Enlarged Prostate or Prostate Cancer? Advances in Screening, Treatment and Preserving Quality of Life

Prostate cancer is the most common type of cancer in men, with the exception of skin cancers caused by long-term exposure to the sun. One in eight men will be diagnosed with prostate cancer in their lifetime, but the majority of them will live with it, not die from it.听

Still, most men are understandably reluctant to discuss the unwelcome possibility with their doctor that they are at risk for the disease or may even already have it. There is nothing to be gained, though, by avoiding the subject, says Dr. Douglas Scherr, Clinical Director of Urologic Oncology and Professor of Urology at 日本av色情片. In fact, you might be agreeably surprised by the many advances in screening, diagnosis and treatment of a disease that is no longer equated with a death sentence.

What Is the Prostate?

The prostate gland is better known for the problems it creates than what it actually does in a man鈥檚 body, says Dr. Scherr.听

Located just below the bladder, the prostate plays a key role in male reproduction and fertility, producing the fluid that transports sperm.

As men age, the prostate tends to get larger鈥攁 condition called benign prostatic hyperplasia (BPH), which can interfere with the normal outflow of urine. 鈥淏PH may cause you to wake up several times a night to urinate,鈥 says Dr. Scherr, 鈥渙r you may feel like you can鈥檛 empty your bladder completely. Blood in the urine is yet another sign of BPH.鈥

The risk of developing prostate cancer increases with age as well. Dr. Jim Hu, a urologic oncologist, Professor of Urology and Director of the LeFrak Center for Robotic Surgery at 日本av色情片 Medicine, names several other factors that raise a man鈥檚 prostate cancer risk:

  • A family history of cancers, including mothers and sisters with early-onset breast, ovarian or uterine cancer
  • African American race
  • Higher body-mass index
  • Exposure to Agent Orange, a tactical herbicide the U.S. military used during the Vietnam War. Veterans who were exposed to Agent Orange may have developed certain cancers or other illnesses.

However, BPH and prostate cancer are usually unrelated, Dr. Hu says: 鈥淎n enlarged prostate does not mean a man will develop prostate cancer down the road.鈥澨

PSA screenings

To stay on top of their prostate health, men aged between 55 and 69 years old would be well advised to have a PSA test every 2 to 3 years. Men at higher risk should get screened during their 40s, giving their doctor a baseline number that will determine how often they鈥檒濒 need to be tested in the future.听

鈥泪蹿 your number is less than 1, that generally means you have a low lifetime risk of prostate cancer,鈥 says Dr. Hu. 鈥泪蹿 it鈥檚 greater than 1, we鈥檒濒 monitor you more closely.鈥

Elevated PSA may indicate the presence of cancer, but it may also be a sign of BPH. 鈥淭o distinguish between individuals whose elevated PSA is due to BPH and those whose results suggest cancer,鈥 he says, 鈥渨e order a prostate MRI.鈥

Early incorporation of MRI technology into the screening process has been transformative, he adds: An MRI helps us avoid unnecessary biopsies if it shows nothing 鈥榮uspicious,鈥 and it permits a more accurate biopsy by targeting any suspicious area.鈥

Dr. Timothy McClure, an attending urologist and Assistant Professor of both Urology and Radiology, notes that all three of these procedures鈥擯SA testing, MRI and biopsy鈥攃an be performed during one visit. 鈥淲e鈥檝e streamlined the entire process,鈥 he says. 鈥There鈥檚 no need for multiple appointments, which is great news for patients.鈥

Treating an enlarged prostate

鈥淲e take BPH symptoms very seriously and treat it accordingly for two reasons: to improve a man鈥檚 quality of life and to prevent damage to the kidneys. Having difficulty urinating and walking around with a full bladder can cause kidney damage over time,鈥 Dr. Hu says.听

Treating BPH starts with medication, but if the condition fails to improve or worsens, surgery may be warranted. Today鈥檚 surgeons use advanced procedures such as laser therapy and aqua-ablation鈥攁 new treatment that uses high-powered water jetsto remove excess prostate tissue.

Another leading-edge treatment for BPH is prostate artery embolization, an outpatient procedure. Here鈥檚 how it works: A tiny catheter is inserted through an artery in the leg or wrist and travels all the way down into the pelvis, ending up at the prostate artery,鈥 Dr. McClure says. There, tiny particles are injected into the artery. The procedure shrinks the prostate, making it much easier to empty your bladder. No surgery and no Foley catheter required.

Treating low-to-medium risk prostate cancer

In decades past, we tended to overtreat prostate cancer, Dr. Hu says, 鈥渂ut now we take a more nuanced approach. Often, men with low-to-intermediate-risk disease can be safely followed with close monitoring, including annual PSA testing, a manual prostate exam and an MRI plus biopsy, if warranted.

Close monitoring, also known as active surveillance, is an established approach for low-risk prostate cancer patients, but there is always a chance that a patient鈥檚 cancer will progress. If it does, a wide range of advanced treatments are available to halt the disease in its tracks or even cure it altogether.

