Clinical Programs / Prostate Cancer Program

Prostate Cancer Program: Urology at UCLA

Prostate cancer is the second-leading cause of cancer death in men

It is a cancer that, when diagnosed and treated early, is highly curable - and one for which there are many different treatment options, each with its own pros and cons when it comes to efficacy and quality of life impact.

The risk of early-stage prostate tumors is wide ranging - some are fast-growing and require aggressive measures, others are slow-growing and pose minimal threat - adding to the importance of a thorough and accurate diagnosis. Few centers are as comprehensive as the UCLA Prostate Cancer Program, which not only offers the full spectrum of treatment options, but also integrates research with clinical care.

UCLA Advantages

Meet the Experts

Belldegrun, Arie MD Chin, Arnold I. MD, PhD DeKernion, Jean MD Litwin, Mark MD Marks, Leonard S. MD Pantuck, Allan MD Rajfer, Jacob MD Reiter, Robert MD Rettig, Matthew MD Saigal, Christopher MD Schulam, Peter MD Smith, Robert MD

Survival is the number-one goal for patients and their doctors after a diagnosis of early-stage prostate cancer. But often, it isn't clear which treatment strategy is superior, and patients find themselves facing difficult choices among therapies that have varying potential side effects - effects that, given the high success rates of localized prostate cancer treatment and the slow-growing nature of most prostate tumors, they are likely to live with for many years. Nationally, few studies have been done on the quality of life effects of each treatment. That's why the UCLA Prostate Cancer Program's large database tracking survival and quality of life outcomes - the latter as determined by patient questionnaires - is such a valuable tool. In choosing among the urological treatments, patients should consider that the most important factors in predicting prostate surgery outcomes are the surgeon's experience and skill. UCLA is among the nation's most active centers for prostate cancer treatment, an important fact given a recent study indicating that high surgeon volume correlates with lower in-hospital complications and length of stay for men undergoing radical prostatectom

Research

Making a Difference in Treatment Today
The UCLA Prostate Cancer Program is renowned for its basic and clinical research excellence. Benefits of UCLA's research excellence to the patient are manifold: Research in the program's laboratories is translated to better therapies and diagnostic methods; patients with high-risk tumors and metastatic disease are able to access cutting-edge treatment approaches through enrollment in clinical trials; and the results of established treatment approaches are monitored to assist future patients and their doctors in making better-informed decisions.

SPORE - Specialized Program of Research Excellence

SPORE Grant Supports Translation of Findings
The National Cancer Institute designated the UCLA Prostate Cancer Program as a Specialized Program of Research Excellence (SPORE) in 2002, making it one of a few institutions nationwide tapped to improve prevention, detection and treatment of the disease. UCLA is the only SPORE site in Southern California and one of only three in the western United States.

The designation came with an $11.5 million grant aimed at furthering the program's ability to bring together laboratory and clinical researchers in a joint effort to improve the detection, treatment and prevention of prostate cancer. The research initiatives that are benefiting patients include the identification of molecular markers that can be used to predict prostate cancer aggressiveness; laboratory research to better understand the biology of the disease, which has led to new drugs and experimental treatments; the program's involvement in making these clinical trialsincluding those in which the laboratory research did not take place at UCLA â?? available to patients; and its large database and ongoing research on patient outcomes to bring greater clarity to the often-difficult decisions about treatment course.

Robotic Procedure | Minimally invasive (laparoscopic) prostatectomy

For many men with early-stage prostate cancer, the robotically assisted minimally invasive prostatectomy has emerged as an attractive option.UCLA physicians are achieving results that are equivalent to the traditional open surgical approach to nerve sparing radical prostatectomy in terms of eliminating cancer and preserving sexual potency and urinary continence for many early-stage prostate cancer patients. The minimally invasive approach offers the advantages of shorter hospital stay and recovery time and less blood loss.

Robotically assisted prostatectomy

Minimally invasive (laparoscopic) prostatectomy capitalizes on the latest fiber optics technology to enable surgeons to poke needle-sized holes into patients, obtain pictures of the surgical site with 15-fold magnification, and insert miniaturized instruments to remove the prostate. The introduction of robotic instruments has helped to improve surgical precision. Surgeons are able to sit in a console with a three-dimensional view inside the patient and move three robotic arms with the full natural range of motion, while a fourth robotic arm controls the camera. The instruments can act like human wrists, giving surgeons greater flexibility as they use the robot to manipulate the tiny surgical tools inside the body. Studies of outcomes with the robotically assisted minimally invasive prostatectomies at UCLA have been very encouraging. Arguably the most important indicator of the success of a nerve sparing radical prostatectomy is whether there are positive surgical margins - cancer found at the farthest edges of the specimen after it is removed. When this occurs - as it does as often as 40% of the time in the community - the risk of recurrence is twice as high as when it does not. Of more than 100 robotically assisted minimally invasive prostatectomies at UCLA, the positive margin rate is only 10% - equal to the rate of the open approach, and as low as any rates reported in the nation.

