Diagnosing and Treating Prostate Cancer (video/podcast)

Prostate cancer is one of the most common types of cancer among men. In fact, one in eight men will develop prostate cancer at some point during their lifetime.

When found in its earliest stages, prostate cancer is highly treatable; the five-year survival rate for early-stage prostate cancer is 99%.

In this video, San Diego Health host Susan Taylor discusses diagnosing and treating prostate cancer with Ramsey Chichakli, MD, a urologist at Scripps Clinic Encinitas and Scripps Clinic Jefferson in Oceanside.

The prostate gland is part of the male reproductive system. Located deep in the pelvis just below the bladder, it produces fluid and hormones that support fertility and nourish sperm. Urine passes through the prostate gland on its way out of the body.

Prostate cancer is the second most common cancer among men after skin cancer, and the risk of developing it increases with age. Other risk factors for prostate cancer include having a family history of the disease and being of African American descent.

In its earliest stages, prostate cancer often has no symptoms. As the disease progresses, symptoms of prostate cancer may include difficulty urinating, a weak urine stream and having to urinate more frequently, especially during the night. Erectile dysfunction is also common in men that have an enlarged prostate.

“Unfortunately, by the time men notice these symptoms, prostate cancer may already be in a very advanced stage where treatment is challenging,” says Dr. Chichakli. “This is why screening for prostate cancer is so important. We want to find it and treat it as early as possible.”

When should men begin getting screened for prostate cancer? That depends on their risk factors. Men who have an average risk should have their first screening at age 45, while those with risk factors, such as family history or African American heritage should begin screening at age 40. Screening should be repeated every two years.

Prostate cancer screening typically involves a prostate-specific antigen (PSA) blood test and a digital rectal exam (DRE). The first test measures the amount of PSA, a protein produced by the prostate, in the blood. Higher levels can indicate prostate cancer. However, it’s important to note that other conditions can also cause high PSA levels, including an enlarged prostate, certain medications and age.

During a DRE, a doctor or nurse inserts a gloved, lubricated finger into the rectum to feel for enlargement, lumps or other abnormalities in the prostate. 

If these initial screening results are normal, the PSA test should be repeated every one to two years. If either test result is abnormal, the doctor may order further testing such as a biopsy or MRI. 

Treatment for prostate cancer depends on the type and stage of the disease and the patient’s medical history.

“Some prostate cancers are very non-aggressive. We call those low-grade cancers, and often in those men, we’ll just observe them without taking any action,” says Dr. Chichakli.

“Alternatively, there are some more aggressive prostate cancers, and those we’ll treat sometimes with surgery, sometimes with radiation, sometimes with a combination of both.”

If the cancer has not spread beyond the prostate gland, removing it may be the best option, especially since prostate cancer surgery has evolved significantly in the last 10 years.

New minimally invasive robotic prostatectomy technologies allow surgeons to remove the prostate through very small incisions with a high degree of precision, minimizing urinary and sexual side effects that were a concern with traditional open surgery.

“After we remove the prostate, we have to reattach the bladder and the urethra, and that can lead to some effects on urinary control. That’s usually temporary, particularly with the robotic approach,” explains Dr. Chichakli. “Also, nerves that give men erections are very close to the outside of the prostate. Again, with robotic technology, we’ve gotten better at preserving those nerves.”

Prostate surgery typically requires an overnight stay in the hospital and one week with a tube that goes into the bladder called a catheter. Men should restrict physical activity for about four to six weeks to allow everything to heal.

If cancer has spread beyond the prostate, treatment also may include radiation therapy, chemotherapy or hormone therapy.

There is no sure way to prevent prostate cancer, so screening is the next best option.

“Prostate cancer is extremely common and we are seeing a lot of it. Fortunately it is treatable, particularly if it’s found in early stages,” says Dr. Chichakli. “We encourage men to discuss it with their doctor and consider getting screened.”

Follow San Diego Health on iTunes for the latest episodes on new medical technologies and wellness tips. We’re also on SoundCloud and Spotify.