BOBÌåÓý

BOBÌåÓý’s expert prostate cancer doctors work as a multidisciplinary team to provide comprehensive care that is personalized for each one of our patients. From leading-edge treatments to traditional methodologies, we offer diverse options to treat prostate cancer in patients across Florida.

Your BOBÌåÓý prostate cancer team includes urologic surgeons, medical oncologists, radiation oncologists and pathologists, working in collaboration with one another and with you to develop the best course of action with your goals and preferences in mind.

Depending on the grade and stage of your cancer, as well as your overall health, treatment may include:

• Active surveillance
• Chemotherapy
• Radiation therapy
• Focal therapy
• Hormonal therapy
• Immunotherapy
• Proton therapy
• Robotic prostatectomy surgery, including outpatient prostatectomies
• Combination of multiple treatment types

Additionally, our prostate cancer team at BOBÌåÓý actively participates in the latest clinical trials and play a part of new discoveries that advance the field of prostate cancer care. Some of the cutting-edge methodologies BOBÌåÓý offers include HIFU focal therapy, outpatient robotic prostatectomies and systematic radioisotope therapy like PLUVICTO.

A National Cancer Institute Designated Care Center

The BOBÌåÓý Cancer Center received designation from the NCI because of the exceptional, multidisciplinary care we deliver to patients, along with the innovative clinical research conducted by our faculty. Our providers across the spectrum of cancer care work together to provide personalized patient treatments. Cases are presented at weekly tumor boards, which are attended by physicians across multiple departments, so they can work together to develop the best treatment plan possible.

The BOBÌåÓý Cancer Center received designation from the NCI because of the exceptional, multidisciplinary care the Cancer Center delivers to patients and the leading-edge clinical research conducted by its faculty. Our providers across the spectrum of cancer care work together to provide personalized care to each individual patient. Cases are presented at weekly tumor boards which are attended by physicians across multiple departments, so they can work together to develop the best treatment plan possible.

What is prostate cancer?

Prostate cancer occurs in the prostate gland, which is a small gland in men that produces seminal fluid. The prostate gland is anatomically situated between the bladder and urethra and is closely involved with urinary control. While prostate cancer can be a serious diagnosis, early detection normally leads to successful outcomes and long-term survival.

What are the causes and risk factors of prostate cancer?

About 1 in 8 men in the U.S. will be diagnosed with prostate cancer in their lifetime.

Prostate cancer tends to occur most commonly in men over the age of 50, and greater than 65% of all cases are diagnosed in men 65 years and older. The incidence of prostate cancer increases with age, but other well-established risk factors include:

• Family history: Especially multiple first-degree male relatives who were diagnosed with prostate cancer at a younger age.
• Race: African Americans are at greater risk of developing prostate cancer as compared to other races and often at an earlier age and with higher grade cancers.
• Geography: Prostate cancer is most common in North America, northwestern Europe, Australia and the Caribbean Islands.
• Genetic mutations and syndromes:
  • BRCA1 or BRCA2 gene mutations especially gene mutation 2, which are associated with breast and ovarian cancers, can increase the risk of developing prostate cancer in men.
  • Patients with the inheritable condition called Lynch syndrome, or hereditary non-polyposis colorectal cancer, are at risk of many cancers including prostate cancer.

Other potential risk factors thought to be associated with prostate cancer include a diet high in saturated fat and obesity.

What are the signs and symptoms of prostate cancer?

For most men prostate cancer does not cause symptoms, but is detected because of an elevation in prostate-specific antigens (PSA). Largely due to the widespread use of PSA tests, most prostate cancers are now diagnosed at an earlier stage and younger age compared to 20 years ago.

As prostate cancer grows, it may cause the following symptoms:

• Difficulty urinating, called dysuria
• Weak urine flow
• Blood in the urine, called hematuria
• Blood in the Semen, called hematospermia
• Frequent urination
• Erectile dysfunction
• Pain in the hips, back, or chest

Other less common symptoms of prostate cancer include urinary retention, weight loss, abdominal pain, bone pain or fractures.

How is prostate cancer diagnosed?

After taking a detailed medical history and performing a physical examination, including a digital rectal exam (DRE), a PSA blood test will be performed. If the PSA level is elevated, or if the urologist feels a lump during a DRE, a prostate biopsy will be recommended.

The biopsy is an outpatient procedure, meaning you go home the same day, and is performed with local anesthesia. Several samples of tissue are collected from the prostate. These samples can tell us if you have prostate cancer and how aggressive it is.

If the biopsy is positive, other tests may be performed based on your PSA level, cancer grade and exam findings. Most commonly, a CT scan of the abdomen and pelvis will be obtained for determining the stage of the prostate cancer detected. In high-risk cases, a bone scan may be recommended to determine if there has been spread to the bones.

There are two main types of prostate biopsies that BOBÌåÓý offers:

• Transrectal biopsy: This is the most common type of biopsy. The doctor inserts a thin needle through the rectum and into the prostate gland to collect tissue samples. The procedure is usually done under local anesthesia, and the patient may feel some discomfort.
• Transperineal biopsy: In this type of biopsy, a needle is inserted through the skin between the scrotum and the anus. Transperineal biopsy can be recommended if a patient has had a biopsy that did not detect cancer, but the PSA level remains elevated. It may also be recommended for patients who are at a higher risk for complications from a transrectal biopsy.

Both types of biopsies are generally safe and have a low risk of complications, such as infection or bleeding. However, as with any medical procedure, there are some risks. Patients should discuss the risks and benefits of the biopsy with their doctor before the procedure.

