The board certified, award winning urologists at Comprehensive Urology are experts in prostate cancer diagnosis and treatment. The team at Comprehensive Urology is an industry leader in providing cutting edge, minimally invasive treatment for prostate cancer at every stage with compassion and an individualized approach to each and every patient.

Call (310) 499-2756 today to contact a specialist in Los Angeles and to learn more about Comprehensive Urology’s state-of-the-art facilities and equipment.

Prostate Biopsies

Michel-Prostate-Stages-Illustration-1-24-14Imaging, diagnostic techniques and equipment for prostate cancer have greatly evolved in recent years. The urology team at Comprehensive Urology in Beverly Hills uses a combination of the most sophisticated and modern approaches available to offer patients as accurate and precise a diagnosis as possible at every stage.

Contact Comprehensive Urology today to learn more about:

  • MRI Fusion Biopsy Imaging
  • Prostate Imaging
  • Prostate Mapping

Prostate Preservation

Traditional treatments have typically involved applying radiation to the entire prostate gland, potentially leading to over-treatment. With new advancements in imaging and diagnostic capabilities, Comprehensive Urology can offer some patients targeted treatment through focal prostate cancer therapy. Contact Comprehensive Urology to learn if focal therapy is right for you.

Robotic Surgery

Modern robotic surgery equipment allows for minimally invasive surgery with more accuracy and precision than ever before. The Da Vinci Surgical System, a robotic, computer-guided surgical platform, is changing the face of surgery.

Radiation Therapy

Comprehensive Urology offers patients the most advanced treatment modalities available in the country. Call (310) 499-2756 today to learn more about:

  • MRI TrueBeam Therapy
  • MRI Brachytherapy

Risk Factors of Prostate Cancer

cancer diagnosis treatment los angelesAge

Prostate cancer is rare in young men, but after age 45 to 50 the risk progressively increases. In the United States, a man has a one in six chance of developing prostate cancer. The cancer is usually slow-growing, and the causes of the disease are multifactorial.

Genetic Link

Men with a son, father or brother with prostate cancer have double the risk of developing the cancer. 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.

Ethnicity

Ethnic origin also plays a part: 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.

Diet

There have been studies linking prostate cancer to a high animal fat and red meat diet. 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. Some studies have also linked a previous history of prostate infection to a higher risk of developing cancer.

Grading and Staging

If cancerous cells are found, the pathologist 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.

Staging of Prostate Cancer

Our physicians will use clinical information such as:

  • 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

…to determine how much cancer is the 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).

Learn more by visiting our sister site, ProstateCancerDR.com.

Tests used for Staging Prostate Cancer

Sometimes the physician will order additional diagnostic exams to help determine if the 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 (for example PSA > 10 or bone pain).

Treatments

early stage treatment los angelesTreatments for Early Stage Prostate Cancer

Men who are determined to have early stage prostate cancer have a high likelihood that their cancer is still limited to the prostate and has not spread elsewhere. Most men with early stage disease have an excellent prognosis and with current treatment options have a high likelihood of becoming cancer free.

Learn more by visiting our sister site, ProstateCancerDR.com.

Patients who have early stage disease have several options for treatment including:

  • Active Surveillance
  • Surgery
  • External Radiation Therapy
  • Brachytherapy
  • Cryotherapy
  • Hormonal Therapy

Active Surveillance

Active Surveillance or, as some call it, watchful waiting, may be an option for older men with a relatively shorter life expectancy, especially if the cancer is small and slow growing. Chances are good that without any form of treatment the cancer will not affect them in their lifetime. However, for men who are healthy and have longer life expectancies (greater than 10 years), some type of active treatment to potentially cure the disease is generally recommended

Active surveillance involves monitoring the cancer by:

  • Assessing the clinical symptoms of the patient,
  • Monitoring his prostate with rectal examinations and PSA testings,
  • Imaging the prostate, and
  • Repeating the prostate biopsies at regular intervals

Surgery

Recent studies demonstrate that, for patients with early stage disease, surgery affords the best long term cancer control as compared to any other available treatment option. With the development of newer, more advanced surgical instrumentation, patients are able to undergo prostate surgery and achieve excellent cancer control while optimizing their recovery and preservation of function.

