Prostate Cancer

 

 

Overview

Cancer of the prostate affects the chestnut-shaped organ surrounding the first part of the urethra in men. The prostate gland, which sits immediately under the bladder and in front of the rectum, produces secretions that form part of the seminal fluid during ejaculation.

Prostate cancer is the most common type of cancer (excluding skin cancers) to be diagnosed in men in the United States. In 2007, the American Cancer Society estimates that almost 220,000 men in the United States will be diagnosed with the disease.

The good news is that prostate cancer is highly curable. The five-year survival rate for localized prostate cancer is just about 100 percent. The five-year survival rate for all stages combined is 99 percent, and the 10-year survival rate for all stages combined is 93 percent.

The Cancer Center's Division of Urologic Oncology and the Prostate Cancer Institute of New Jersey at Hackensack University Medical Center provide all of the comprehensive services needed to prevent, diagnose, treat, and manage prostate cancer. The Cancer Center's urologists, radiation oncologists, medical oncologists, radiologists, and pathologists work together to provide the most advanced treatment methods available today, including minimally invasive laparoscopic and robotic-assisted radical prostatectomy, brachytherapy, high-dose-rate brachytherapy, intensity modulated radiation therapy, and the new TomoTherapy radiation therapy system, which is revolutionizing the treatment of prostate cancer. The Cancer Center is one of only several places in New Jersey to acquire TomoTherapy, and it is one of only a handful of cancer centers in the United State to dedicate its system to the treatment of prostate cancer.

The Division of Urology's co-chief, Ihor S. Sawczuk, M.D., and members of the urologic oncology team are nationwide leaders in the use of robotic-assisted radical prostatectomy to treat localized prostate cancer. Hackensack University Medical Center is the first institution in the world to own four robotic surgical systems. In 2006, The Cancer Center's urologic oncology team performed an astounding 95 percent of radical prostatectomies at the medical center using the robot. (At the time the national average was only 20 percent.).

Robotic-assisted surgery translates a surgeon's hand movements into precise robotic movements. Robotic-assisted radical prostatectomyaffords urologists greater precision in performing the surgery and may reduce the incidence of the onerous side effects of impotence and incontinence. robotic-assisted radical prostatectomy offers patients the benefits of less pain, bleeding, and scarring; a shorter hospitalization; and a quicker return to normal activities. It is expected that robotic-assisted radical prostatectomy may soon become the "gold standard" of treatment for localized prostate cancer.

Members of the Division of Urologic Oncology and the Division of Radiation Oncology are also leaders in the use of brachytherapy to treat prostate cancer. Brachytherapy uses rice-like "seeds" of radiation that are implanted directly into the tumor. The seeds deliver the radiation over a period of up to six weeks. High-dose-rate is another type of brachytherapy, which uses small catheters to deliver the radiation directly into the tumor more quickly than seeds.

 

Risk Factors

The chances of developing prostate cancer increase rapidly after age 50. More than 70 percent of men diagnosed with prostate cancer in the United States are over age 65. African-Americans have the highest documented incidence rates
in the world. In the United States, the death rate for African-American men is twice that of other races. It is estimated that 5 to 10 percent of all prostate cancers may be inherited.
 
 

Symptoms

Symptoms of prostate cancer are caused by enlargement of the prostate gland:
  • difficulty starting urination
  • poor flow of urine
  • an increased need to urinate

Prevention

In order to detect prostate cancer at an early, treatable stage, the American Cancer Society and the American Urology Association recommend men over age 50 undergo a yearly digital rectal examination and a simple blood test that measures prostate specific antigen (PSA). Antigens are substances that are normally secreted. If large amounts of PSA are present in the blood, there is a risk that cancer is developing. Because African-American men are at higher risk of developing prostate cancer than other races, they should begin having yearly screenings at age 40.

The Prostate Cancer Institute of New Jersey at Hackensack University Medical Center provides preventive screening, diagnostic, and treatment services in the fight against prostate cancer. Each year, the institute runs low-cost prostate cancer screenings.

 

PROSTATE CANCER TREATMENT OPTIONS

There are several different prostate cancer treatment options: surgery to remove the tumor (called radical prostatectomy), brachytherapy using seeds and implanted tubes of radiation to destroy tumors, cryosurgery using extreme cold to destroy tumors, and hormonal therapy, which may be combined with other methods to shrink the size of the tumor and to prevent recurrences of the cancer. For some patients, no treatment - called "watchful waiting" - may be recommended. Because there are side effects to be considered with each prostate cancer treatment method, you should discuss all your options thoroughly with your urologist before you make any decisions about which treatment to pursue.

Surgery

Surgery is one of the most common treatment methods for prostate cancer. Removal of the tumor (and sometimes the entire prostate gland) is called a radical prostatectomy. Our co-chief of the Division of Urologic Oncology, Ihor S. Sawczuk, M.D., and other urologists on staff at The Cancer Center are highly skilled in using minimally invasive robotic-assisted techniques to perform radical prostatectomies for localized prostate cancer. In 2006, Dr. Sawczuk and his colleagues used the robotic Surgical System to perform an astounding 95 percent of the radical prostatectomies performed at the medical center to treat localized prostate cancer that year. The national average was only 20 percent at the time. The robot's technology translates the urologist's hand movements into precise robotic movements, which enable the urologist to perform surgery more accurately, without the risk of slight hand quirks. The robot's magnification system also enhances the urologist's ability to view the prostate, and it reduces the potential for human error.

Research studies investigating robotic-assisted radical prostatectomies are not yet complete, but initial results show the procedure may reduce the incidence of impotence and incontinence in patients undergoing radical prostatectomy. It is expected that robotic-assisted radical prostatectomy may become the "gold standard&quot: of treatment once data is completed that shows it is comparable to traditional "open&quot: surgery, yet is easier for the patient.

Radiation Therapy

There are several different types of radiation therapy that may be used to treat prostate cancer: brachytherapy (using permanent "seed" implants), high-dose-rate brachytherapy (using temporary catheters), intensity modulated radiation therapy (IMRT), and The Cancer Center's revolutionary new radiation therapy system, TomoTherapy.

Brachytherapy uses rice-like "seeds" implanted directly into the tumor to deliver the radiation over a period of several months. High-dose-rate brachytherapy uses thin temporary catheters to deliver the radiation more quickly over the course of several weeks. Intensity modulated radiation therapy (IMRT) shapes the beams of radiation to the exact contours of the tumor, enabling radiation oncologists to use higher doses of radiation therapy without harming normal tissue surrounding the tumor.

TomoTherapy takes IMRT to the next level of advancement using a unique integrated system that combines the three steps of radiation therapy - treatment planning, patient positioning, and treatment delivery. TomoTherapy offers the safety of double-checking the tumor's position before the actual treatment begins with a spiral CT scan taken every day. TomoTherapy is particularly useful in the treatment of tumors that can move from day to day, such as prostate cancer tumors. Once the double-checking CT scan has been checked, the patient's position can be adjusted if necessary to ensure maximum dosage to the tumor. TomoTherapy can also be combined with brachytherapy or high-dose-rate brachytherapy for optimal treatment.

Cryosurgery

Cryosurgery utilizes liquid nitrogen at extreme cold temperatures to freeze a prostate tumor and destroy it.

Hormonal Therapy

Injections of hormones may be combined with other treatment methods to shrink the size of a prostate tumor before surgery or radiation therapy or to prevent recurrences of the cancer.

Watchful Waiting

In some cases of prostate cancer, a urologist may recommend no treatment at all and to simply monitor the cancer. This is called "watchful waiting."