What types of prostate cancer are there?

The overwhelming majority of prostate cancers are adenocarcinomas, meaning they arise from the glandular component of the prostate. Other rare and atypical types of prostate cancer include:

• Ductal carcinoma
• Mucinous carcinoma
• Signet-ring cell carcinoma
• Small cell carcinoma
• Clear cell adenocarcinoma
• Giant cell carcinoma

These rare and atypical variants can act aggressively and may respond differently to therapy than the more common prostate adenocarcinoma.

The prognosis of prostate cancer is directly linked to the stage of the disease. Staging is a process that demonstrates how far the cancer has spread. The stage of prostate cancer in a patient will inform their treatment options.

Local prostate cancer

Approximately 90% of prostate cancers are diagnosed at a localized stage. This means that the cancer is confined to the prostate without evidence of spread. Localized cancers are most commonly detected through an elevation in PSA without any symptoms.

Less commonly, prostate cancer may be detected by an abnormal digital rectal exam (DRE) or urinary symptoms. Symptoms may include blood in the urine or problems with urination. Not all local prostate cancers are the same. Some will not cause problems, while others are clinically significant and require treatment.

Even among clinically significant cancers, there are differences that further separate the various types. For example, low, intermediate and high-risk prostate cancer. Factors that determine the risk and clinical significance of prostate cancer include:

• PSA
• Gleason grade and disease stage

Following treatment, approximately 15% to 25% of patients with early-stage or localized prostate cancer experience a recurrence, indicating possible need for additional therapy. However, the overall 5-year survival for patients with localized prostate cancer is close to 100%.

Advanced prostate cancer

About 10% of prostate cancers are diagnosed at an advanced stage. This means that there is involvement of surrounding structures, spread to lymph nodes or metastasis to distant sites. Advanced prostate cancer causes symptoms that may include blood in the urine, urinary obstruction or bone pain.

Treatment options for patients with metastatic prostate cancer are more limited, although in some settings, surgery or radiation therapy may still be indicated. More commonly, androgen deprivation therapy (ADT) or hormone therapy is used to control metastatic disease and slow the growth of advanced prostate cancers. Chemotherapy may also be used to manage patients with metastatic prostate cancer, although it is not a mainstay of management.

Common sites of metastatic spread include the bone, liver and lungs. The overall 5-year survival for regionally advanced and metastatic prostate cancer is approximately 32%.

At BOBÌåÓý, we have a high-skilled and specialty-trained team to treat our prostate cancer patients. Medical oncologists work in tandem with our urologists, pathologists and radiation oncologists to manage individualized treatment plans for all of our prostate cancer patients.

What are the treatment options for prostate cancer?

If the prostate cancer is:

• Aggressive (has a high chance of spreading)
• Isolated to the prostate

It is called clinically significant localized prostate cancer.

There are several effective treatments for men with this condition. Some options, other than active surveillance, include:

• Robotic prostatectomy: This is a type of laparoscopic surgery where a surgeon uses the assistance of a robot to help remove the prostate and nearby tissue. The robot provides better visualization and greater precision during surgery. These benefits can help lower the chances of side effects like urinary problems or erectile dysfunction. Robotic prostatectomy is the gold-standard of prostate cancer removal surgery. Depending on the grade of the cancer and cancer location, the surgery may be able to be nerve-sparing.
• Focal therapy: This treatment effects just the cancer in the prostate, not the whole gland. It has a lower risk of side effects. 6-12 months after treatment, doctors check to see if the treatment was successful. They will look at urine samples, take images, and take a biopsy. Some types of focal therapy are:
  • High-intensity focused ultrasound (HIFU): This treatment uses sound waves to destroy cancer cells. HIFU can be performed as an outpatient procedure. It can be a good option for men who are not candidates for surgery or radiation therapy.
  • Cryotherapy: This focal therapy freezes the prostate to destroy cancer cells. It is guided by ultrasound. Cryoprobes are placed that freeze and thaw the prostate tissue. Cryotherapy can be a good option for men who are not candidates for surgery or radiation therapy. This therapy is also called cryoablation.
• Radiation Therapy: Radiation therapy is a common therapy for localized prostate cancer. There are different types:
  • External beam radiation therapy (ERBT): High-energy radiation is externally targeted at the cancer. The radiation is while avoiding healthy tissue.
  • Prostate Brachytherapy
  • Intensity-modulated radiation therapy

What treatment is right for me?

We recommend a treatment based on several factors, including:

• The characteristics of your disease
• What your category of risk is for the treatment
• Whether you are a suitable candidate for a particular treatment, and
• Your preference as the patient

In some low to intermediate-risk prostate cancers, a single treatment may be recommended. For others, a combination of treatments may be required.

For low-risk prostate cancer and among older men, active surveillance is another management option.

What are the potential risks of prostate cancer treatment?

Although effective in cancer control, most prostate cancer treatments carry some risk. Treatment can impact urinary, sexual and bowel health. Newer treatment methods work to lessen these risks. These methods include nerve-sparing radical prostatectomy and focal therapy.

How to lower your risk of prostate cancer

There is no guaranteed way to prevent prostate cancer, but there are some things you can do to reduce the risks.

If you have any concerns, talk to your doctor about a prostate cancer screening. Men normally start prostate screening around age 50. For men who have a family history of prostate cancer or are African American, screening should start at age 40.

Associated locations

Initial consultations with the BOBÌåÓý Urologic Cancer Center are held at the BOBÌåÓý Urology practice, located on the third floor of BOBÌåÓý Medical Plaza.