Surgery (called Radical Retropubic Prostatectomy) is considered the gold standard and most common treatment for prostate cancer. The surgeon removes the prostate while sparing muscles and nerve fibers surrounding the prostate gland that control erectile function and urination.

Open radical retropubic prostatectomy (the “open” approach) is performed using an incision from the lower abdomen from just below the umbilicus to the pubic bone. The prostate is removed through this incision while sparing the nerves and muscles surrounding it which help to control urination and sexual function. It is the traditional method of prostate removal and sampling of the lymph nodes surrounding the gland where the cancer can potentially spread. The gland is surgically removed, and the surgeon then reconnects the bladder to the urethra to reconnect the urinary tract.

With the advent of newer surgical technology, surgery is now being done in a minimally invasive manner termed the Da vinci prostatectomy (or robot-assisted radical prostatectomy). The benefits of open surgery are maintained (excellent cancer control, preservation of urinary control and erectile function) while using minimally invasive surgical techniques. This results in smaller incisions, less bleeding, less pain, shorter hospitalization and a much faster recovery time. Preliminary data also suggests a more rapid return of urinary control and erectile function with the “robotic” approach.

External Radiation Therapy

Radiation therapy can take different forms- either externally beamed from a machine or by radioactive seeds implanted in the prostate (see brachytherapy). It can be used as an alternative to surgery for localized prostate cancer, or to treat cancer that has spread beyond the prostate. In certain clinical situations, radiation treatment can be useful in treating prostate cancer after surgery. Radiation therapy can also help shrink tumors in men with advanced disease, and may also be used to relieve pain caused by prostate cancer.

Radiation therapy has recently been more widely used in conjunction with hormonal therapy in the treatment of more aggressive localized prostate cancer.

The course of external beam radiation therapy is usually 6-8 weeks. Newer therapies are continuously being developed (i.e. Conformal beam radiotherapy, intensity modulated radiotherapy) to improve localization of radiation treatment to the prostate without damaging adjacent structures like the bladder or rectum. Widespread long-term data is awaited to determine durable cure rates compared to other therapies such as radical prostatectomy.

Brachytherapy

Radioactive seed implants are placed into the prostate gland to help localize radiation treatment to the prostate and minimize the effects to the surrounding structures (bladder and rectum). The technique is performed by implantation through the skin utilizing ultrasound and x-ray for localization into the gland. Results published to date show good control of cancer at 5-8 years following treatment in persons with very low grade cancers. Overall, the treatment appears to be as effective as external radiation. Long-term results are awaited in order to determine durable cure rates compared to radical prostatectomy.

Cryotherapy

Cryotherapy is performed by freezing the prostate with liquid nitrogen. In the operating room, small probes are placed by ultrasound guidance into the prostate and then are used to freeze the gland, while the urethra is monitored to minimize the risk of damage to it as well as the rectum. It was first developed in the 1960’s and refined in the early 1990’s but had significant side effects to the urinary tract and rectum. Improved technology and the use of ultrasound has allowed for improved localization of treatment to the prostate gland. The overall cure rate with this technique for primary prostate cancer is yet to be determined due to the short term data that is available.

The therapy has gained more widespread acceptance not in the primary treatment of prostate cancer, but in the recurrence of prostate cancer after radiation treatment has failed. It appears that this may be the more promising role for cryotherapy in the treatment of prostate cancer.

Hormonal Therapy

Many men choose hormonal therapy for advanced prostate cancer to help cut off the supply of the hormone (testosterone) that makes prostate cancer cells grow faster. As it is not a curative mode of treatment, it is generally not used in early cancer. Hormonal control can be achieved through the use of medications or through surgical means. The medications used help to stop the production of these hormones or block them from feeding the cancer cells. Surgical options include removal of the testicles, which are the main source of testosterone production in men.