Nerve Sparing Prostatectomy | New Strategies for "Open" Surgeries

For some patients, the nerve-sparing radical prostatectomy continues to be the best option. In the hands of experienced surgeons, this "open" operation is highly effective in removing the cancer and preserving potency. UCLA's data base of the results of more than 1,400 patients treated with the surgery at UCLA indicates that 80%-90% of patients under the age of 60 regain their sexual function, with a 5%-10% risk of stress urinary incontinence after one year. Recovery time has been reduced to one and a half days, with catheterization averaging seven days and patients returning to regular activities in as little as two to four weeks. UCLA doctors have adopted new strategies in an effort to improve nerve-sparing abilities for surgical patients. During the open procedure, patients with bulkier tumors and aggressive cancers are monitored pathologically by the surgeons, who obtain frozen sections when necessary to better facilitate decisions on preserving the nerves. Medications such as Viagra are being given to prostate cancer patients both pre- and postoperatively to enhance potency rehabilitation.
Read more about Nerve Sparing Prostatectomy >>

Non-Surgical Options

Several non-surgical options are also available for early-stage prostate cancer patients. Since the early 1990s, UCLA has offered brachytherapy, in which a urologist, working in collaboration with a radiation oncologist and physicist, implants small radioactive pellets, or seeds, into the prostate under ultrasound guidance. The pellets then emit high doses of radiation exclusively to the prostate over the course of several months, minimizing radiation exposure to the surrounding healthy tissues. At UCLA, which has an extensive database of brachytherapy cases, patients return for follow-up visits a month after the procedure so that their doctors can ensure through a CT scan that the radiation is being appropriately distributed. UCLA is also bringing the latest advances in radiotherapy to patients who opt for radiation treatment over surgery. With advances in computer and imaging technology, radiation treatment has evolved in recent years from conventional extra-beam radiation therapy to three-dimensional, image-guided therapy that better conforms to the tumor. More recently, radiation oncologists have begun intensity-modulated radiotherapy, a more advanced approach to high-precision, three-dimensional image-guided radiotherapy.

During the course of radiation treatment, which typically lasts six to eight weeks, the tumor and prostate gland can move. UCLA physicians have begun using the newest technique, image-guided radiotherapy (IGRT). Three seeds are implanted inside the prostate to provide a way of tracking the gland; this allows doctors, with the aid of the computer-guided technology, to adjust the radiation beam based on a more up-to-date view of the position of the target tumor and organs. IGRT is currently being offered to patients with low-risk early-stage prostate cancers. When patients experience a cancer recurrence following radiation treatment, surgery tends not to be a good option. For these individuals, cryotherapy can be an effective alternative. Cryotherapy involves the application of extreme cold to destroy diseased tissue, including cancer cells. In addition to patients who have previously had radiation treatment, men who are not concerned about potency may find cryotherapy appealing: Aside from impotence, which occurs in all patients, the procedure's side-effect profile is favorable compared to other prostate cancer treatments.

Back to top

Prostate Cancer Treatments

Learn more about prostate cancer Prostate cancer occurs in 1 out of 6 men. Reports of diagnosed cases have risen rapidly in recent years and mortality rates are declining, which may be due to increased screening. Read More »

Prostate cancer is the most common type of cancer found in men and usually begins without symptoms. The chances of surviving prostate cancer are greatly improved with early detection and treatment. Prostate cancer is more common in African American men and in men with a father or brother with prostate cancer. At UCLA, we offer the latest and most advanced care for both early and late stage prostate cancer. Our faculty are fellowship trained in urologic oncology and have been consistently ranked among the top prostate cancer practitioners in the United States. For early stage, localized prostate cancer, we offer the entire gamut of procedures, including:

• Nerve-sparing radical prostatectomy (RRP)
• Robotically-assisted laparoscopic prostatectomy (rLRP)
• Laparoscopic prostatectomy (LRP)
• Brachytherapy and cryotherapy

We work closely with our radiation therapy colleagues to offer both low dose-rate and high dose-rate (HDR) brachytherapy as well as intensity modulated radiation therapy (IMRT). We monitor our results closely with databases and quality of life studies in order to improve the quality of our care and in order to better inform patients about the risk and benefits of all treatments. Our overriding philosophy is that no one treatment is appropriate for all individuals and that treatments need to be tailored to the disease and to the individual's own values and goals.

Because of the extensive basic and translational research done at UCLA in prostate cancer, we are actively studying new forms of treatment for patients with high-risk, locally advanced and metastatic prostate cancers. These include studies of molecularly targeted small molecules and antibodies, the latest in drugs that are able to target the genetic changes in an individual's tumors while sparing normal tissues. We are also on the leading edge of studies of nutrition and alternative medicines for prostate cancer. The Prostate Cancer Program at UCLA is a nationally acknowledged center of excellence which received the National Cancer Institute designation as a Specialized Program of Research Excellence (SPORE) in 2002-one of only 11 in the country.The Prostate Cancer Program includes internationally regarded researchers such as Robert Reiter, M.D.

Basic science research conducted by Robert Reiter, MD led to the discovery of Prostate Stem Cell Antigen (PSCA), a gene found more extensively in cancerous prostate cells than in normal prostate cells. Dr. Reiter's research is now focusing on the development of PSCA monoclonal antibodies to prevent tumors from growing or spreading to other parts of the body, and shows great promise in the treatment of advanced prostate cancer. Another research project for prostate cancer treatment is based on the discovery by Charles Sawyers M.D. of the role a specific gene, PTEN, plays in blocking the growth of tumors. The study, which is in the clinical trials stage and is the only one of its kind in the world, is based on the use of an immunosuppressive drug approved for kidney transplant patients and may prove beneficial for high risk patients with localized prostate cancer.

The UCLA Prostate Cancer Index, developed by Mark Litwin, M.D., M.P.H., has become the gold standard worldwide in measuring outcomes and quality of life in prostate cancer survivors, and is now in use in over 200 studies throughout North America. In 2001, the State of California acknowledged UCLA's leadership in the fight against prostate cancer by awarding the Department of Urology $50 million to administer IMPACT, a statewide prostate cancer awareness and treatment program targeting uninsured men.

Learn more about Prostate Cancer:

Prostate Cancer Treatment, Symptoms, Screening and Diagnosis >>

Back to top