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Prostate Cancer
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Urology

Prostate Cancer

At the Urologic Oncology Program at Montefiore Einstein Center for Cancer Care, our board-certified, fellowship-trained urologists and uro-oncologists are among the finest the nation has to offer, and fully understand that the mere prospect of prostate cancer raises countless concerns. They collaborate in a multidisciplinary approach to offer a precise diagnosis, answer all questions and provide unparalleled expertise with every treatment should it be required.

Symptoms

Prostate cancer, which is the abnormal growth of cells that leads to a malignant tumor in a man's prostate gland, is the second most common malignancy among men in the U.S. behind skin cancer. Unfortunately symptoms do not typically arise in the early stages, so it occasionally proposes difficulties with detection during that time. When symptoms do occur they may include:

  • A weaker-than-normal urine stream
  • Having to urinate frequently, especially at night
  • Encountering difficulties staring a urine stream (hesitancy)
  • Painful or burning urination
  • Blood in the urine (hematuria) or blood in the semen (hematospermia)
  • Difficulties with getting/maintaining an erection
  • Loss of appetite
  • Experiencing a deep pain in the lower back, hip, upper thighs, pelvis, or abdomen

Symptoms related to urinating could also be due to benign enlargement of the prostate (BEP), also known as benign prostatic hyperplasia (BPH) or nodular hyperplasia. This increased sized of the prostate is quite common, as it affects 60 percent of men in their sixties and 70 percent of men by age seventy. It could obstruct the normal flow of urine and may also lead to elevated prostate-specific antigen levels, but is not considered to be a premalignant indicator. However, regular prostate examinations and monitoring any and all symptoms is crucial to men's overall health care, as early diagnosis and treatment is the key to a successful outcome.

Diagnosis

If test results or symptoms suggest a presence of prostate cancer, your physician will ask you about your medical history, conduct a rectal exam, and may order laboratory tests. These may include: a urine test to check for blood or infection, a blood test to measure PSA (prostate-specific antigen) levels, and possibly a PAP (prostatic acid phosphatase) check, which may also be assessed in the blood test.

If a higher than normal level of PSA is detected in the blood or if the level continues to rise over time, it may indicate prostate inflammation, prostate enlargement, or prostate cancer. Some medical professionals will generalize a normal PSA level as anything less than three nanograms per milliliter (ng/Ml). However, evidence suggests that the PSA level naturally increases with age. More specifically, a normal PSA reading will hover around two-and-a-half ng/mL for men age 40-49, three-and-a-half ng/mL for men age 50-59, four-and-a-half ng/mL for men age 60-69, and six-and-a-half ng/mL for men 70 and older.

A rectal exam or digital rectal exam (DRE) and PSA tests cannot accurately diagnose prostate cancer, but they can signal a need for a biopsy to determine if the prostate cells are cancerous and the precise cause of a high PSA. The biopsy procedure may cause some discomfort, but it is brief and does not typically require an overnight hospital stay. Needles are inserted into the prostate during the biopsy to gather small samples of tissue via the guidance of ultrasound imaging. The cells are then evaluated under a microscope and a Gleason score is assigned to predict the aggressiveness of the disease and how it will behave. The higher the grade, the more aggressive the tumor is. If the biopsy confirms cancer cells, your urologist may request further testing, such as a bone scan, CAT scan, and MRI to assess if the cancer has spread and chart a path of treatment.

Treatment Options

Our patients have access to some of the most technologically advanced surgical, radiation therapy and chemotherapy offerings available in the New York Metropolitan region and every case is closely monitored through monthly tumor boards, weekly multidisciplinary meetings and consultations.

Our internationally recognized fellowship-trained urologists and uro-oncologists have years of expertise with every stage of prostate cancer, as well as every possible type of surgery.  Patients from all over the globe come to Montefiore Einstein Center for Cancer Care for prostate operations in every possible method—traditional/open, laparoscopic, and robotic. Our surgeons’ unparalleled expertise is essential for optimizing each patient's outcomes, as no two cases are precisely the same.