Hormonal therapy targets cancer that has spread beyond the prostate gland and is thus beyond the reach of local treatments such as surgery or radiation therapy. Hormonal therapy is also helpful in alleviating the painful and distressing symptoms of advanced disease. It is also being used in conjunction with external radiation therapy for more aggressive but localized prostate cancer. Furthermore, it is also used as a treatment for prostate cancer recurrence after previous treatment. Although hormonal therapy cannot cure prostate cancer, it will usually shrink or halt the advance of disease, often for years. With hormonal control, about half of men who have the cancer spread to other organs in the pelvis live at least 5 years.

Treatments for Advanced Stage Prostate Cancer

prostate treatment options los angelesAdvanced stage prostate cancer signifies that the cancer cells have likely grown outside the prostate and may have spread to other parts of the body (such as the bones or lymph nodes). Once the cancer cells have grown out of the prostate and spread elsewhere in the body, the likelihood of complete cure is low. However, with the use of combined medications and treatment modalities, the cancer cells can be effectively managed to keep them controlled.

Treatment Options

The therapeutic options most suited for each patient will depend on a host of clinical parameters and are tailored for each patient. Our physicians work in collaboration with other physicians and support staff to create a comprehensive therapeutic plan.

Treatment options can include any combination of external beam radiation therapy, hormonal therapy and surgery (termed “multimodal therapy”) when the disease appears contained within the pelvis. When the disease appears to have spread beyond the pelvis to other organs, hormonal therapy is the mainstay to help delay progression of the cancer. After a certain amount of time, certain cancers no longer respond to hormonal blockade. Chemotherapy also has a role in the treatment of advanced prostate cancer. There are multiple chemotherapy trials underway investigating the optimal treatment regimen to help manage these cancers.

Prostate Biopsies

Prostate cancer is the most common form of cancer among men after skin cancer. However, the disease can be extremely curable when diagnosed in the early stages. The urologists at Comprehensive Urology in Los Angeles have access to the industry’s most cutting edge diagnostic and surgical tools. Whether obtaining a diagnosis for the first time or looking for a second opinion, men can get faster and more accurate results than ever before. With new imaging techniques and highly refined, minimally invasive procedures, cancer screenings and biopsies have come a long way in the last few decades, offering men higher survival rates and better quality of life.

Enhanced Prostate Imaging Techniques

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 the regular test. It merges the images and data from an ultrasound and MRI screening to offer urologists a more precise, accurate view of the prostate and more specifically the size, location, and severity of the tumor.

Cancer Specialists in Los Angeles

The expert urologists at Comprehensive Urology in Los Angeles are industry leaders in diagnosis and treatment. They operate on the philosophy that every patient is unique and one size does not fit all when it comes to treatment and care.

Patients can expect individualized, comprehensive exams and evaluations to determine the treatment plan most appropriate for their situation. Determining the right stage and grade of tumors is very important in devising an adequate treatment plan for each patient, and the state-of-the-art tools available at Comprehensive Urology help to yield clearer and more accurate results than ever before.

Robotic Prostate Cancer Surgery

In keeping with a career-long commitment to excellence, the team of experts at Comprehensive Urology offers the most advanced diagnostic and imaging capabilities for treatment in Beverly Hills. Recent advancements in medical technology have made it possible for the specialists and urologists at Comprehensive Urology to offer patients a range of minimally invasive, high precision treatment options in a state-of-the-art facility.

What is Robot Prostate Cancer Surgery?

Robot-assisted, or robotic, surgery allows the urology team at Comprehensive Urology to operate on patients with greater precision and flexibility than previously available with traditional “open” surgical methods.

