Cancer of the prostate is the most common type of cancer and the second leading cause of cancer deaths among American men.
It is estimated that one of every six American men will develop prostate cancer before age 85. The risk of developing prostate cancer greatly increases with age. It rarely occurs in men younger than 50. The average age is 72. Black American men are at greater risk than white American men, but the reason for this is not known. The cause of prostate cancer is also unknown.
As with any cancer, early detection is the key to successful treatment. At Urology of Indiana, we encourage men age 40 and over to schedule a prostate exam and PSA blood test.
The specialty of Urology is on the front lines of detection, evaluation, diagnosis and treatment of prostate cancer. Dating back to Dr. William N. Wishard in 1887, the physicians of Urology of Indiana have been pioneers in their continuing commitment to the successful treatment of this disease.
Within our practice, we provide prostate cancer patients up-to-the-minute access to the latest surgical and non-surgical treatment options, including five da Vinci Prostatectomy surgical teams and two radiation therapy centers --Integrated Cancer Care centers North and South -- featuring external beam image-guided radiation therapy.
The cause of prostate cancer remains unknown. The risk of developing prostate cancer increases as a man ages. Almost all patients with prostate cancer are older than 50 and 80 percent are over age 65. For reasons not currently known, black Americans have the higher incidence. A family history of prostate cancer in a brother or father also doubles one´s chances of getting prostate cancer. There is emerging evidence to date that diet, nutrition and obesity may play a role in developing prostate cancer.
In the very early stages of prostate cancer there usually are no symptoms. When symptoms do develop, they vary according to the size and location of the tumor, and are often the same as those for benign prostate conditions. In fact, it is more likely that any of these symptoms would indicate prostate enlargement (known as benign prostatic hypertrophy), infection or other conditions rather than cancer. Still, a physician should check any symptom. Only a physician conducting the proper tests can determine for sure whether the condition is cancerous or benign.
In addition, the American Urologic Association (AUA) recommends that early detection of and risk assessment for prostate cancer should be offered to asymptomatic men 40 years of age or older who have a life expectancy of at least 10 years. Men who wish to be screened should have both a prostate-specific antigen (PSA) test and a digital rectal exam (DRE). The decision to proceed to prostate biopsy should be based not only on PSA and DRE results, but should take into account multiple factors including free and total PSA, patient age, PSA velocity, PSA density, family history, ethnicity, prior biopsy history and comorbidities.
The AUA strongly supports informed consent before screening is undertaken and the option of active surveillance, in lieu of immediate treatment, for certain men found to have prostate cancer.
When a change is detected in the prostate either by digital rectal exam (DRE) or rising PSA, a prostate biopsy may be recommended to determine the presence of cancer.
A prostate biopsy involves removal of a small tissue sample that is examined under a microscope and is the ONLY way to determine conclusively if a growth is cancerous. Unfortunately there are no current imaging studies that can detect prostate cancer. Tissue samples are usually obtained by inserting an ultrasound probe into the rectum to visualize the prostate on a monitor. A thin needle is placed through the probe into the prostate. This procedure is known as needle biopsy. Local anesthesia is used for a needle biopsy of the prostate, and the procedure is usually performed in the office.
At Urology of Indiana we offer a wide range of the latest options available for the treatment of prostate cancer, including robotic surgery and radiation therapy. We have dedicated teams of physicians and health providers that specialize exclusively in the treatment of prostate cancer. Our focus and specialization allows for the best possible outcomes for our patients that face this common yet significant disease.
Radical prostatectomy is the surgical removal of the prostate gland and surrounding tissues, including the seminal vesicles and the pelvic lymph nodes. Traditionally, surgeons use one of two surgical techniques, including retropubic prostatectomy or perineal prostatectomy. With these open surgeries, patients typically remain in the hospital for 3 to 7 days after surgery and are catheterized for 2 to 3 weeks.
Robot-assisted Laparoscopic Surgery
Another option for clinically appropriate patients is robot-assisted laparoscopic surgery -- better known as the da Vinci prostatectomy. This minimally invasive technique increases surgeon precision by enhancing the ability to perform complex minimally invasive surgery. Benefits can include shorter hospital stay, less post-operative pain, less blood loss, faster recovery and quicker return to work.
Image Guided Radiation Therapy (IGRT)
Radiation therapy uses high-energy particles or waves, such as x-rays, gamma rays, electrons, or protons to destroy or damage cancer cells. It is one of the most common treatments for cancer.
Special equipment delivers high doses of radiation to cancerous cells, killing or damaging them so that they cannot grow or spread. Although some normal cells may be affected by radiation, most recover fully from the effects of the treatment. Unlike chemotherapy, which exposes the entire body to cancer-fighting chemicals, radiation therapy is a local treatment and affects only the part of the body being treated.
Radiation therapy treatment is a coordinated team effort. Our radiation therapy team of medical professionals at Integrated Cancer Care will care for you throughout your course of treatment.
