Los Angeles Prostate Cancer Treatment from Urology Experts
How Important are Prostate Cancer Screenings

Aside from skin cancer, prostate cancer is the most common cancer for men in the United States. Although 1 in 6 men will be diagnosed with this disease, millions of men have survived their diagnosis and are leading normal, happy, and healthy lives. When diagnosed early, prostate cancer is one of the most treatable forms of cancer.

Why Choose Comprehensive Urology?

Comprehensive Urology - Prostate Cancer Specialists in Los Angeles

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.

4 Risk Factors for Prostate Cancer

In the United States, a man has a 1 in 6 chance of developing prostate 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.

Prostate Cancer Infographic

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.

Grading and Staging

Prostate Cancer Grading and StagingIf 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, malignancy, and more. For more information about grading and staging prostate cancer, please contact our Los Angeles urologists today.

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:

  • 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
Prostate Cancer Grading and Staging

Tests Used for Diagnosing Prostate Cancer

Sometimes, our 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 (e.g., a PSA score greater than 10 or bone pain).

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 screening to offer urologists a more precise, accurate view of the prostate and the size, location, and severity of the tumor.

Prostate MRI for Prostate Cancer

Treatments

Prostate Cancer TreatmentsComprehensive 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.

Active Surveillance

Active surveillance (also known as “watchful waiting”) is an option for older men with a relatively shorter life expectancy, especially if the cancer is small and slow-growing. For these individuals, chances are good that without any form of treatment, 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
  • Repeating the prostate biopsies at regular intervals

Robotic Prostate Cancer Surgery

Robotic prostate cancer surgery is changing the face of prostate cancer treatment. Also known as robotic prostatectomy, this 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.

Robotic Prostate Cancer Surgery IncisionsDuring robotic prostatectomy, a computer-guided system focuses on a targeted area of the prostate gland to remove tumors with high accuracy. The arms of the robot are more flexible than human arms and can focus on a smaller and more targeted surface area, providing 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 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 and 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

HIFU

HIFU Specialists of Los AngelesHIFU (which stands for “high intensity focused ultrasound”) is a state-of-the-art prostate cancer treatment method pioneered by the urologists at Comprehensive Urology. During a HIFU procedure, high frequency ultrasound waves are used to heat and destroy cancer cells within the prostate. The highly focused nature of this treatment helps to ensure that ONLY cancerous tissue is targeted; tissue outside of the focal point is untouched, leading to safer and better treatment outcomes.

HIFU has numerous benefits over traditional prostate cancer surgery, but treatment ultimately comes down to whichever option our specialists feel is right for you and your unique condition.

HIFU State of the Art Prostate Cancer Treatment

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 below). Radiation therapy 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 forms of the disease, and may also be used to relieve pain caused by prostate cancer.

Recently, radiation therapy has been widely used in conjunction with hormonal therapy when treating aggressive forms of 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).

MRI Brachytherapy

Prostate Cancer Specialists in Los AngelesDuring brachytherapy treatment, 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 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.

MRI brachytherapy 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 focused treatment helps preserve as much healthy tissue as possible and avoids over-treatment.

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. Cryotherapy 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 is yet to be determined due to the short-term data that is available.

Cryotherapy 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

Urology Experts in Los AngelesMany men choose hormonal therapy for advanced prostate cancer to help cut off the supply of testosterone, the hormone that makes prostate cancer cells grow faster. As it is not a curative mode of treatment, hormonal therapy is generally not used for early stages of cancer. Hormonal control can be achieved through the use of medications or through surgical means. These medications help 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 often found in advanced stages of prostate cancer. This treatment 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 the 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.

Intensity-Modulated Radiation Therapy (IMRT) / MRI TrueBeam Therapy

Prostate Cancer Experts in Los AngelesTraditionally, 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.

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 by mistake. 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.

Prostate Cancer Radiation Therapy with TrueBeam IMRT

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 on prostate cancer treatment, visit WebMD.com.

Frequently Asked Questions

Frequently Asked Questions About Prostate CancerThe 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.

Click on the question to see the answer

Q: What is prostate cancer?


A: 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).

Q: What causes prostate cancer?


A: 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.

  • 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.
  • Ethnicity. African Americans are at a higher risk of the disease. Because of this, we recommend that African American men be screened at the age of 40, regardless of their family history of the disease.
  • Diet. A few research studies have shown that certain diets, specifically a Mediterranean diet, may help reduce a person’s chances of developing prostate cancer. Some recent studies promote the consumption of vegetables and vitamin B to be beneficial in the prevention of prostate cancer.
  • 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: What are the signs and symptoms of prostate cancer?


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 a 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 some prostate cancer treatment options?


A: 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


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 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.

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 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.

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.

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. With thousands of successful prostate cancer surgeries, our urologists are the top prostate cancer treatment specialists in Los Angeles. If you would like to receive a screening and biopsy or are interested in learning more about your prostate cancer treatment options, please make an appointment with Comprehensive Urology today.

Next, learn more about HIFU.

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The information available on this web site is provided for informational purposes only. This information is not intended to replace a medical consultation where a physician's judgment may advise you about specific disorders, conditions and or treatment options. We hope the information will be useful for you to become more educated about your health care decisions.