Prostate cancer

Prostate cancer (PCa) is cancer that begins in the prostate. The prostate is a small organ that plays a role in a man’s reproductive system. A normal prostate is the size of a walnut. It wraps around the urethra (the tube that carries urine out of the body). If the prostate begins to grow it may eventually reduce the ability for urine to leave the body. This is felt as a weak stream, frequent need to urinate or the “gotta go, gotta go” feeling. An enlarged prostate is common among all men as they age. This is called Benign Prostate Hyperplasia or BPH. BPH does not indicate prostate cancer. BPH can also cause nocturia, which is the need to void during your normal sleeping hours.

Prostate Cancer is the most common cause of death from cancer in men over 75 years of age. Prostate cancer is rare in men under the age of 40.

Risk factors include:

  • African-American men
  • Men older than 60
  • Men with a family history of prostate cancer (father, brother)
  • Men who have had exposure to agent orange
  • Men who use alcohol to excess
  • Farmers
  • Men who eat a high fat diet – especially those who eat a lot of animal fat
  • Tire plant workers
  • Painters
  • Men exposed to Cadmium

Prostate cancer is less common in people who eat a vegetarian diet.

Because PSA screening is typically performed on men 40 years of age or older, most prostate cancer is found before any major symptoms are noted. However, if you have not had a PSA test and have any of the following symptoms you may want to talk to your primary care physician or make an appointment with a urologist. These symptoms include:

  • Delayed or slow start of urinary stream
  • Dribbling or leakage of urine, most often after you’ve finished voiding
  • Slow urinary stream
  • Straining when urinating or not being able to completely empty your bladder
  • Blood in the urine or semen
  • Bone pain or tenderness most often noted in the lower back and pelvic bones. This can be a sign that the cancer has spread.
Diagnosing Prostate Cancer:

Prostate-specific antigen (PSA) level is determined through a blood test. PSA is found in cancerous and non-cancerous prostate tissue. PSA helps liquefy semen. A small amount of PSA in the blood stream is normal. Prostate cancer often causes a higher PSA level. But PSA levels can be high in men who have BPH or have prostatitis (infection of the prostate) so the PSA blood test on its own is not an indicator of prostate cancer.

Digital rectal exam. This exam allows the physician to feel the prostate to see if it is of normal size, has hard, lumpy or abnormal areas.

Prostate Biopsy which is a procedure performed in the office under local anesthetic using a finger like probe which is placed in the rectum. A fine needle is placed through the probe and 8-12 biopsies are taken. The procedure takes about 30 minutes. Results take 5 business days.

Treating Prostate Cancer:

The treatment plan will be determined on a variety of things; including the biopsy results (Gleason score), your age and overall health. Treatment for early stage prostate cancer may include, medical monitoring with scheduled PSA and biopsy tests, surgery (prostatectomy – radical, perineal, robotic); radiation which may include brachytherapy or proton therapy. If the cancer has spread treatment may include hormone therapy, surgery, chemotherapy.

All treatments come with some side effects. The side effects of prostate cancer treatment can include a decrease in sexual desire, sexual performance and problems with urinary control. These issues should be discussed with your surgeon. Following the treatment for prostate cancer you will need to be medically monitored to make sure the cancer does not spread. Follow up care involves routine office visits with PSA blood tests. These repeat PSA blood tests are usually scheduled at intervals of 3 months to 1 year.


Surgical Approach to Prostate Cancer

General Overview:

You’ve been diagnosed with prostate cancer and your treatment plan involves a prostatectomy. Here is some information to help you through the recovery period.

There are several prostatectomy surgical approaches. They include, radical laparoscopic, radical perineal and robot assisted. Dr. Downey performs the radical perineal approach. The radical perineal approach reduces surgical times and associated risk of complications especially in men who are obese or have had prior abdominal surgery. It allows for low blood loss, low post-operative use of narcotic pain medications, shorter hospital stays and requires only 1 incision.

Robotic assisted prostatectomy has similar benefits to the perineal approach but some studies show more problems with post-surgical issues such as impotency and urinary incontinence.

