Prostate cancer is the most common cancer in men. Many cases are indolent and low grade, in younger patients, however (between the ages of 40-65), cancers can be aggressive and require treatment.
Detection and Screening
Prostate cancer detection is done through a digital rectal exam (DRE) and Prostate Specific Antigen (PSA). PSA is a protein made by the prostate gland that is found in both blood and semen. In the semen, it serves to liquefy the seminal fluid, but in the blood it is inactive. PSA, however, can be used as a tumor marker for prostate cancer. Elevated PSA levels may indicate the presence of prostate cancer. However, it may also occur in some non-cancerous situations, as well, such as infection, prostatitis and benign prostatic enlargement (BPH). Other tests including, total versus free PSA, PSA velocity and urine markers such as PCA3 are helpful adjuncts in detecting prostate cancer. Ultimately, the only way to detect prostate cancer is through a biopsy.
% FREE PSA | % RISK FOR PROSTATE CANCER |
Less Than 10% | 56% Chance of Having Cancer |
11% — 15% | 28% Chance of Having Cancer |
16% — 20% | 20% Chance of Having Cancer |
21% — 25% | 16% Chance of Having Cancer |
More than 26% | 8% Chance of Having Cancer |
Age-Based PSA The normal range for PSA is related to a person’s age. In general, a PSA greater than 4.0 ng/ml is considered abnormal. However, age-based PSA can be used to fine-tune the need to proceed with a biopsy. Normal PSA ranges are listed below based on age of the patient.
AGE | PSA RANGES (NG/ML) |
40 — 49 | 0 — 2.5 |
50 — 59 | 0 — 3.5 |
60 – 69 | 0 – 4.5 |
70 – 79 | 0 – 6.5 |
Signs and Symptoms
Historically, before the age of early detection, prostate cancer would present bone pain and weight loss as signs of metastatic disease. In the advent of PSA screening, however, prostate cancer does not usually have any presenting symptoms. That is why it is important to get regular screenings in the healthy, young and at risk populations.
Treatment
Dr. Movassaghi recognizes that not all prostate cancers should be treated the same. Individual recommendations are made based on a patient’s age, health history and aggressiveness of the disease. Treatment modalities include active surveillance, surgery, radiation, hormones, chemotherapy or a combination of the above.
Active Surveillance
This is reserved for patients who have low-grade, low-risk prostate cancer. This type of cancer is not believed to affect a person life expectancy. Thus the approach to treatment is minimal. Patients are monitored quarterly through a PSA blood test and annually with a prostate biopsy. As long as the findings remain stable, no further treatment is indicated.
Surgery
Historically, this was done in an open fashion and patients would stay in the hospital for 2-4 days and have a large scar on their abdomen. Currently, with the use of the Da Vinci Robot, most patients are discharged home within 23 hours of surgery and have a few small cuts on their skin. Nonetheless, although the robot allows for better visualization of the pelvis, robotic surgery like its predecessor, is subject to the same surgical risks and complications.
This can be done through an external energy source (XRT), or through small seeds placed directly within the prostate tissue (brachytherapy). Radiation oncologists perform these procedures and at the Los Angeles Men’s Health Center, we have a wide network of specialists, both local and abroad who can help perform XRT and brachytherapy and counsel patients regarding the risks and the procedures.
Radiation
This can be done through an external energy source (XRT), or through small seeds placed directly within the prostate tissue (brachytherapy). Radiation oncologists perform these procedures and at the Los Angeles Men’s Health Center, we have a wide network of specialists, both local and abroad who can help perform XRT and brachytherapy and counsel patients regarding the risks and the procedures.
Hormones and Chemotherapy
Because prostate cancer grows in response to testosterone, hormones, which block testosterone production and activity are used to help stop the growth of cancer cells. Hormone therapy is usually reserved for very aggressive cancers or when cancer has spread beyond the prostate gland. If cancer becomes unresponsive to hormone treatment, chemotherapy is used.
