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Prostate Cancer

Prostate cancer is the second most common cancer in men.  It usually occurs after the age of 50.  It is more common in Afro-American men and in men with a family history of prostate cancer.

Prostate cancer usually produces symptoms when it is far advanced.  In the early stages, it is best detected with digital rectal exam or the prostate specific antigen – PSA blood test. Screening men with PSA blood tests is controversial.

The main argument PSA against screening is that it leads to overtreatment.  The main argument in favor of screening is that it has resulted in a sharp reduction in the annual death rate of prostate cancer.

*Introducing Dr. Lazare
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The diagnosis of prostate cancer is made by ultrasound guided biopsy of the prostate.  Tiny tissue samples are sent to the pathologist who examines them under the microscope.

There are two important things to note in prostate biopsy reports that are positive for cancer.  The first is the amount of cancer in the biopsy specimen.  The second is the Gleason Sore of the cancer.  The Gleason score reflects how aggressive the cancer looks under the microscope.  The score ranges from 6, which is the least aggressive, to 10, which is the most aggressive.

The specific treatment for prostate cancer depends upon whether the cancer is confined to the prostate.  There are three treatment options for cancer confined to the prostate.

Active Surveillance.  This approach involves careful monitoring of the cancer to make sure it does not grow or spread.  It is only appropriate for patients with a Gleason score of 6 or 7.

Radical Robotic Prostatectomy.  This treatment involves removing the prostate with minimally invasive surgery.  The entire prostate is removed without a skin incision.  It is the most effective treatment for patient with localized cancer of the prostate.

The surgery is performed using laparoscopic instruments along with the Da Vinci robot. The surgeon makes tiny holes in the abdomen and then inserts the laparoscopic instruments. The instruments are then attached to the arms of the robots. The surgeon controls the movements of the robot arms from a separate station work station.  Risks of the procedure include bleeding, erectile dysfunction and urinary incontinence.

I do not recommend radiation therapy for prostate cancer due to lack of proven efficacy.

If the cancer is no longer confined to the prostate, there are several treatment options.  Hormone therapy works by reducing the level of circulating testosterone.  This slows or stops the growth of prostate cancer cells.  In addition, chemotherapy drugs have been recently developed for advanced disease.  They include Zytiga , Xtandi, and Taxotere.  Finally, Radium 223 directly exposes bone metastasis to radiation and Sipuleucil T works via the immune system. These two approaches represent new and exciting treatment modalities.