Prostate Cancer

Position Statement.

Prostate cancer screening is extremely important. A simple blood test called a PSA, (Prostate Specific Antigen) can determine if you have a problem with your prostate. It depends on your age, but typically a PSA of greater than 4.0 generally indicates a problem (not necessarily cancer, it can also be elevated if you have BPH, Benign Prostatic Hypertrophy and non malignant disease). If you are 40 and have a PSA of 3.0 it should be rechecked in 3-4 months. If your PSA comes back high, a second test in 3 months is recommended. If that one is significantly higher a biopsy should be performed. A biopsy is when a needle is inserted into the prostate and a core of prostatic tissue is removed and examined under a microscope. One result, if the biopsy is cancerous, is a Gleason score. The Gleason score is reported as the sum of two numbers e.g. 3+3 (The grade and architecture). The higher the numbers the more aggressive the cancer.

Should prostate cancer be found there are a number of treatment options:

Radical Prostatectomy—Surgical removal of the prostate.
External Beam Radiation Therapy—Radiation from a machine is used to destroy the cancerous prostate tissue.
Prostate Seed Implant—Insertion of radioactive seeds into the prostate using needles.
Intensity Modulated Radiation Therapy—A specialized form of external beam radiation therapy, but highly focused with fewer side effects.
Watchful Waiting—Waiting to see if the PSA rises; if it does, treat it, if not continue to watch it.
Cryosurgery—Freezing the prostate to destroy cancer cells.

Radical Prostatectomy has long been considered the “gold standard”; that is, the treatment of choice. However for the last 20 years we have been doing seed implants and external beam radiation therapy which has resulted in the same cure rate with fewer complications. Prostatectomy can result in permanent impotency, whereas seed implants and external radiation therapy cause short term urinary frequency and dysuria.

Deciding between external beam and seed implants is made easier. There is a protocol developed by the radiation oncology and urology community that uses the PSA, biopsy and clinical stage to help decide which treatment would be most appropriate.

IMRT can be used in place of conventional external beam radiation therapy, it reduces the side effects which in turn allows higher radiation doses to be used.

Watchful waiting can be appropriate depending on patients age and stage of the cancer. If you are in you 90’s and have a non aggressive tumor (a low PSA and Gleason score) waiting with regular PSA tests is a viable option.

Recently Cryosurgery has also become an option. When it first came out, it was reserved for patients that had failed another type of therapy. Just recently it has been added as the primary form of treatment of prostate cancer. Many oncology professionals feel it is too early to recommend this as a viable treatment option for primary prostate cancer.

Some medical professionals question the PSA test because of false positives and false negatives. However the test still detects prostate cancer at very early stages allowing many treatment options including radical prostatectomy, external beam radiation therapy and radioactive seed implants. The PSA test is even more useful in evaluating the success of the cancer treatment. Follow up visits that include continued PSA testing are essential and will determine whether or not the disease has been controlled or eliminated.

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Tampa Bay Oncology Center

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Copyright ŠTampa Bay Oncolocy Center Inc., 2012

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Copyright ŠTampa Bay Oncolocy Center Inc., 2012