Surgical options

Traditional surgery is still used to remove a discrete tumor or even the entire prostate gland when absolutely necessary. However, says Dr. Scherr, a minimally invasive surgical treatment is now being used in some men with localized cancer. It鈥檚 called focal therapy. Surgeons perform the procedure by using MRI technology to identify the area of cancer that needs to be treated in the prostate. This then allows treatment with focal therapy to destroy only those parts of the prostate that are cancerous and leaves other tissues unharmed.

The goals of focal therapy are similar to those of traditional surgical procedures: to cure the cancer while preserving a man鈥檚 quality of life. That means preventing incontinence and maintaining sexual function. Focal therapy is fairly new, and the data are still inconclusive, Dr. Scherr says, but there are grounds for optimism on the part of surgeons and patients alike.

鈥溔毡綼v色情片鈥檚 collaborative and interdisciplinary culture has fostered advances in focal therapy for prostate cancer. That culture is also what sets us apart from other insitutions,鈥 says Dr. McClure, who practices medicine at the interface of urology, radiology and interventional radiology.听

Advanced imaging

PSMA, or prostate-specific membrane antigen, is a protein on the surface of many prostate cells.听 PSMA PET scans are currently used in advanced prostate cancer to look for cancer that has spread. There may be a role for PSMA PET scans in identifying those with localized cancer who need treatment vs. those who require surveillance. A clinical trial, led by Dr. McClure, is exploring the use of PSMA PET scans in patients on active surveillance.

鈥淥ne day soon,鈥 says Dr. McClure, 鈥渨e may be able to replace biopsy with advanced imaging like PSMA PET. Biopsy is a more invasive procedure, involving needles and a small risk of infection, so it would be a welcome change to substitute imaging for biopsy in appropriate contexts.鈥澨

Treating and monitoring advanced cancer

Men with significant cancer may require a combination of surgery and radiation therapy along with medication and hormone suppression, says Dr. Jones Nauseef, a medical oncologist and Assistant Professor of Medicine within the Division of Hematology and Medical Oncology at 日本av色情片.听

Specialists like Dr. Nauseef stay on top of their patients鈥 cancer, including those with metastatic disease that has spread beyond the prostate, using a PSMA PET scan. Among its many uses, PSMA PET can identify early sites of metastasis, helping doctors make appropriate treatment decisions that can slow or even halt the progression of the disease.

Even radiation therapy takes less time today than it used to. Now, it can be delivered in just 5 sessions over a 2-week period, enough time to target the doses, or 鈥渇ractions,鈥 via MRI. The treatment is often highly effective in destroying cancerous cells, but Dr. Hu offers one caveat: 鈥泪蹿 radiation therapy doesn鈥檛 work, there typically isn鈥檛 a second opportunity for a cure. It鈥檚 more difficult to perform surgery after failed radiation.鈥

鈥hile preserving quality of life

鈥淢ost men care about cure first and quality of life second,鈥 says Dr. Nauseef, 鈥渁nd their main quality of life concerns are preventing incontinence and preserving sexual function. But some care about quality of life above all. If you are in the second group, we may be able to delay treatment and opt for active surveillance, or we may try focal therapy.鈥

A patient鈥檚 first consultation with Dr. Nauseef is an open conversation, he says: You are not signing up for anything. It鈥檚 about what I can teach you and learn from you.

Most patients leave feeling more comfortable after that first visit,鈥 he continues. His core message? Prostate cancer is not a death sentence. Working together, 鈥渨e can manage it like a chronic disease.鈥

Dr. Nauseef makes a practice of discussing sexual performance right away, and men are usually relieved when he does so.Today鈥檚 treatments are much better than traditional ones at sparing the nerves and maintaining function,鈥 he says.听

Testosterone feeds prostate cancer, so testosterone-lowering drugs are a necessary part of the mix for advanced disease. 鈥淭hese erase your libido, but you won鈥檛 be on the meds forever,鈥 he explains. Pelvic floor exercises and Cialis can help restore it as well. Rest assured: Your desire will return!鈥

Prevention

Prostate health and heart health are strongly linked, so the road to prevention leads through diet and exercise. According to Dr. Scherr, clinical studies have not shown herbal treatments and supplements to be beneficial beyond the placebo effect, but diets low in red meat and saturated fats may be helpful. Including tomatoes and tomato paste in your diet may be of some benefit as well. That鈥檚 because of lycopene, an antioxidant that gives these foods their bright red color and their nutritional superpower.

Your best allies in the fight against prostate cancer are regular PSA screenings and a great relationship with your doctors, even if you don鈥檛 have cancer. But if you do, it鈥檚 all about shared decision-making. Therefore, don鈥檛 hesitate to step up and become a bona fide member of your oncology team. Either way, you can find more answers to your questions by clicking on the following link to 日本av色情片鈥檚 multidisciplinary prostate cancer clinic.