ó The detection and treatment of prostate cancer is getting
sophisticated screenings, better tests for evaluating biopsied
tissue and use of MRI-ultrasound fusion to accurately map
prostate cancer are the latest advancements in detecting and
treating the disease.
are the things that are new and exciting," said Dr. Dipen
Parekh, professor and chairman of the department of urology
and director of robotic surgery at the University of Miami
Miller School of Medicine. "If you do get a diagnosis of
prostate cancer, if you seek out treatment with the right
people, and you are in the right hands, you should expect an
excellent future course."
addition, robotic-assisted laparoscopic prostatetectomy
continues to advance as a surgical tool, along with radiation
therapy or brachytherapy, which uses radioactive seeds to kill
cancer cells. Still others undergo a radical prostatectomy,
the removal of a cancerous prostate and its surrounding
post-surgical pelvic floor physical therapy, a series of
exercises under the guidance of a therapist, can also
strengthen pelvic areas to end incontinence, said Louise
Gleason, a physical therapist with South Miami Hospitalís
Pelvic Floor Center.
those for whom prostate cancer has become too advanced and who
are not candidates for surgery, Provenge, a restorative
treatment of cellular immunotherapy, made from a patientís
own immune cells, can stimulate a patientís immune system to
identify and target prostate cancer cells, thus prolonging
life, said Dr. Michael Cusnir, an oncologist at Mount Sinai
Medical Center in Miami Beach, Fla.
for screenings of the prostate, a walnut-sized portion of a
manís reproductive system that wraps around the urethra, the
tube that carries urine out of the body, have changed since
of every man over 40 getting a PSA (prostate-specific antigen
blood test), now itís more focused on screening for patients
with a high risk for prostate cancer, those who have a family
history, or who are African American," said Parekh.
fusion, adopted early by the University of Miamiís Sylvester
Comprehensive Cancer Center, can result in more accurate
prostate biopsies than ultrasound alone or digital rectal
American Cancer Society recommends that at age 50, men who are
at an average risk of prostate cancer have a discussion about
the risks and potential benefits of a screening with their
screening discussion can start at 45 for men at higher risk of
developing prostate cancer, which, according to the American
Cancer Society, will impact one out of seven men in the United
States ó though only one out of 36 will die from the
disease. Most older men who have been diagnosed with prostate
cancer will die from other causes before succumbing to the
men would include African Americans, who have a higher
instance of prostate cancer compared with their white and
Hispanic counterparts, or men who have an immediate relative
such as a father, brother or son who was diagnosed with
prostate cancer before age 65.
who have had more than one immediate relative with the disease
at an early age should begin discussions with their doctors
even earlier, at age 40.
cancer is the second most common cause of cancer death in men,
behind lung cancer and ahead of colon cancer.
233,000 new cases of prostate cancer will be diagnosed
nationwide in 2014, and 29,480 men will eventually die from
it, according to the American Cancer Society. The upshot: More
than 2.5 million men in the United States who have been
diagnosed with prostate cancer at some point ó the average
age at the time of diagnosis is 66 ó are still alive. Active
surveillance, or monitoring the disease with doctor and
patient working in tandem, can also improve quality of life.
Diner, a litigator who lives in Plantation, Fla., advocates
for PSA testing after he underwent treatment for prostate
cancer last summer with Parekh at the University of Miami.
Diner, 67, lost his father to prostate cancer in 1987. His
uncles, on both sides of his family, also had prostate cancer.
He has had routine PSA tests for years.
attitude is if one person can benefit from early detection,
then it is worth it to share my story," he said. "I
consider myself so lucky by being detected early and having
great robotic surgery."
and treatment, "is not as draconian as it used to be when
I think of my fatherís diagnoses in the Ď80s. Mine wasnít
noticeable from a physical exam," he said.
January 2013, after returning home from a visit to Vermont,
Dinerís PSA test was high and he went to a local urologist.
A second PSA test was not as high as the first but still not
where it should have been, he said. A biopsy revealed cancer.
my family history, this was something I didnít want to fool
around with," Diner said.
did some research, contacted an uncle who teaches at the
university, and came into contact with Parekh. "With
prostate cancer itís not something that grows fast so you
have an opportunity to check things out."
and Parekh opted for robotic surgery in July.
surgery, guided by infrared vision, is a preferred treatment
because blood loss is minimized as is the risk of damaging
blood vessels and nerve bundles that are responsible for blood
flow to the penis that allows a man to achieve an erection.
The image-guided surgery is also less traumatic.
patients go home within a day or two with a catheter, for
about a week, to help drain the bladder until the sutures
heal. Normal continence resumes for 95 percent of patients
within the first six months.
was back at work in 10 days. No complications. He said he had
no need to take the prescribed pain medication.
went well, the pathology came back great, everything was
contained, it was no place else. They monitor me every three
months to make sure everythingís OK. Iím grateful to get
this behind me and (regain) my normal life and my work and not
miss a beat," Diner said.
patients who need help dealing with issues of incontinence,
which can occur before or after prostate cancer surgery, or
from an enlarged prostate as a man gets older, therapeutic
exercises can be a remedy.
Pelvic Floor Center at South Miami Hospital focuses on a ring
of bones that includes the sacrum at the bottom of the spinal
column and the pelvic bone on either side. At the base of that
bone structure lie muscles that hang like a hammock from the
tailbone to the pubic bone, supporting the pelvis. These
muscles are voluntarily controlled, like the biceps or
triceps, and are used to control the passage of waste from the
gear my physical therapy toward the muscles and bones of the
pelvis to see if we can help patients restore that function
after whatever procedure they have," Gleason said.
"When these muscles are weak, or not working properly,
they canít close that urethra to hold that urine back and
thatís where I come in. I assign people exercises based on
the strength they already have so as to maximize their
improvement," she said.
general, it takes about a month before a patient will see real
strengthening, Gleason said.
sessions run once a week for about six to eight weeks with
home exercises suggested afterward. A simple exercise might go
like this: Recline on the floor with knees bent, a hand on the
belly, another on a leg. Tighten up around the anal area as if
holding back gas. Release and repeat.
first goal is to isolate the pelvic floor and be able to
recognize when they are using it," Gleason said.
"From there, you can begin to exercise because you are
using the correct muscle."
other therapies can utilize electrodes placed on the skin to
measure activity in the muscles to train the muscles to
contract and strengthen. If the incontinence or sexual
dysfunction is muscular related, these exercise combinations
can be effective, Gleason said.
cases, prostate cancer has advanced beyond surgical solutions.
Provenge, a therapeutic class of cellular immunotherapies, is
not curative. But this non-surgical alternative to prostate
cancer treatment can improve the survival rate of patients for
months or years.
cells are collected, infused with an antigen that helps
activate the patientís T-cells to help fight the cancer
cells, and then placed back into the patientís body
like a blood transfusion," explains Mount Sinaiís
Cusnir. "We almost train the patientís own immune
system to recognize the cancer cells and fight them on their
process is repeated three times in two-week intervals.
still looking for a big change," Cusnir said about the
treatment of prostate cancer, "but at least we keep
Treatment Centers of America has identified the following
symptoms related to prostate cancer:
or pain during urination.
urinating, or trouble starting and stopping flow, or decreased
flow or velocity.
frequent urges to urinate at night.
urine or semen.
in legs or pelvic area.