This year, more than 230,000 men will be diagnosed with prostate cancer, and 32,000 will die from the disease. When caught and treated early, prostate cancer has a cure rate of more than 90 percent, according to the Prostate Cancer Foundation; however, only 10 percent of men are screened for this cancer.
Dr. Tony Bedsole of Eastern Urology in Birmingham encourages physicians to advise their patients of the advantages of prostate screening. "It's a travesty to see a young man in his 40s with advanced prostate cancer because he didn't know he needed to be screened," said Bedsole.
Most cancers present warnings that there may be a problem, but because prostate cancer grows slowly there typically are no early signs, according to Dr. Scott Tully of Urology Centers of Alabama in Homewood. If the cancer does grow quickly, the patient may complain of frequent urination, blockage of urinary flow, a need to get up at night and urinate, urinary leakage and an urgency to urinate. "Unfortunately, these symptoms can also indicate an enlargement of the prostate which is normal as men age," Tully pointed out.
According to Dr. Chester Hicks of Clinical Urology Associates, PC, in Gadsden, all men age 50 and older need an annual screening that includes a urinalysis, a digital rectal examination and a test to determine the level of prostate specific androgen (PSA) in the blood. If the patient has a family history of prostate cancer or is African American, screening should begin at age 40. "This is a silent disease in its early states," Hicks said, "and it's nine times more likely to occur in African American men. We don't know why but doctors need to be attuned to that fact."
Hicks added that the way doctors diagnose prostate cancer has evolved. "Years ago, we didn't have the PSA test and most prostate cancer was diagnosed in the late states," he said. "With the PSA test, we can diagnose earlier so most of our prostate cancer patients are men with an elevated PSA and no other symptoms."
As a diagnostic tool, the PSA test itself has evolved in the way physicians use it to determine the presence of cancer. Tully said that an elevated PSA doesn't always indicate prostate cancer, so he encourages doctors to also do a digital rectal exam. "If that exam is abnormal, the patient definitely should be referred to a urologist," he said. A PSA level of 4.0 or greater was once the point at which a patient was referred, but Tully said that scale has changed to an age-specific one because studies show that a man's PSA level naturally increases with age. "Research found that men under 60 with a PSA greater than 2.6 have an increased incidence of cancer," he said.
Bedsole said medical journals state that physicians probably fail to detect prostate cancer in a number of patients using the 4.0 PSA as an indicator and agrees with others in the medical community that the 2.5 level makes sense for screening men in their 50s and 60s. He added that he realizes men have been dubious of the PSA test in past years because of the documented 60 to 70 percent false positive test results. "Given those past issues, I still think the PSA is still the best tumor marker available, and researchers are continuously looking for ways to make the test more reliable," he said.
Once a patient is diagnosed with prostate cancer, he has a number of treatment options available to him. Prostatectomy can be performed to remove the prostate in early stages where the cancer is confined to the gland. If the patient decides against surgery, radiation therapy is another option. External beam radiation is used to target tumor cells, or the patient may opt for brachytherapy which involves insertion of small metal beads containing radioactive iodine or palladium. The beads are inserted into the prostate through needles and are placed in the proper location to attack the cancer.
For patients who decide to have their diseased prostate surgically removed, a new device combines laparoscopy with new robotic technology to improve outcomes and to lessen side effects, which can include incontinence and erectile dysfunction. Tully and his partner, Dr. Ed Bugg, have been performing robotic laparoscopic prostatectomy for more than two and a half years with the state-of-the-art daVinci® system at St. Vincent's Hospital in Birmingham. "It's been a huge learning curve but we've learned to spare the bladder neck and the nerves around the prostate," Tully said. "We reconstruct the pelvic floor support muscles to put things back the way they were."
The robotic surgery uses three-dimensional computer vision to manipulate robotic arms which hold special surgical instruments that are inserted into the abdomen through small incisions. A laparoscope is inserted and connected to the computer monitor. "This surgery is so precise. The 3-D view helps us easily find nerves and muscles around the prostate, and we can remove the prostate, lymph nodes, seminal vesicles and surrounding tissue through small incisions," said Tully. "Patients are concerned about continence and potency and that's where we are seeing better results."
