All of our urologists at Urology Specialists of Oregon have expertise in diagnosis and management of prostate cancer. Our practice employs advanced techniques for diagnosis and management of prostate cancer including MRI-guided biopsy, genetic testing and robotic surgery. Dr. Simmons has extensive experience and expertise in robotic prostatectomy. Since 2004 he has been involved in over 400 minimally-invasive and robotic prostatectomy surgeries. He has conducted over 300 of these surgeries in Bend. His outcomes for these surgeries have been published and rival those of the best surgeons nationwide.
Prostate cancer is detected with either a blood test called “PSA” or with a prostate exam. PSA detects a protein in the blood that is produced by prostate tissue. PSA values depends on a man’s age, but a level higher than 4ng/dL is generally considered abnormal. We extensively employ genetic testing to determine need for biopsy. Ultimately, results of a prostate biopsy are used to make a diagnosis.
The biopsy pathology report provides information about the “Gleason score,” the amount of cancer and the location of the cancer. This information along with your PSA level and individual health status factors into the decision of how to treat the disease.
The goal of treating prostate cancer is to prevent death due to metastatic disease. Some prostate cancers need treatment, and others do not. The decision to treat is complex and involves an in-depth discussion with your urologist.
Low risk prostate cancer (Gleason 6 and PSA <10) usually progresses very slowly and poses low risk for metastasis. Most men with low risk disease opt for treatment, and
cancer control is excellent. Select patients choose to undergo active surveillance. It involves a repeat biopsy every 18-24 months. If cancer detected on a repeat biopsy is more severe than on the initial biopsy then the patient moves forward with treatment. The advantage of this approach is that some men are spared the side effects of treatment. The disadvantage is that there may be disease present that the biopsy didn’t detect, and there is risk of disease progression during the surveillance period. Close follow-up in this process is critical.
There are two time-tested data-proven methods for treating prostate cancer. The first treatment is surgical removal of the prostate or “prostatectomy.” The second is radiotherapy. State of the art care for both of these treatments are available in Bend.
Prostatectomy involves removal of the prostate, the seminal vesicles, and in some cases the pelvic lymph nodes. Most patients stay overnight in the hospital and return home the following day. A catheter remains in place for one week. Typical full recovery is 4-6 weeks.
Most men in the immediate weeks after surgery will have a small degree leakage with activity, coughing or sneezing. By 6-12 months the amount of leakage tends to be minimal. Continence improves for up to 18 months after surgery. If bothersome incontinence persists after 18 months it can be effectively treated. Men are instructed to perform Kegel exercises which help strengthen the pelvic floor muscles. Formal pelvic floor physical therapy is available locally in Bend.
This is a complicated topic and depends on several factors such as age, presence of erectile dysfunction before surgery, and whether a “nerve-sparing” was able to be conducted. In men with good erections before surgery who undergo nerve-sparing prostate surgery, most will regain good function. A smaller percentage will have a decrease in function that can usually be managed with medication. In men with pre-existing erectile dysfunction, or in those without nerve-sparing the success rate tends to be lower.
External beam radiotherapy (EBRT) involves radiating the prostate using a focused beam of energy. Most patients who undergo this treatment receive daily treatments for several weeks. The main advantage of EBRT is that it provides effective control of intermediate and high risk cancers without the need for surgery. This type of treatment is managed by a radiation oncologist.
After surgery the PSA should decrease to undetectable levels and should remain there. An increase in PSA after surgery is termed “biochemical recurrence.” When the PSA reaches a level of 0.2ng/dL, then it is assumed that the cancer has returned. Imaging studies are conducted to make sure that there is no metastasis. If this is the case, and the disease is confined to the pelvis, then it is often possible to successfully treat this with radiation.
If you have any questions, contact Urology Specialists of Oregon at (541) 322-5753.