Prostate Cancer Diagnosis and Treatments

Emory Urology's extensive experience in minimally invasive surgery makes us one of the nation's busiest laparoscopic (and now robotic) academic centers. The da Vinci robot is an extension of laparoscopic surgery that allows greater high definition magnification and greater precision when treating prostate cancer.

An abnormal age-adjusted prostate specific antigen (PSA) test or abnormal digital rectal (DRE) exam should be followed by a biopsy of the prostate cells to determine whether they are in fact cancerous. A biopsy is a procedure in which a sample of tissue is taken from the prostate and then viewed under a microscope to check for abnormalities. In some patients a high normal or borderline PSA may also warrant a biopsy, especially if it is accompanied by changes in urinary or sexual function. Occasionally, patients with extremely elevated PSA also report bone pain and have abnormal bone X-rays indicating extra bone growth, or osteoblastic metastases. This situation also requires a biopsy of the prostate.

Before the biopsy, the doctor will prescribe antibiotics to reduce the risk of infection. The biopsy itself is performed by a urologist on an outpatient basis and usually takes a little more than half an hour. After the patient receives an enema and the area is numbed, a transrectal ultrasound (TRUS) probe is inserted into the rectum. The TRUS allows the urologist to view the prostate. A fine-gauge biopsy needle is then used to remove several samples of tissue from various areas of the prostate gland. The tissue samples are then sent to the lab for analysis. Although the procedure may cause some discomfort or pain, the process is generally well tolerated. For a few days after the procedure, the patient may feel sore and notice blood in the urine and light bleeding from the rectum. Your doctor may also use other prostate cancer diagnostic tools, such as ultrasonography.

Robotic Prostatectomy

Robotic prostatectomy is the latest minimally invasive surgical option for prostate cancer. Robotic prostatectomy includes complete removal of the prostate, lymph nodes (if necessary), and reconstruction. Robotic prostatectomy requires five to six small (1/4 inch) muscle-splitting incisions. Patients are less likely to need a blood transfusion, often require less pain medication, and are usually discharged one to two days after surgery.

Radical Prostatectomy Interstitial Radiation or Seeds (Brachytherapy)

Brachytherapy, also referred to as seed implantation, is a type of internal radiation therapy used to treat prostate cancer. The radioactive material or source is placed directly inside the prostate.The exact dose of radiation is determined so that the cancer cells get enough radiation, but the surrounding normal tissue does not. Brachytherapy may be used alone to treat low risk prostate cancer, or in combination with external radiation for intermediate or high risk prostate cancer.

External Beam Radiation

Radiation therapy is one of several methods used to treat cancer. The radiation comes from beams of high-energy waves or from streams of radioactive particles. Using specialized equipment and materials, radiation from these beams and particles targets cancer cells in order to kill them or stop their growth and spread. Normal cells are also affected by radiation so to protect them the amount of radiation that is given is limited over time. Normal tissue cells are shielded as much as possible during the treatment. The rectum, which is just behind the prostate, is the structure that limits the total dose of local prostate radiation that can be delivered over one's lifetime.

Adjuvant Hormonal Therapy

Hormone therapy is used to treat prostate cancer by reducing the levels of male hormones, known as androgens, in the body. Most prostate cancers need testosterone, one of the primary male hormones, to grow. By lowering androgen levels, doctors can often shrink prostate prostate cancer; but it can shrink a tumor's size.

The Emory Department of Urology is affiliated with The Winship Cancer Institute of Emory University, Georgia's only National Cancer Institute-Designated Cancer Center and serves as the coordinating center for cancer research and care throughout the Emory University system. With NCI Designation Winship joins an elite group of 65 cancer centers in the United States to have earned this coveted status.

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