Feature

What You Need to Know about Prostate Cancer

WRITTEN BY NANCY SOKOLER STEINER

Although it’s not a topic men might choose to discuss, knowledge is power when it comes to prostate cancer. “Prostate cancer is extremely common. About 1 in 8 men will be diagnosed with the disease over their lifetime,” says Timothy Lesser, MD, a urologist affiliated with Torrance Memorial Medical Center. “However, fewer than 3% die from it thanks to better treatments and because most prostate cancers are not aggressive. Most men live with prostate cancer and die of other causes.”

What’s the Deal with PSA Tests?

Dr. Lesser says the public—and even physicians—have received mixed messages about PSA tests, a blood test measuring levels of prostate-specific antigen. High PSA levels may indicate the presence of cancer. Beginning in the 1990s, many men diagnosed with prostate cancer due to high PSA levels received treatment, yet mortality rates did not decrease as expected. Many treatments turned out to be unnecessary.

Then in 2012 the U.S. Preventive Services Task Force (USPSTF) recommended against PSA screening, saying it did more harm than good. As a result, more patients did not seek care until their prostate cancer had spread to other parts of the body.

The USPSTF now recommends men ages 55 to 69 who are of average prostate cancer risk decide whether to have the PSA test in consultation with their physicians. It does not recommend the test for men at average risk who are over 70.

“Current treatment is based on risk stratification,” says Dr. Lesser. “We have various tools including biopsies, PSA trends and genetic testing that can indicate the aggressiveness of the cancer. Based on that, we determine whether the patient is a candidate for treatment or if we can just monitor him.”

Prostate Cancer Treatment

For men at low risk and some at intermediate risk, active surveillance is a safe treatment, says Dr. Lesser. This involves checking PSA levels and repeating biopsies at specific time intervals.

Other patients at intermediate risk and high risk generally undergo surgery or radiation. Surgery involves removing the prostate gland, a procedure often performed robotically at Torrance Memorial using the da Vinci surgical system.

“Robotic surgery is more precise, so rates of complications are lower than with traditional surgery,” says Dr. Lesser. Men who have their prostates removed will no longer produce semen but can still achieve orgasms. Dr. Lesser says their ability to achieve an erection will depend on their preoperative level of function. Surgery generally involves an overnight stay in the hospital and the use of a catheter for about a week.

“Torrance Memorial has had a robotic surgery program for about 15 years,” notes Dr. Lesser. “We have a well-established program and team.”

Radiation treatment can take several forms, all designed to spare nearby tissue from side effects. Intensity-modulated radiation therapy uses three-dimensional images to achieve precision and vary the intensity of the radiation beams. Stereotactic body radiation therapy delivers powerful and precise doses of radiation in a shorter time frame. High dose-rate brachytherapy involves delivering a radiation source to the area via a catheter.

Prior to delivering radiation, physicians may use SpaceOAR (Spacing Organs at Risk), a temporary gel placed between the prostate and rectum. The gel physically separates the prostate from the rectum to minimize unnecessary radiation and reduce side effects.

Risk Factors, Symptoms & Diagnosis

Risk factors include age (risk increases after age 50) and family history. African American men tend to have a higher incidence of prostate cancer and experience it at a younger age.

Screening detects most prostate cancers. More advanced prostate cancers may cause symptoms including problems with urination; blood in the urine or semen; difficulty getting an erection; weakness or numbness in the legs or feet; pain in the hips, back, chest or other areas; or loss of bladder or bowel control. These symptoms can have other causes and should be checked.

The combination of PSA and digital rectal examination is the standard screening protocol for prostate cancer. If either of these is abnormal, a prostate biopsy may be performed to see whether cancer cells are present. MRI can help diagnose the cancer, determine its size and show whether it has spread outside the prostate.

“At Torrance Memorial, we have a scan called a PSMA (prostate-specific membrane antigen), a type of PET scan, that is helpful in staging cancer,” says Dr. Lesser.

PSA Revisited and Prostate Cancer Screenings

Dr. Lesser believes the benefits of PSA testing outweigh the risks “Urologists are making careful and proper decisions with PSA. We’re appropriately selecting patients who need to be treated. Knowledge is power. So I think it’s proper for patients to advocate having their PSA tested.”

The American Cancer Society recommends men have a chance to make an informed decision with their health care provider about whether to be screened for prostate cancer. For a full list of screening recommendations visit cancer.org and search for prostate cancer screenings.•

For patients facing a cancer diagnosis, the Hunt Cancer Institute at Torrance Memorial is a place for hope and healing in the South Bay. An affiliate of Cedars-Sinai, the Hunt Cancer Institute offers comprehensive cancer care from national and regional cancer experts— including preventive screenings, the latest treatment options, access to promising clinical trials and a full range of supportive services available from diagnosis through survivorship.

Timothy Lesser, MD, practices in Torrance at 20911 Earl Street, Suite 140. He can be reached at 310-542-0199.

AQUABLATION:

A New Treatment for Enlarged Prostates

Torrance Memorial Medical Center now offers an innovative new treatment for enlarged prostates. Aquablation uses a high-pressure, robot-guided water jet to remove obstructing prostate tissue. “Aquablation uses no incisions, reduces the risk of side effects, and allows us to treat bigger prostates more safely and efficiently,” says urologic surgeon Garrett Matsunaga, MD, who performed the first procedures at Torrance Memorial in June.

The Aquablation system provides 3D ultrasound imaging, enabling physicians to precisely map the tissue to ablate. During the procedure, real-time imaging and robotic guidance help physicians precisely direct the water beam and avoid damaging surrounding anatomy.

“For men with larger prostates, a transurethral resection of the prostate (TURP)—the traditional treatment for enlarged prostates—is often incompletely effective. These larger prostates may need two surgeries or a more invasive procedure to get relief,” says Dr. Matsunaga. “Now men with very large prostates have a safe, effective, minimally invasive option.”

An enlarged prostate, also referred to as benign prostatic hyperplasia (BPH), can obstruct the urethra, which is the tube that carries urine out of the bladder and penis. It can cause slow or difficult urination and prevent the bladder from emptying fully. A common condition in men 50 and older, BPH often triggers frequent urges to urinate and regularly interrupts sleep. Without treatment, it can sometimes lead to bladder stones, infections and even kidney failure.

Patients who undergo Aquablation generally stay in the hospital overnight. After a four- to six-week recovery, they can expect to stop taking prostate medication and be able to completely empty their bladders and have less urinary frequency and urgency day and night.

“My patient told me it changed his life,” says Dr. Matsunaga. “He is off all prostate medication and only has to get up once during the night to urinate, and sometimes not at all.”