Urology of Indiana offers SpaceOAR Hydrogel. This is the first and only FDA-cleared spacer to help reduce the radiation dose delivered to the rectum of men undergoing radiation treatment for prostate cancer. SpaceOAR is designed and applied to reduce rectal complications and help patients to maintain their quality of life after radiation treatment.
Because of the proximity of the prostate to the rectum, prostate radiation therapy can cause unintended damage to the rectum, which can lead to fecal incontinence issues or other long-lasting side effects. In a randomized clinical study, men who underwent radiation therapy without SpaceOAR Hydrogel were eight times more likely to experience a decline in bowel, urinary and sexual function when compared to men who underwent radiation therapy with SpaceOAR Hydrogel (at a median follow-up of three years).
SpaceOAR is an absorbable gel inserted via a minimally invasive injection and creates a temporary space between the prostate and the rectum. It is performed in the office setting at Urology of Indiana, allowing us to complement the patient’s radiation treatment to better target their cancer while preserving healthy tissue. The hydrogel spacer remains in place for about three months. After about six months, the hydrogel is naturally absorbed and cleared from the body in the patient’s urine.
SpaceOAR is an important advance that reduces radiation dose to the rectum during radiation treatments to help prevent unwanted side effects. We understand that men diagnosed with prostate cancer may have some difficult decisions to make regarding their treatment, but knowing that an option like SpaceOAR Hydrogel can help limit the risk of damage to other organs during radiation treatment will hopefully make a few of those decisions easier.
SpaceOAR Hydrogel is best suited for men undergoing prostate cancer treatment that are proceeding with radiation therapy. Prior prostatectomy patients, cryotherapy patients and laser ablation patients are not eligible. Patients are typically referred to Urology of Indiana by their radiation oncologist for this procedure.
Artemis MRI/Ultrasound Semi Robotic Fusion Prostate Biopsy
Urology of Indiana has offers a technology that help to diagnose sometimes difficult to find prostate Cancer. Artemis MRI/Ultrasound Semi Robotic Fusion Prostate Biopsy is available for patients that have undergone a previous negative biopsy or are on Active Surveillance for prostate cancer.
It is estimated 25% to 40% of patients that undergo a standard template transrectal ultrasound prostate biopsy may have a false negative result. This is a well-known statistic among Urologists and represents a diagnostic dilemma for both patients and doctors. There are a number of tools Urologists have used to help determine if and when a patient should undergo a repeat biopsy. Urologists have used a number of “fancier” PSA type tests such as free and total PSA, PHI (Prostate Health Index), and 4k , and the PCA-3 to help determine who should undergo a repeat prostate biopsy. Confirm MDX was introduced to look at the methylation patterns of certain genes in previous negative prostate biopsy tissue to help urologists decide on a repeat biopsy.
MRI-CAD (computer assisted diagnostics) is now emerging as a very helpful diagnostic tool as well. This imaging test allows radiologists and urologists to “peer inside” the prostate and get additional information about the size and any suspicious areas within the prostate and pelvis. When suspicious areas exist within the prostate, Artemis MRI/Ultrasound Fusion biopsies can be performed to target the suspicious areas. This exciting technology allows the Urologist to overlay (of Fuse) the real-time ultrasound images with the MRI-CAD. Any suspicious areas can then be targeted with great accuracy. This technique has been shown to increase detection rates of high risk prostate cancer and is an important tool. In addition, MRI/Ultrasound Fusion biopsy of the prostate has an emerging role in monitoring and managing patients who have already been diagnosed with prostate cancer and are on Active Surveillance.
UroPlan: A Roadmap For Return to Sexual Function After Cancer
There is much more to a man’s life than his cancer diagnosis. As a result, we believe preserving and maintaining quality of life to be an essential component of comprehensive cancer care. By helping patients prepare for surgery with a solid strategy for recovery, we know that we’re able to offer men their best chance to experience a satisfying outcome.
UroPlan by Urology of Indiana uses a “stepwise” approach to facilitate recovery of both sexual and urinary function following cancer treatment. The recovery rate after surgery is highly individualized.
Many factors such as desire for sexual activity, partner interest, pre-treatment sexual function, existing medical conditions and the presence of anxiety or depression can greatly influence the recovery process. Therefore, the roadmaps we follow should be considered a starting point.
Our Care Team will optimize and customize the program for each man, as the pace of recovery and return to sexual activity varies significantly for each patient. Our Timeline and Roadmap Choices will help guide your recovery.
There are three elements of the Surgical Consultation:
- Decision is made to proceed with surgery
- Assessment is made of current sexual function, activity level and interest in restoration
- Patient and Surgeon decide upon choice of Restoration Roadmap Program
Roadmap 1: Active Restoration
Roadmap 2: Passive Restoration
Roadmap 3: No Restoration
For more detailed information about UroPlan, read our brochure here.