A computer guided system focuses on a targeted area of the prostate gland to remove tumors with greater accuracy. The “arms” of the robot are more flexible than human arms and can focus on a smaller and more targeted surface area, providing the surgeons with greater manual dexterity while performing surgery. Robotic surgery is a tool that works as an extension of the surgeon’s hand; they remain in control of the surgery and of the patient at all times.

Da Vinci Surgical System

The Da Vinci Surgical System is a revolutionary platform that allows Comprehensive Urology to offer patients minimally invasive, top of the line surgery for prostate cancer. The Da Vinci system is distinguished from earlier surgical tools and procedures with many unique features:

  • Innovative EndoWrist instrumentation for greater manual dexterity and control
  • High-resolution brilliant color 3D stereo viewer offers higher magnification to enhance natural depth of field
  • Four robotic arms with jointed wrist design for greater dexterity and flexibility
  • Motion scaling and tremor reduction of surgeon’s hand movements
  • Multi-level fail-safe design to help minimize potential for human error

Benefits of Robotic Surgery

Robotic surgery allows the experts at Comprehensive Urology to offer patients a less invasive, more precise operation. Minimally invasive surgery generally has many advantages over traditional open surgery, including:

  • Smaller incisions
  • Less blood loss
  • More precise preservation of the erectile nerves
  • More accurate urethral anastomosis
  • Lower risk of complications and infections
  • Potentially shorter hospital stays and healing time

Intensity-Modulated Radiation Therapy (IMRT)

Prostate Cancer TreatmentTreatment options have come a long way in the many years since the disease was first treated. However, the fight against the cancer has evolved at a far greater rate in only the last few years.

In addition to being able to catch the disease at an early stage in order to make it highly treatable, treatments have become exceedingly sophisticated. These countless advancements mean that patients have a better chance than ever to enjoy better post-operative health and preserve their quality of life.

Innovative new technologies and procedures for performing surgery and administering treatment to patients have made it possible for the urology team at Comprehensive Urology to treat all stages with more precision and success than ever before.

Treatment Options

While a cancer diagnosis can be frightening and overwhelming at any stage, men diagnosed with prostate cancer today have more treatment options than ever before. The experts at Comprehensive Urology work closely with each patient to accurately determine the stage and grade of the tumor(s) and to design an individual, customized treatment plan most appropriate for each particular case.

Traditionally, radiation treatments have been delivered to the entire prostate gland. The state-of-the-art facilities and equipment at Comprehensive Urology make it possible to offer each patient targeted and localized radiation treatments to the prostate gland in many cases.

MRI Truebeam Therapy

TrueBeam intensity-modulated radiation therapy (IMRT) is a modern, highly sophisticated method for delivering targeted radiation treatments to the prostate gland with greater accuracy and precision. Because the positioning of the prostate gland tends to shift regularly due to its location near the bladder and rectum, older methods for administering radiation made it difficult to pinpoint the precise location of the gland. This increased the likelihood of applying radiation to healthy tissue as well. The enhanced imaging capabilities of the MRI Truebeam system make it possible to target and administer radiation to the cancer cells in the prostate with greater accuracy and precision.

IMRT typically takes eight and half weeks to deliver. Radiation is delivered in small fractions on a daily basis, Monday through Friday for 42 sessions. Each day that a patient shows up for his treatment, the prostate is in a slightly different position. This is because the prostate sits on top of the rectum and just below the bladder. Therefore, depending on the amount of fecal material in the rectum or the amount of urine in the bladder, the prostate can actually shift up or down slightly on a daily basis.

Standard IMRT radiation therapy cannot visualize the prostate with high accuracy. For this reason, to ensure that the prostate is being adequately radiated, some of the healthy tissue around the prostate also receives radiation. This is done to compensate for the lack of prostate visualization. The downside is that normal, healthy tissue gets destroyed with standard IMRT therapy.

For more information, visit WebMD.com.

