Prostate Cancer

From your first visit for prostate cancer screening, diagnosis and treatment, you are the focus of an incredible team of experts that personalizes every aspect of your care especially for your unique situation.

Prostate Cancer Symptoms

Prostate cancer often shows no symptoms in the early stages. If symptoms do appear, they vary from man to man. Signs you may have prostate cancer may include:

Having any of these symptoms does not mean you have prostate cancer. Some of the same symptoms can occur with BPH (benign prostatic hypertrophy) or other health problems. If you notice one or more of these symptoms for more than two weeks, see your doctor.

Prostate Cancer Diagnosis

The experts at Basil specialize in diagnosing prostate cancer. They have the expertise and technology to evaluate the growth pattern and extent of each particular cancer, which will affect treatment.
If you have prostate cancer, it’s important to get an accurate diagnosis as soon as possible. This helps increase the odds for successful treatment and recovery.

Prostate Cancer Diagnosis

If you have symptoms that may signal prostate cancer, your doctor will ask you questions about your health, your lifestyle and your family medical history.
One or more of the following tests may be used to find out if you have cancer and if it has spread. These tests also may be used to find out if treatment is working.

Biopsy:

If your doctor suspects prostate cancer, a biopsy may be performed. This is the only way to tell for sure if you have prostate cancer. Biopsies for prostate cancer are done in a doctor’s office or other facility as an outpatient procedure. A local anesthetic like dentists use, often lidocaine, is injected into the area close to the prostate to make the procedure more comfortable.
A small transrectal ultrasound (TRUS) probe with an imaging device is inserted into the rectum so the doctor can view the prostate on a video screen. Using this image as a guide, the physician injects a thin needle through the wall of the rectum into the prostate. Several tiny samples of tissue are removed.
Sometimes a biopsy will not find prostate cancer, even if it is there. If your doctor is concerned that you may have prostate cancer based on a follow-up PSA test, a second biopsy may be performed.

Digital Rectal Exam (DRE)

The simplest screening test for prostate cancer is the digital rectal exam (DRE). The health care provider gently inserts a gloved forefinger into the rectum to feel the prostate gland for enlargement or other abnormalities, such as a lump. The DRE is not a definitive cancer test, but regular exams help detect changes in the prostate over time that might signal cancer or pre-cancerous conditions.
Although this test usually is not as reliable as the PSA blood test, a DRE may be able to find cancer if a man has a normal PSA level. A DRE also may be used to tell if prostate cancer has spread or returned after treatment.

Prostate-specific antigen (PSA) Test

Prostate-specific antigen (PSA) is a protein produced by the cells of the prostate gland. It is found mostly in semen, but a small amount is in the blood as well. A blood test measures the amount of PSA circulating in the blood, expressed in nanograms per milliliter (ng/mL). This level is used to assess prostate cancer risk. A higher PSA level usually means a higher chance of having prostate cancer.
However, the test has limitations. PSA is produced by both prostate tissue and prostate cancer. Sometimes prostate cancer does not produce much PSA and higher levels can be caused by factors other than cancer, including:

On the other hand, certain conditions may make PSA levels low, even when a man has prostate cancer. These include:

Despite its limitations, PSA testing has helped detect prostate cancer in countless men. In 1984, before PSA testing was available, the chance of finding early prostate cancer was about 50%. In 1993, after PSA testing became widely used, that figure jumped to more than 90%. Men with very low PSA levels may need to be tested every two years. However, if PSA is higher, the doctor may recommend more frequent testing.
Because prostate cancer develops slowly, physicians usually do not recommend the PSA test for men who are older than 75 or have other significant health issues.

