Prostate Cancer

The Prostate is a male reproductive gland which primarily functions to store and produce seminal fluid, the fluid which transports sperm. Often described as “walnut sized,” it is located above the base of the penis, below the bladder and in front of the rectum.

Prostate cancer is a malignant tumor that consists of cells from the prostate gland. As the cancer grows, it can spread beyond the Prostate into the surrounding tissue or to distant parts of the body such as the bones, lungs and liver. Besides being potentially life-threatening, a Prostate Cancer diagnosis can be frightening as various treatments can result in side effects like incontinence and impotence.

According to the American Cancer Society, the leading location of cancer in men is the Prostate. With the advent of PSA testing and early detection, death rates from Prostate Cancer have declined. Still, Prostate Cancer is the second-leading cause of death in men. Obtaining the best care possible (yearly digital rectal exam and PSA screening) is important.

Cure and survival rates vary, depending on the progression of the disease at the time of diagnosis and response to treatment. The combination of early intervention, advanced treatment technologies and skilled doctors helps many Prostate Cancer patients find successful treatment and cure.

Symptoms & Diagnosis

Early detection of prostate cancer is key to successful treatment. However, at first, the disease often presents no symptoms. Since the following symptoms could be cause for concern, bring them to the attention of your Urologist:

  • Trouble urinating
  • Frequent need to urinate, especially at night
  • Painful or burning urination
  • Blood in your urine or semen
  • Pain or discomfort in lower back, hips or upper thighs
  • Swelling in your legs
  • Bone pain that doesn’t go away

To determine whether you have a benign Prostate condition or Prostate cancer, your doctor is likely to conduct some combination of the following tests:

  • A Digital Rectal Exam to find any abnormalities in the size, texture or shape of your gland
  • Blood tests to measure Prostate Specific Antigen (PSA) and Prostatic Acid Phosphatase (PAP)
  • A urine test to detect blood or infection
  • A Transrectal ultrasound which uses sound waves to produce an image of your Prostate gland
  • A biopsy to sample very small amounts of tissue from your Prostate gland

Treatment

When you are diagnosed with Prostate Cancer, your Urologist may recommend radiation therapy or radioactive seed implants to kill cancer cells. Both methods can be very effective but can have unpleasant side effects including urinary, bowel and sexual problems. Nonetheless, radiation plays an important role in the treatment of appropriately selected patients.

Another option is hormone treatment to block production of testosterone, which stimulates Cancer growth. Hormones can slow Cancer’s progress but alone are not a cure for Prostate cancer in the long run. The disease can adapt to the body’s lack of testosterone over time becoming virtually immune to the therapy. Side effects range from reduced sex drive and erectile dysfunction to nausea, diarrhea or fatigue.

Alternatively, many physicians refer their patients to the NJ Center for Prostate Cancer & Urology which specializes in the most advanced treatments and technologies currently available for Prostate Cancer, in particular, Robotic Prostatectomy utilizing the da Vinci Robot.

Traditional open prostatectomy requires a large incision to provide the surgeon access to, and vision of, the Prostate gland as well as surrounding organs, nerves and blood vessels. A robotic radical prostatectomy allows the meticulous removal of your cancerous prostate gland, while sparing nerves needed for erection and significantly decreasing the chance of urinary incontinence.

The world-renowned Drs. Vincent Lanteri, Michael Esposito, Mutahar Ahmed, and Gregory Lovallo pioneered this minimally-invasive surgery which offers you many additional advantages over older treatments. NJCPC&U offers:

  • Smaller, more precise incisions minimize the amount of tissue exposed, thus reducing the risk of infection.
  • It is essentially bloodless surgery and transfusion-free.
  • Most procedures are completed in less than 2 hours and require only a 1-day stay in the hospital for post-operative care (NJCPC&U average stay = 1.025 days).
  • The patient experiences less pain, less scarring and a quicker return to normal activities.
  • Nerve-sparing preserves erectile function (NJCPC&U ED rate = 15%).
  • Patients gain rapid urinary control with less incontinence (NJCPC&U incontinence rate = 2.2%).
  • And most importantly, the results are an equal or improved Cancer cure rate when compared to published data on open and laparoscopic radical prostatectomy.

Cryotherapy is an innovative, minimally invasive procedure for treatment of prostate cancer which uses ice to destroy cancer. Temperatures of -20 to -40°C are instantly lethal to cancer, resulting in immediate cancer cell death. Cryosurgery is approved by Medicare as a primary treatment for prostate cancer. It’s also approved for prostate cancer that recurs after radiation therapy. Prostate cyrotherapy is an excellent option available for cure after radiation failure beyond palliative hormonal therapy or potentially difficult, higher risk post-radiation radical prostatectomy.

Prostate cancer cryotherapy provides an option for a patient not willing or able to tolerate an open surgical technique or radiation/seed therapy. Recovery times tend to be shorter and the cancer-free survival rates are equivalent to surgery and to radiation in properly selected patients.

The procedure involves no incisions, takes 1-2 hours to perform and most patients go home the same day or the next day. Patients are discharged home with a urinary catheter which is removed in the office within 4-5 days.

Patients can expect modest side effects including moderate pelvic pain, blood in the urine, scrotal swelling, mild urinary urgency and occasionally, urinary retention. In most cases symptoms resolve in 1-2 weeks. Follow up care after Cryotherapy is important. Appointments should be kept and the PSA should be repeated every 3-6 months.

Post-operative Sexual Function

It’s a terrible decision to have to make – to pursue life-saving prostate cancer treatment at the risk of erectile dysfunction. However, the emergence of the Robotic Prostatectomy and the Center’s expertise in the procedure, offer new hope for successful outcomes on both fronts. The most important factor in sexual function after Prostate Cancer surgery is whether the surgeon is able to spare the nerves around the Prostate during the procedure. The highly skilled surgeons here at the Center have an unprecedented level of dexterity and precision available to them thanks to the da Vinci Robot. As long as the Cancer is not extending outside the prostate, the cancerous gland can be removed while preserving the nerves, without compromising cancer cure.

Without complications, complete sexual function should return within 12-24 months. Age and previous level of erectile function are factors in future sexual function. There are a variety of medications and devices which can help achieve an erection in the case of erectile dysfunction. After Robotic Prostatectomy, most men will resume a satisfactory sex life.

Post-operative Care

Since Robotic Prostatectomy is minimally-invasive, post-operative pain is much less acute than with open surgery. Patients do receive pain medication but a somewhat more common complaint is a gaseous, distended feeling in the abdomen. Some patients experience bladder spasms which can also be treated with medication. Generally, without complications and under typical nursing observation, the patient needs minimal after-care and can go home within 24 hours. Rest and gradual resumption of normal activities is recommended.