MRI Brachytherapy

MRI Brachytherapy also utilizes the advancements in imaging and diagnostic capabilities that have occurred in recent years to help deliver precise, targeted radiation to the portion of the prostate gland where the cancer cells are located. This focus treatment helps preserve as much healthy tissue as possible and avoid over-treatment. With brachytherapy, the radiation doses are delivered through small capsules or “seeds” placed inside the patient near the location of the tumor.

Frequently Asked Questions

cancer signs symptoms los angelesThe team at Comprehensive Urology in Beverly Hills provides diagnostic capabilities and treatment options that are among the most sophisticated and effective in the country.

Patients from across the United States and even around the world seek out the practice’s industry-leading expertise and knowledge of the most advanced and cutting-edge treatments available for patients diagnosed with prostate cancer at any stage.

Q: What are the signs and symptoms?

A: 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 an urologist as soon as possible.

Q: When should I seek a second opinion?

A: It is never too late or too early to seek a second opinion.

Q: What is the screening process?

A: 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

Q: Is this condition preventable?

A: 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.

Q: What are the treatment options?

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

  • Active Surveillance
  • Radiation Therapy
  • Minimally invasive Robotic Surgery

Q: How do I know what the best treatment option is for my case?

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

Q: What is the Prostate?

A: 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.

Q: What is the Prostate’s Normal Function?

A: The prostate is comprised of thousands of tiny glands that produce fluid. This fluid forms part of the semen and primarily protects and nourished 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 functions to control urine, or continence, by contracting and releasing the flow of urine through the urethra.

Q: What is Prostate Cancer?

A: Prostate cancer normally starts in the gland cells, which 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).

Q: What Causes Prostate Cancer?

A: To this day, the specific causes of prostate cancer are still not certain. However, there are many contributing factors to the illness including age, ethnic background, lifestyle choices, medications, family history, and more.

  • Age. The primary risk factor in developing prostate cancer is age. The risk is higher with age as there are more diagnoses of prostate cancer with men over the age of 50.
  • Genetics. Family history also plays a major factor in prostate cancer risk. A man whose brother or father was diagnosed with the illness runs twice the risk of developing prostate cancer, compared to other men who do not have any affected family members.
  • Diet. A few research studies have shown that certain diets, specifically a Mediterranean diet, may help reduce a person’s chanced of developing prostate cancer. Some recent studies promote the consumption of vegetables and vitamin B to be beneficial in prevention.
  • Obesity. Those who are obese have been linked to an increased chance of developing cancer of the prostate.
  • Other factors that increase the likelihood of developing cancer are linked to medication history and the contraction of sexually transmitted diseases (STDs).

Q: How is Prostate Cancer Classified?

A: 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.

Q: What are the Signs and Symptoms?

A: As mentioned earlier, prostate cancer is not easily detected early on. Symptoms don’t normally appear during the early states, making it difficult for men to even they know they need treatment. Most men find out they have this condition after a routine check up or blood test. However, when symptoms do exist, they may involve one or more of the following:

  • Frequent and sometimes painful urination
  • Disruption in sleep due to more frequent urination at night
  • Difficulty in starting and continuing to urinate
  • Blood may be present in the urine
  • Less common symptoms may include painful ejaculation, or achieving and maintaining an erection

Q: What are the Symptoms Associated with Advanced Prostate Cancer?

A: The following are possible signs and symptoms of advanced state prostate cancer:

  • Bone pain, most likely in the spine (vertebrae), pelvis or ribs
  • Pain in the proximal part of the femur
  • If the cancer has spread to the spine and is compressing the spinal cord, typical symptoms may include: leg weakness, urinary incontinence and fecal incontinence.

Contact a Specialist Today

It is crucial to receive a proper diagnosis in order to determine the best plan of care for those who have or think they may have prostate cancer. The skilled doctors at Comprehensive Urology are leaders in their field. If you would like to receive a screening and biopsy or are interested in learning more about your treatment options, please contact us today at (310) 499-2756.

Next, read High Intensity Focused Ultrasound (HIFU)/Focal Therapy.

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