What to avoid after surgery:

Any activity that will put stress or strain on your incision site. Even every day activities such as lifting tools or groceries and toileting can cause problems.
Do not strain to have a bowel movement and avoid constipation (refer to the post-operative bowel program).
Place a pillow or your hand over your lower abdomen or incision area before coughing or sneezing to counteract the intra-abdominal pressure
No lifting over 10 pounds for the 1st four (4) weeks following surgery. You can gradually add weight after the 4th week. Use proper body mechanics when lifting (keep your back straight and your knees bent, keep the object you’re lifting close to your center of gravity (belly button) and lift with your legs NOT your back.
Sexual activity for four (4) weeks following surgery

Activities you can do to help improve your outcomes:
  • Pelvic floor exercises starting before surgery. These exercises help strengthen the muscles that support your internal organs. We recommend 2-3 appointments with Nora Biechele, PA-C to make sure you’re identifying the correct muscles and doing the exercises correctly.
  • Maintain good posture. It’s often common to lean forward after any kind of abdominal surgery. Below is a general posture exercise – do this 3-5 times at least 2-3 times each day.
  • Stand against a wall with your knees slightly bent
  • Place your arms in a “hold up” position or in the shape of a goal post
  • Perform a pelvic brace by contracting your pelvic floor and lower abdominal muscles together
    While in this position, slide your hands up toward the ceiling being careful not to let your arms come away from the wall
  • Repeat this exercise 3-5 times
  • Add back physical activity slowly. (i.e. if you regularly run 3 miles a day, start with 1 mile and work up).

If any activity causes pain STOP the activity immediately.


PROVENGE® treatments for Prostate Cancer

Urology Northwest is the first urology office in Washington to offer prostate cancer patients one of the latest advances in treatment options, the first-in-class immunotherapy, PROVENGE® (sipuleucel‑T). PROVENGE is the only FDA-approved treatment for certain men with advanced prostate cancer that uses the patient’s own immune system to fight the disease. PROVENGE is designed to stimulate a patient’s immune system to identify and target prostate cancer cells. Each dose is manufactured specifically for each patient using his own immune cells.

PROVENGE is not a chemotherapy drug and is different from hormone therapy which decreases the level of testosterone in the body. PROVENGE is an immunotherapy that works by stimulating the natural ability of immune cells already in the patient’s body and may help patients live longer. A typical PROVENGE course of treatment can be completed in about a month, and the most common side effects are primarily mild or moderate.

You can download A Prostate Cancer Fact Sheet from Dendreon (the developer of PROVENGE®), and you can of course contact our office for answers to your questions.

Indication and Important Safety Information

PROVENGE® (sipuleucel‑T) is approved by the FDA as an autologous cellular immunotherapy for the treatment of asymptomatic or minimally symptomatic metastatic castrate resistant (hormone refractory) prostate cancer.

PROVENGE is made from a patient’s own immune cells. The patient’s cells will be collected at a cell collection center approximately 3 days before each scheduled infusion of PROVENGE. There can be risks associated with the cell collection process, which patients should discuss with their doctor before deciding to begin treatment with PROVENGE.

PROVENGE can cause serious reactions. In controlled clinical trials for the treatment of prostate cancer, serious reactions reported in patients in the PROVENGE group include reactions resulting from the infusion of the drug, which occurred within 1 day of infusion, and strokes. Severe infusion reactions included chills, fever, fatigue, weakness, breathing problems (shortness of breath, decreased oxygen level, and wheezing), dizziness, headache, high blood pressure, muscle ache, nausea, and vomiting. Tell your doctor right away if you have breathing problems, chest pains, racing heart or irregular heartbeats, dizziness, nausea, or vomiting after getting PROVENGE because any of these may be signs of heart or lung problems.

The most common side effects reported with PROVENGE are chills, fatigue, fever, back pain, nausea, joint ache, and headache. These are not all the possible side effects of PROVENGE treatment. For more information, talk with your doctor.

For more information on PROVENGE from the manufacturer, please see the Full Prescribing Information at provenge.com or call Dendreon ON Call at 1-877-336-3736.