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Prostate Cancer

At Cleveland Clinic Florida's Maroone Cancer Center, doctors are experts in diagnosing, staging and treating prostate cancer. Treatment options depend on many variables including the type, stage and aggressiveness of the cancer as well as the age of the patient. Our multidisciplinary team of doctors collaborates with each other and develops a treatment plan based on what is appropriate and best for each patient.

Prostate Cancer Risk Assessment

Prostate Cancer is the most common cancer in men, and the second leading cause of cancer death among men in the U.S. Every year, about 185,000 new cases of prostate cancer will be diagnosed in the United States. About one in six men will be diagnosed with prostate cancer during his lifetime and one in 35 will die from it. More than two million men alive in the United States today have been diagnosed with prostate cancer at some point.

Cleveland Clinic Florida specialists collaborate with urologists at the Glickman Urological & Kidney Institute at Cleveland Clinic in Ohio. Experts work together to explore all medical and surgical options to ensure that our prostate treatment program will result in a successful outcome for each patient. Among the options offered to patients is robotic prostatectomy in Cleveland Clinic Florida’s new, state-of-the-art operating room equipped with magnified 3D video projection. The operating room was the first in Florida and the second in the nation to combine state-of-the-art magnified video projection with a 3-D robotic surgical system.

What is prostate cancer?

Prostate cancer is a malignant tumor that usually begins in the outer part of the prostate. In most men, the cancer grows very slowly. In fact, many men with the disease will never know they had the condition. Early prostate cancer is confined to the prostate gland itself, and the majority of patients with this type of cancer can live for years with no problems.

Age

The greatest risk factor for prostate cancer is age. More than 75 percent of all prostate cancers are diagnosed in men over 65.

Family History

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, according to the American Cancer Society. Therefore, screening for prostate cancer should begin 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 nine percent of all cases.

Race

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.

African Americans have the highest incidence of prostate cancer and they are 30 to 50 percent more likely to get prostate cancer than any other race in the U.S. 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 U.S. 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.

Diet

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.

Male Hormones

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.

Sedentary Lifestyle

You may be able to reduce your risk for prostate cancer by getting regular exercise and maintaining your optimal weight.

Physicians at the Maroone Cancer Center screen patients for prostate cancer by performing a digital rectal exam, in which physicians feel the prostate for abnormal areas, and by performing a blood test to evaluate the level of Prostate-Specific Antigen (PSA). PSA is a protein produced by the prostate gland and secreted into the blood. An elevated level could indicate that cancer is present; although other benign conditions such as enlarged or inflamed prostate also may cause elevated levels of PSA.

If cancer is suspected following these tests, a biopsy will most likely be performed. A tissue sample is taken with a small needle and examined under a microscope so doctors can confirm or rule out a cancer diagnosis.

PSA Test (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.

Prostate MRI (Magnetic Resonance Imaging) Test

The Imaging Institutes 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 each 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 elevated levels 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).

Disadvantages of Prostate MR:

  • Recent biopsy of the prostate (within eight weeks) can mask prostate cancer on an MR. Whenever possible patients should not undergo prostate MR after a recent biopsy.
  • In general, MR exams are not recommended 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.

Prevention

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 Florida urologist.

Radiation Therapy

Radiation therapy is the use of high-energy X-rays, electron beams or radioactive isotopes to kill cancer cells and shrink tumors. Radiation ionizes or damages the chromosomes in the cell so that they cannot multiple. Radiation can be produced from a machine outside the body (external radiation) or by putting materials that produce radiation (radioisotopes) through thin plastic tubes into the area where the cancer cells are found (internal radiation).

Varian Edge Radiosurgery

Cleveland Clinic Florida has very recently acquired some exciting new technology that helps us deliver radiation therapy more accurately, precisely and quickly. It is called the Varian Edge radiosurgical suite. Only a few centers around the world offer Varian Edge technology. Many patients only need to come for five outpatient treatments with the Varian Edge, significantly fewer visits than required with traditional radiation technologies.

Intensity-Modulated Radiation Therapy (IMRT)

Intensity-Modulated Radiation Therapy (IMRT) uses sophisticated computer software to deliver different dose intensities of radiation directly to the tumor or to specific areas, minimizing exposure to surrounding healthy tissue.

Brachytherapy

In this form of radiation therapy, radioactive pellets – each the size of a grain of rice – are implanted into the prostate. The number of pellets implanted (up to 200) depends on the size and location of the cancer. The implant procedure takes about one hour and is done on an outpatient basis. Placement of the radioactive pellets inside the prostate minimizes the radioactive exposure of the surrounding normal tissues.

For more information on Radiation Therapies, visit Radiation Oncology.

Surgical Approaches

Robot-assisted prostatectomy

This minimally invasive procedure takes advantage of the newly equipped operating room for 3-D robotic surgery. The surgeon uses a 3D robotic system combined with state-of-the-art magnified video projection. Two large 110 inch stereoscopic displays provide accurate depth perception allowing the surgical team to operate with better precision and clarity.

Open prostatectomy

This traditional form of surgery for removing the prostate gland is done under general anesthesia. The surgeon makes a cut from below the navel to the pubic bone to access the prostate. The surgery may require several days in the hospital and recovery takes several weeks.

Other Therapies

Chemotherapy

Chemotherapy is the use of any one or combination of drugs that are aimed at killing cancer cells. Chemotherapy is typically reserved for advanced prostate cancer and prostate cancer that has not responded to other treatments.

Cryotherapy

Cryotherapy involves freezing the prostate gland to temperatures the cancer cannot withstand. It is a minimally invasive procedure that is conducted as an outpatient procedure and occasionally requires an overnight in the hospital. Four to eight small needle-shaped temperature-monitoring probes are inserted into the prostate. Recovery takes a couple of days and there are minimal after effects.

Chemotherapy

Our new leading-edge chemotherapy infusion suite is designed to include the family in a healing environment. The new suite increases the number of patients we can treat from 12 to 37. Infusion treatments are delivered by chemotherapy-certified registered nurses who educate and support patients and their care partner and are present throughout the entire procedure.

Urology

Oncology