Prostate Cancer Care at Cleveland Clinic
Each year, Cleveland Clinic physicians provide prostate cancer treatment for more than 1,000 men. Our urologists were among the first to offer advanced local anesthesia techniques for prostate biopsy. This helps men avoid the pain that used to be associated with a prostate biopsy.
Institute specialists consider many factors when recommending the most appropriate form of prostate cancer treatment. For example, a variety of surgical techniques can be used to remove the prostate gland, a procedure called prostatectomy. Radical prostatectomy can be performed by open, laparoscopic and robotic techniques, each of which has its own unique advantages. An open prostatectomy removes the entire prostate through an incision made in the lower abdomen. A laparoscopic prostatectomy uses minimally invasive tools, including a tiny camera, to remove the prostate gland through tiny incisions. Robotic prostate surgery uses a robotic system and small incisions to remove the prostate.
What is prostate cancer?
Prostate cancer, which develops from cells in the prostate gland, is the second most common cancer in American men. The walnut-sized prostate gland, located between the pubic bone and rectum, wraps around the urethra, the tube that carries urine from the bladder.
The American Cancer Society (ACS) estimates that 180,400 new cases of prostate cancer will be diagnosed in the United States each year, and that 31,900 people in our country will die of prostate cancer this year. Although the number of cases of prostate cancer declined among white American men, the incidence of the disease in black men and the mortality rate among black men is more than twice that of white men, according to the ACS.
The disease grows very slowly in most cases. In fact, 89 percent of patients diagnosed with prostate cancer have a five-year survival rate, and 63 percent live at least 10 years after the disease is found and treated.
Eventually, the cancer may spread outside the prostate gland to other parts of the body. Since lymphatic vessels of the prostate lead to pelvic lymph nodes, cancer cells can spread out along these vessels, where they can reach lymph nodes and continue to grow.
What are the causes of prostate cancer?
Although the number of cases of prostate cancer declined among white American men, the incidence of the disease in black men and the mortality rate among black men is more than twice that of white men, according to the American Cancer Society.
The greatest risk factor for prostate cancer is age. More than 75 percent of all prostate cancers are diagnosed in men over 65.
Men whose relatives have had prostate cancer are considered to be at high risk. Having a father or brother with the disease doubles your risk for prostate cancer. Therefore, screening for prostate cancer should be started at age 40 in these men.
To date, two genes have been identified that predispose a man to prostate cancer. Experts estimate that the hereditary form of prostate cancer accounts for just 9 percent of all cases.
African Americans have the highest incidence of prostate cancer. They are 30 to 50 percent more likely to get prostate cancer than any other race in the United States. However, Japanese and African males living in their native countries have a low incidence of prostate cancer. Rates for these groups increase sharply when they immigrate to the United States. African Americans are another group of men for whom prostate cancer screening should begin at age 40.
Experts have theorized that this suggests an environmental connection, possibly related to high-fat diets, less exposure to the sun, exposure to heavy metals such as cadmium, infectious agents, or smoking.
Research also suggests high dietary fat may be a contributing factor. The disease is much more common in countries where meat and dairy products are dietary staples, compared with countries where the basic diet consists of rice, soybean products, and vegetables.
High levels of male hormones called androgens may increase the risk of prostate cancer for some men, according to the American Cancer Society. Research is currently under way to determine whether medicines that lower androgen levels can lower the risk of prostate cancer.
You may be able to reduce your risk for prostate cancer by getting regular exercise and maintaining your optimal weight.
How is prostate cancer diagnosed?
If you have prostate cancer symptoms, the most effective means of detecting prostate cancer is through a screening, which involves a digital rectal exam and a PSA test, which checks the amount of prostate-specific antigen in patients’ blood.
PSA (Prostate-Specific Antigen) Test
The blood test, which is believed to detect a significant majority of prostate cancers and has the highest validity of a cancer screening to date, looks for increased levels of the prostate-specific antigen, a protein secreted by the prostate into the bloodstream. Elevated levels of the antigen may indicate the presence of prostate cancer. If cancer is suspected, a prostate biopsy will be performed. By removing a tissue sample from the tumor and examining it through a prostate biopsy, doctors can confirm or rule out a diagnosis of cancer and determine whether the disease has spread to other organs.
PCA3 (Prostate Cancer Gene 3) Test
Cleveland Clinic urologists are now offering a new innovative screening test for prostate cancer called PCA3. Compared to a traditional PSA blood test (which is not specific for cancer), PCA3 is a prostate cancer-specific marker. In clinical trials, it has been shown to provide improved sensitivity and specificity for detection of prostate cancer.
For men with an elevated PSA and prior negative biopsy, PCA3 may assist in the decision of whether or not to have additional biopsies. PCA3 is also being tested in a clinical trial in patients undergoing radical prostatectomy to test its predictive value for pathologic outcomes. PCA3 is measured in urine following a digital rectal exam (DRE).
Prostate MRI (Magnetic Resonance Imaging) Test
The Imaging Institutes’s Section of Abdominal Imaging performs and interprets prostate MR at Cleveland Clinic’s Main Campus. Prostate MR is advanced imaging technology that provides accurate, clear images of the prostate, which helps physicians accurately diagnose prostate cancer and determine the most effective treatment plan for patient.
This procedure allows radiologists to assess patients with biopsy-proven or suspected prostate cancer.
Advantages of Prostate MR
- Identifies suspicious areas to direct transrectal ultrasound (TRUS) guided-biopsy in patients with concerning rises in PSA but no documented prostate cancer.
- Assesses patients with biopsy-proven prostate cancer for possibility of multifocal disease before considering focal therapy.
- Assesses patients with biopsy-proven prostate cancer for extension outside the prostate.
- Assesses patients with suspected or biopsy-proven prostate cancer for pelvic extension into the lymph nodes, rectum or bladder.
- Assesses patients for recurrence after prostate cancer therapy (cryotherapy or prostatectomy.)
Contraindications of Prostate MR
- Recent biopsy of the prostate (within eight weeks) can mask prostate cancer on a MR. Whenever possible, patients should not undergo prostate MR after a recent biopsy.
- In general, MR exams are contraindicated in almost all patients with pacemakers, defibrillations and implanted ferromagnetic metallic foreign bodies. The presence of other implanted medical devices is evaluated on a case-by-case basis.
- Patients with moderate to severe chronic kidney disease (GFR less than 30 ml/min/1.73m2) are not recommended to have contrast-enhanced MRI exams. However, limited, non-contrast enhanced studies can be performed on these patients.
What are the symptoms of prostate cancer?
Prostate cancer, by nature, is silent in its initial stages. Its symptoms don’t appear until later, when patients may notice a need to urinate frequently, particularly at night. Prostate cancer may also cause a difficulty or inability to urinate, a weak or interrupted flow of urine or painful and burning urination. Other symptoms may include painful ejaculation, blood in urine or semen, and frequent pain or stiffness in the lower back, hips or extremities.
How is prostate cancer treated?
Physicians tailor prostate cancer treatment plans to their patient’s needs, taking into account the type of cancer, the age of the individual, the degree to which the cancer has spread and the general health of the patient.
Can I prevent prostate cancer?
Regular screening is the key to catching prostate cancer in its early stages. The American Cancer Society and the American Urological Association recommend that all men 50 and older receive a PSA screening annually. In some cases, however, younger men who run a higher risk of developing the disease (African American men and those who have a family history of prostate cancer) may be encouraged to be tested regularly beginning at age 40. In many instances of prostate cancer, prostate surgery may be required. For more information on prostate cancer treatment or prevention, contact a Cleveland Clinic urologist.