the number, the more abnormal the tissues are compared to healthy prostate tissue. It is important to grade the tumor properly as it decides what treatments should be recommended.

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