Clinical Programs / Prostate Cancer Treatment

Prostate Cancer Surgery and Treatment

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Overview | Anatomy | Risk Factors | Symptoms | Diagnosis | Prostate Cancer Surgery

Prostate Cancer Overview

Prostate cancer is the most common cancer among men in the United States, and the second-leading cause of cancer death, following lung cancer. It tends to be slow-growing, such that many men die of other diseases before the prostate cancer causes problems – in fact, autopsy studies have shown that upwards of three-fourths of men 80 and older have prostate cancer, though many were not diagnosed.

The American Cancer Society estimates that one in six men will be diagnosed with prostate cancer during their lifetimes, but only one in 35 will die of the disease. However, certain prostate cancers are more aggressive and can quickly spread outside the confines of the prostate gland, which can be lethal. Early detection can ensure successful treatment. Overall, the five-year survival rate for prostate cancer is now up to 92 percent, in large part because of earlier diagnosis.

Dr. Christopher Saigal answers real questions about prostate cancer What are the symptoms of prostate and colon cancer? Can benign prostate enlargement become cancerous? How are seed implants used for the treatment of prostate cancer? View Webcast >>

UCLA is one of only ten centers approved and funded by the National Cancer Institute as a Special Program Of Research Excellence in Prostate Cancer.  This marks the institution as one of the leaders in translational research, which involves the application of the newest discoveries to prostate cancer patients in our clinics.  Patients at UCLA have access to cutting-edge technology as well as innovative treatments for both localized prostate cancer and advanced or metastatic cancer.  A well-coordinated team of clinical nurse specialists, clinical trials experts, surgeons, medical oncologists and radiation oncologists, evaluate each patient to determine the best possible treatment. This sometimes combines different forms of treatment and may include treatments not available at other institutions.

Prostate Anatomy

The prostate is the walnut-sized gland in men, located just below the bladder and in front of the rectum, surrounding the urethra – the tube that carries urine out of the bladder. The prostate produces and stores fluid that helps to make semen, and is involved in regulating bladder control and sexual functioning.

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Risk Factors - Prostate Cancer

Certain people are at higher risk than others for prostate cancer, which may affect when they should start being screened. The risk increases with age, particularly after age 50. African American men are twice as likely as white men to develop the disease. Having a family history – a father or a brother diagnosed with prostate cancer, particularly if it is at a relatively early age – increases the risk. Other potential risk factors include a high-fat diet, obesity, smoking, high testosterone levels, and a sedentary lifestyle. Conversely, there may be measures that can reduce risk, including diets low in fat and high in fruits, vegetables and whole fibers. Foods with high amounts of the antioxidant lycopene – such as tomatoes, grapefruit, and watermelon – may help to lower the risk, as can regular exercise. Other prevention strategies are being studied.

Prostate Cancer Symptoms

In rare cases, men may experience symptoms that could indicate early prostate cancer (as well as other conditions), including more frequent urination or difficulty urinating, blood in the urine or semen, painful erections or ejaculations, and pain and stiffness in the back, hips, upper thighs or pelvis. But prostate cancer has often been called a “silent” cancer because it typically does not produce symptoms in its early, most curable stages. This makes routine prostate cancer screening at the appropriate ages particularly important.

Screening and Diagnosis of Prostate Cancer

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In general, it is recommended that men begin having annual screening tests at age 50; men in high-risk groups such as African Americans and those with a family history of prostate cancer are advised to begin at age 40 or 45. The two screening methods are the digital rectal examination, in which the doctor inserts a lubricated gloved finger into the rectum to check for lumps on the prostate; and the prostate-specific antigen (PSA) blood test, in which a blood sample is analyzed for levels of a protein produced by the prostate that, when elevated, can indicate the presence of cancer. If either test is abnormal, a transrectal ultrasound – in which a small probe is inserted into the rectum and sound waves are used to get a picture of the prostate – can provide additional information; ultimately, a biopsy is used for a definitive diagnosis.

Screening is not without controversy – the PSA, for instance, is often elevated when there is no cancer, and may not be elevated when there is. In addition, neither screening test can distinguish life-threatening tumors from those that are so slow-growing that they would be unlikely to pose any problem before the patient dies of something else. Patients should discuss the pros and cons of screening with their physician.

If cancer is confirmed by the biopsy, the tumor’s aggressiveness can be characterized using the Gleason grading system. Looking at the cellular structure of the tumor, a pathologist will assign a Gleason score based on whether it is likely to grow quickly and spread outside the prostate. Further tests can help determine whether the tumor remains confined to the prostate or, if not, the extent to which it has already spread. This process is called staging.

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Prostate Cancer Surgery | Treatments | Nerve Sparing Prostatectomy

A wide variety of treatments are used for prostate cancer, depending on the stage of the disease, the patient’s age and overall health, and patient preferences or concerns about potential risks and side effects such as erectile dysfunction, urinary incontinence, and other bladder or bowel problems. For early-stage disease when remaining life expectancy is at least 10 years, prostate cancer surgery is often the preferred option. In the past, this has meant a nerve sparing radical prostatectomy, in which the prostate is removed while, in most cases, potency is preserved.

Increasingly, this prostate cancer surgery procedure is now done laparoscopically: This minimally invasive prostate cancer surgery shortens hospital stay and recovery time and results in less pain and scarring, while achieving comparable results. At UCLA, robotic instruments have been introduced for prostate cancer surgery to improve surgical precision.
View Webcast of Robotic Prostate Cancer Surgery >>

Robotic Prostate Cancer Surgery Barry’s cancer was diagnosed following a test called a PSA, which measures a protein produced by the prostate that is elevated in most men with prostate cancer. Barry and his physician, UCLA urologist Dr. Robert Reiter (pictured left), talked about his options for treatment View Webcast >>

Early-stage prostate cancer can also be successfully treated with radiation therapy – the use of high-energy rays delivered by external beam, or, more recently, by radioactive seeds implanted into the prostate under ultrasound guidance, which then emit high doses of radiation exclusively to the prostate over the course of several months (an approach known as brachytherapy). For patients with early-stage prostate cancer in whom radical prostatectomy or radiation is not a good option, cryoablation is a minimally invasive procedure that destroys the cancer cells by rapidly freezing and thawing the cancerous tissue. Still others, particularly older patients, choose a “watchful waiting” approach in which there is no immediate treatment but the tumor continues to be closely monitored.

For patients with later-stage prostate cancer, or who are at high risk for recurrence, treatment often includes chemotherapy and/or hormone therapy, which aims to lower the levels of androgens – male hormones such as testosterone – that help prostate cancer cells to grow. Hormone therapy can control but will not cure prostate cancer, and eventually patients’ cancer cells will develop a resistance to the treatment. For this reason, many patients with advanced disease choose to enroll in clinical trials of promising new experimental treatments.

Prostate cancer demands individualized treatment.  UCLA has expertise in virtually every form of treatment of prostate cancer including radioactive seed implants, new techniques in external radiation therapy, nerve sparing prostate cancer surgery, and cryotherapy.  Appropriate patients are offered a “watchful waiting” program, allowing avoidance of treatment related side effects until such time as the cancer begin to behave in an aggressive fashion and must be treated.

UCLA has the latest in robotically assisted minimally invasive technology, and a great deal of experience in this technique.  For decades the institution has been known for its success in surgical management of prostate cancer.  It is also the home of one of the largest programs that studies the outcomes of treatment and quality of life after prostate cancer treatment.  This has enabled the physicians to tell patients, with great accuracy, the exact risk and probability of any complications of treatment.

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