Since 2001, we have been at the forefront of minimally invasive surgery, when we established one of the first laparoscopic radical prostatectomy programs in the nation. Our years of experience with minimally invasive surgery provided a seamless transition for us to adopt robotic surgery after we acquired the da Vinci Surgical System in 2005. Now the majority of our radical prostatectomy surgeries are conducted via robotics, which offers numerous benefits to patients.

The Center for Cancer Care offers all the latest surgical, radiation and chemotherapy options for prostate cancer patients:

  • Traditional/open, nerve-sparing prostatectomy: This procedure saves the bundles of nerves on each side of the prostate gland that enable a man to get and maintain an erection. If your surgeon is able to save both bundles, the chance of regaining sexual potency is approximately 50-80 percent. If only one side can be spared, the likelihood is 30-40 percent. Be sure to ask your surgeon how many of these procedures he's conducted (should not be less than 150) and what his results reflect about the return to incontinence and potential impotence.
  • Robotic radical prostatectomy: Robotic removal of the prostate offers at least the same, and in many cases, better outcomes than traditional/open prostatectomy. With robotic surgery, patients experience less blood loss, less pain, a speedier discharge and recovery, and less scarring, while surgeons have the advantage of the da Vinci's magnified 3D view of the operation, which offers more accurate visualization during the procedure. Most candidates opt for robotic surgery, as the patient benefits are tremendous.
  • Laparoscopic radical prostatectomy: Only one tiny incision and three puncture sites are used in this minimally invasive procedure, which involves inserting a laparoscope (a lighted viewing instrument) into the pelvic region and removing the prostate. The small incisions translate to less pain and a shorter recovery time, as well as a shorter hospital stay, as compared to traditional/open surgery.
  • Radical retropubic prostatectomy: A common technique for removing the prostate gland, this method involves making an incision in the lower abdomen to remove the prostate, located retropubically, or behind the pubic bone.
  • Perineal prostatectomy: This operation is offered to patients who are not candidates for other forms of radical prostatectomy.
  • IMRT (Intensity Modulated Radiation Therapy): An advanced form of 3D radiation therapy, this technique involves using beams from several directions to target the tumor with a higher dose of radiation, while minimizing the amount that reaches normal tissue. It is a state of the art mechanism for radiation delivery and Montefiore possesses extensive experience in this form of therapy.
  • Brachytherapy: Otherwise known as radioactive seed implantation, this procedure is typically done in the operating room on an outpatient basis and takes approximately one hour. The number of seeds depends on the size of the prostate and location of the cancer. With accurate dosimetry (dose calculation) it is performed under transrectal ultrasound guidance by members of the departments of radiation oncology and Urology.
  • Cryotherapy (cryosurgery): Using liquid nitrogen to freeze and kill cancer cells involves generally reduces urinary problems and complications, but is also associated with a higher rate of impotence, as the nerve bundles which lie close to the prostate may be affected. This procedure takes under two hours, and can be conducted under general anesthesia or on an outpatient basis.
  • Hormonal Therapy and Chemotherapy including Jevtana®, Provenge® and Zytiga

Research that Advances Cancer Care

Montefiore Einstein Center for Cancer Care gives prostate cancer patients access to the most advanced treatments through its portfolio of clinical trials. The Center for Cancer Care participated in an international consortium of institutions that conducted the first generation of clinical trials on the BioProtect SpaceGuard Balloon™, an inflatable, absorbable balloon that is inserted between the prostate and the rectum using a minimally invasive procedure.  The goal is to minimize radiation exposure to the rectum.  Once inserted, the biodegradable balloon is inflated, creating additional space between the rectum and prostate.

The Urologic Cancer Program of the Center for Cancer Care is also one of a few sites in the northeast participating in a clinical trial examining the efficacy and safety of High Intensity Frequency Ultrasound (HIFU) as a minimally invasive treatment for the treatment of recurrent prostate cancer after radiotherapy.

In addition, various clinical trials are available for the treatment of advanced hormone refractory prostate cancer.