Additional PSA Testing

Besides screening, PSA testing can be used in other ways in men who have been diagnosed with prostate cancer. For instance, it may:

Prostate Cancer Treatment

At Basil, you receive customized care that is planned by some of the nation’s leading experts. Your personal team of specialists communicates and collaborates at every step to be sure you receive the most advanced therapies with the least impact on your body.
Our Prostate Cancer Treatments
Your options for prostate cancer treatment may include:
Basil has a multidisciplinary prostate cancer clinic to help you decide which prostate cancer treatment is best for you. If you and your physician decide surgery is your best alternative, you should look for a surgeon with as much experience as possible in performing the procedure. Studies have shown this increases odds for successful surgery with fewer side effects.
The surgeons at Basil are among the most experienced and skilled in the country in prostate cancer procedures. They have the latest technology and equipment as well as an effective team approach.
In addition, our status as one of the nation’s most active prostate cancer research centers enables us to offer a wide range of clinical trials of new treatments for all stages of prostate cancer.

Prostate Cancer Treatments

If you are diagnosed with prostate cancer, your doctor will discuss the best options to treat it. This depends on several factors, including:
Your treatment for prostate cancer will be customized to your particular needs. One or more of the following therapies may be recommended to treat the cancer or help relieve symptoms.

Surgery

The most frequent surgical procedure to treat prostate cancer is radical prostatectomy, which is removal of:
The urinary system is reconstructed by suturing (sewing) the bladder opening to the urethra. In some patients, one or more lymph node groups in the pelvic area may be removed to find out if the prostate cancer has spread. This is called lymphadenectomy or lymph node dissection. In more advanced prostate cancer, one or both of the neurovascular bundles, which play a part in erectile function, may be partially or completely removed.

Prostate Cancer Surgery Techniques

The two main surgical techniques for removal of the prostate are:
Open: A large incision is made in the lower abdomen, and the prostate is removed.
Robot-assisted (laparoscopic) minimally invasive: Multiple small incisions are made in the abdomen, and then an endoscope connected to robotic arms is inserted. A miniature video camera and surgical tools are attached to the end of the endoscope. The surgeon, seated at a console, can view the surgery site on a video screen and control the robotic arms.Basil surgeons are experts at nerve-sparing techniques and sural nerve grafts that may help men keep urinary and sexual function.

The robotic technique is commonly used in the United States. Studies show robotic-assisted surgery may result in:

However, the techniques are fairly equal in retaining urinary and sexual function and controlling cancer. The experience of the surgeon probably will affect your result more than which set of tools is used.

Recovery of function after prostate cancer surgery

Urinary control: Most men have stress urinary incontinence (leakage of a small amount of urine when laughing, sneezing, coughing, etc.) after a radical prostatectomy.
Sexual function: Since the prostate and seminal vesicles produce the majority of semen, sexual climax after a prostatectomy does not produce fluid. However, the climax response is preserved.

The success of preserving sexual function (the ability to maintain erections for sex) depends on:

Hormone Therapy

The majority of prostate cancers are hormone-sensitive, which means male hormones (androgens) such as testosterone fuel growth of the cancer. About one-third of prostate cancer patients require hormone therapy (also called androgen deprivation), which blocks testosterone production or blocks testosterone from interacting with the tumor cells. This reduces the tumor size or makes it grow more slowly. While hormone therapy may help control prostate cancer, it does not cure it.
Hormone therapy is most often used for late-stage, high-grade tumors (Gleason score of 8 or higher) or in patients with cancer that has spread outside the prostate. However, doctors have different opinions about the length and timing of hormone therapy.

Hormone therapy may be used to treat prostate cancer if:

Intermittent hormone therapy is a variation of hormone therapy in which drugs are used for a period of time, then stopped and started again. For some men, this approach to prostate cancer causes fewer side effects. The effectiveness of this approach is still being studied, but it appears particularly useful in some situations.

