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Dr. Harold Tsai
Prostate Cancer in and near Florida

Prostate Cancer

Approximately 200,000 men in the U.S. are diagnosed with Prostate Cancer every year.  One in six men will develop prostate cancer in his lifetime.  The PSA (Prostatic Specific Antigen) is a blood test which can identify which men are at risk of prostate cancer.  It is not a cancer test nor does it mean that a man will ultimately develop prostate cancer if it is high or abnormal.  When a PSA is elevated, prostate cancer, prostate enlargement, and prostate infection or inflammation, and difficulty emptying the bladder are potential causes. 


We do not know what exactly causes prostate cancer but there have been evidence that diet high in animal fats can be a risk factor for prostate cancer.  Prostate cancer begins in the cells of the prostate.  Most prostate cancer cells are slow growing and may take years to become aggressive. 


Prostate cancer is a silent disease and there are no symptoms in the majority of patients.  An elevated PSA is the first sign or clue that there may be presence of cancer.  When the cancer has spread to the bone, spine, hip or pelvis then there is bone pain.


The PSA blood test identifies which man should undergo further testing. For most men, a PSA above 4 is considered abnormal.  However, men 65 years and younger, a cutoff of 2.5 is now being used.  A digital exam of the prostate is performed but is usually normal.  The definitive procedure is a prostate ultrasound and biopsy.  This is performed in the urologist’s office.  A local anesthetic is used to numb the prostate and 12 specimens are then taken from different regions of the prostate.  There are different grades of prostate cancer and this is referred to as Gleason score or grade.  The higher the grade, the more aggressive the cancer.


Treatment options include surgical removal called radical prostatectomy.  There are different ways to remove the prostate based on the surgeon’s preference.  For men who do not wish to have surgery or who cannot have or tolerate surgery, radiation treatment would be a good alternative.  There are different types of radiation which range from seed implant to high dose radiation. 
Prostate cryotherapy is usually reserved for men who are older and do not want radiation or surgery.  Also cryotherapy is the ideal treatment for patients if they fail radiation treatments.  (www.galil.com)
Hormonal therapy consists of routine injections in the office which will lower the testosterone levels and keep the prostate cancer in check.  This is not a cure but will lower the PSA.  It is ideal in men who are elderly, not good candidates for surgery or radiation.
There is also immune therapy available now for men who have failed primary therapy whether it is surgery or radiation.  Usually the PSA is rising and there is slight pain and spread to other organs.  This treatment is called Provenge (www.dendreon.com).  This uses the patients own blood and immune agents are added and then infused back into patient as an outpatient.
High-Intensity Focused Ultrasound is not yet FDA approved but is another way to treat prostate cancer without using surgery or radiation (www.sonatherm.com)
Chemotherapy is usually reserved for men who are diagnosed with advanced disease and not considered curable by surgery or radiation.
Watchful waiting is ideal for men who are 75 or older and most likely will outlive their prostate cancer and potentially have more medical problems and issues which have higher priority.


Prevention of prostate cancer starts by getting routine prostate exams, PSA blood tests and eating healthy.  Many men who are on hormonal treatment for prostate cancer can develop osteoporosis (thinning of the bones) and require supplementation with calcium and vitamin D.  Antioxidants such as selenium and vitamin E have been shown to be helpful.  Diet and nutrition are very essential in prevention of any cancer but especially in prostate cancer. 

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