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Advancements in prostate cancer treatment

By: A. Taylor Kingman, MD, Shannon Clinic Urologist

Next to skin cancer, prostate cancer is the most common cancer affecting American men. It is estimated that more than 180,000 new cases and 26,000 deaths occurred last year due to the disease. In recent years, more light has been shed on this disease that affects 1 in 7 men, and advancements in screening and treatment are available in San Angelo at Shannon.

How is prostate cancer detected?

Prostate cancer is a tricky disease. In its early stages, there can be virtually no symptoms, making the disease difficult to detect without regular screening. Additionally, some prostate cancers are fast growing and aggressive, while others are rather idle. Urologists and primary care physicians work hand-in-hand to identify prostate cancers that are more likely to cause symptoms or death.

Is prostate cancer treatable?

The good news regarding prostate cancer is that it is highly treatable and curable when detected in the early stages, even though it’s hard to detect. This statement seems contradictory, but it also shows the importance of screening for prostate cancer and discussing your risk factors with your doctor.

Asymptomatic men should have a discussion with their urologist or primary care physician regarding the benefits and risks associated with screening.

Although there is controversy regarding screening, the American Urologic Association has adopted several general guidelines:

  • Men at high risk, African Americans and those with a family history of the disease should discuss screening at age 40.
  • All other men with a greater than 10- to 15-year life expectancy should discuss routine screening at age 55.
  • Routine screenings are no longer recommended for ages 70 and above.
  • These guidelines do not apply to men with symptoms from their prostate, such as voiding difficulty, which can signify a benign or malignant disease process.

Through screening, we attempt to provide the most tailored program possible to limit identification of clinically insignificant cancer.

How does prostate cancer screening work?

To screen for prostate cancer, your physician will perform a digital rectal examination (DRE) and prostate-specific antigen (PSA) exam every one to two years. The DRE checks for abnormalities in size and consistency of the prostate. PSA is a substance produced only by the prostate. The PSA exam measures the level of the substance in the bloodstream.

A new option for prostate cancer screening is the 4Kscore. This blood test combines several biomarkers that are prostate-specific with the patient’s clinical information. The result provides an accurate and personalized measure of a man’s risk for aggressive prostate cancer. If the patient’s risk level is on the low side of the scale, the patient will be less likely to need a biopsy.

If a patient does need a biopsy, we also do genetic testing on that sample to determine the risk level. A DNA test reveals the patient’s risk and helps us determine the next course of treatment.

What are the treatment options?

Once a man is diagnosed with prostate cancer, recommended treatment varies with an individual’s stage of cancer, PSA level, age, overall medical condition and even personal—preference after a detailed discussion with a urologist regarding the risks and benefits of each treatment.

Treatment options include:

  • Surgery to remove the prostate (prostatectomy).
  • Radiotherapy.
  • Hormone deprivation therapy.
  • Observation.
  • In rare cases, cryotherapy (freezing the prostate).

While prostate cancer is much more common as a man ages, early prostate cancer detected in elderly men is much less likely to cause death than in younger and healthier men. Prostate cancer typically advances slowly. Therefore, surveillance, or observation, is the best treatment choice for men of advanced age or poor medical condition. Younger men have a longer life expectancy and the most years of life to lose if intermediate or aggressive cancer is not detected early. Most urologists recognize that risk and will usually offer more aggressive treatment with surgical removal of the prostate for younger men in overall good health.

When detected and treated early, surgery most often is curative.

What about surgery?

An exciting advancement in surgical options for prostate cancer at Shannon is the addition of robotic-assisted surgery. Our da Vinci Xi™ Surgical System allows us to offer the most advanced surgical techniques for our patients right here in San Angelo.

A prostatectomy removes the prostate gland and surrounding lymph nodes. Previously, this was an open procedure that required a larger incision and lengthier recovery time for the patient. Using the robotic-assisted approach, only a few small incisions are made. The cancer cure rate of both procedures is equivalent, but the roboticassisted option allows the patient to heal faster and recover quicker, getting them back to their day-to-day routine.

Screenings save lives

The most important item to remember is to always discuss your options with your physician. They want to provide the best and most suitable care for you.

For more information, call the Shannon Urology Department at 325.481.2231.

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