The types of hormone therapies for prostate cancer are:

Anti-androgens: These drugs, which include Eulexin® (flutamide or flutamin) and Casodex® (bicalutamide), block testosterone from interacting with the cancer cell. They are taken by mouth every day.
Anti-androgens are used most often in combination with LHRH agonists (see below). Occasionally, anti-androgens are used as an alternative to LHRH agonists if the side effects are excessive for the patient.
LHRH agonists: These drugs work by over-stimulating the pituitary gland to release luteinizing hormone-releasing hormone (LHRH). After an initial surge, this signals the testicles to suppress testosterone production. Treatments are injections, which last from one to six months, or implants of small pellets just under the skin.
LHRH agonists may cause a spike or flare in the testosterone level before treatment takes effect. To offset this effect, anti-androgens may be given for a few weeks before the initial LHRH injection. The effects of LHRH are usually not permanent, such that testosterone production may resume once the medication is stopped.
Orchiectomy: Surgical removal of the testicles. This removes the organ, which produces testosterone, and is another way to keep testosterone from the prostate cancer. Orchiectomy is an efficient, cost-effective and convenient method of reducing testosterone, and it is an option if you will be treated with testosterone suppression indefinitely. After this surgery, most men cannot have erections.

Side effects of hormone therapies for prostate cancer may include:

If you are treated with hormone therapy and have side effects, be sure to mention them to your doctors. Many of these side effects can be treated successfully.

Gene Therapy

We have the expertise to examine each prostate cancer tumor carefully to determine gene-expression profiles. Ongoing research will help us determine the most effective and least invasive treatment targeted to specific cancers. This personalized medicine approach sets us above and beyond most cancer centers and allows us to attack the specific causes of each cancer for the best outcome.

Cryotherapy

The tumor is frozen with a long, thin probe inserted into the tumor. Intensive follow-up with X-rays or other imaging procedures is required to ensure that the tumor has been destroyed.

Targeted Therapies

Basil is leading some of the world’s most innovative research into these newer agents that are specially designed to treat each cancer’s specific genetic/molecular profile to help your body fight the disease.

Vaccine Therapy

These agents help the body fight the cancer on a molecular basis.

Active Surveillance or Watchful Waiting

Because prostate cancer usually grows slowly, some men with prostate cancer, especially those who are older or have other health problems, may never be treated for it. Instead, their doctors may recommend active surveillance, an approach also known as "watchful waiting."
This approach involves closely monitoring the prostate cancer without active treatment such as surgery or radiation therapy. Biopsies and PSA tests are repeated at set intervals, and treatment may be recommended if the tumor shows an increase in the volume or the grade (Gleason score).
Long-term studies of active surveillance for men with low-volume, low-grade prostate cancer tumors show that approximately 70% can maintain this approach for up to 10 years without requiring treatment.

Side Effects of Treatment

After treatment for prostate cancer, you may have side effects. These depend the therapy you received and may involve:
Talk to your doctor about any side effects you have. Treatments are available to help with most of them.

Sexuality after Prostate Cancer

Impotence, or not being able to maintain an erection to have sex, may be a problem after prostate cancer treatment. This may be temporary or permanent. If you are able to get an erection, you may be able to achieve orgasm. However, no semen will be ejaculated during orgasm. Some people call this dry orgasm.
Talk to your health care provider about erection problems. Treatments include pills (such as Viagra®, Levitra® or Cialis®), vacuum erection devices and medications given by injections (shots).

Fertility after Prostate Cancer

Surgery to treat prostate cancer usually requires cutting the tubes between the testicles and urethra that transport the sperm and semen. Furthermore, surgery removes the prostate and seminal vesicles that produce the semen. Radiation significantly decreases the amount of semen that is produced, and semen is necessary to carry the sperm. This makes it impossible to father children without highly sophisticated sperm retrieval and in-vitro fertilization procedures.

Radiation Therapy

Radiation therapy uses high-energy beams to destroy cancer cells. New radiation therapy techniques allow to target tumors more precisely, delivering the maximum amount of radiation with the least damage to healthy cells.

Chemotherapy

In prostate cancer, chemotherapy most often is given before or after surgery. It also may be the main treatment for cancer that has spread outside the prostate.
BASIL team offers the most up-to-date and effective chemotherapy options for Prostate cancer. Our experts helped develop many drugs now used as standard care at other centers, as well as novel approaches to administer them.