Prostate Cancer Q&A

-Posting last reviewed by Dr. Lanctin, September 2018

Every hour three patients lose their battle to prostate cancer. Prostate cancer is the most common cancer in men and is the second most common cause of cancer mortality. Prairie Lakes Urologist, Dr. Lanctin gave his attention to some pressing questions, and we have his answers. 

Q: How can prostate cancer be detected early?

A: Testing for the early detection of any cancer is called “screening”. Screening for prostate cancer includes the examination of the prostate and a blood test.

Physicians examine the prostate with a digital rectal exam. Unfortunately the majority of prostate cancer patients will have a normal prostate exam and in fact up to 20% of men with a normal prostate exam already have bone metastases. Metastases is when cancer spreads from the part of the body where it started (its primary site) to other parts of the body.

The blood test conducted for this screening is called a PSA. Since its introduction in the 1980s the death rate from prostate cancer has decreased by 40%. The PSA has had a great effect on the lives of patients, but cannot detect all cancers.

Q: What are the current recommendations for prostate cancer screening?

A: Men need to have a discussion with their primary care provider regarding prostate cancer screening to determine if it’s right for them. Generally speaking, a baseline PSA should be done in the mid to late 40s or earlier if there is family history.

The results will determine when the next PSA should occur. Men between the ages of 50 and 70 years of age should have a PSA every year or two, and men over the age of 70 should have a discussion with their doctor and only have a PSA if they are very healthy.

Q: My close friend was recently diagnosed with prostate cancer and decided to have no treatment. Is this wise?

A: This is called active surveillance and is becoming a more common way of actively managing men with biopsy-proven prostate cancer. Men who may be candidates for active surveillance have smaller amounts of slow-growing prostate cancer on biopsy with low PSA levels and are willing to participate in long-term close monitoring with regular examinations, PSAs and perhaps more biopsies. These gentlemen also tend to be older. In the past, these patients may have been over treated with more aggressive ways of managing prostate cancer and therefore subjected to unnecessary side effects.

Q: In a man who needs active treatment for his prostate cancer, what options are available?

1. A: There has been significant research and development in the past decade to improve prostate cancer treatment, allowing eradication of the cancer while minimizing complications which are mainly related to urinary incontinence and erectile dysfunction.
3. Surgical removal: A common treatment option, either with minimally invasive open techniques or utilizing robotic assisted laparoscopic surgery. Most men are now discharged from the hospital within one to two days and are back to full activity within three to four weeks.
   
   
6. Radiation: Radiation remains an excellent option for some patients with newer technology like TomoTherapy at Prairie Lakes Cancer Center. It delivers high doses of radiation to the prostate while sparing the adjacent tissue; therefore, minimizing side effects.
   
   
9. New Energy Technology:
11. 1. 1. One of the most active areas of research in urology is the development of newer techniques to remove the prostate cancer using various forms of energy.
          
          
       2. This area has been significantly advanced with improved MRI imaging techniques, especially when fused with ultrasound. There is increasing usage of these technologies to treat just the cancer and not the entire prostate which further reduces potential side effects.
          
          
       3. Cryotherapy, freezing the prostate, is currently the most common form of this new technology in the United States and an experienced team can provide this treatment at Prairie Lakes Healthcare System. Other techniques being investigated include high intensity focused ultrasound (HIFU), photodynamic therapy, and interstitial laser.