The Hubbard Clinic Center for Bladder Control: Louisville, Ky

The Condition
The Diagnosis
The Treatment

Prostate cancer is the transformation of normal glandular cells to malignant cells that multiply and spread to other areas of the body. It is the most common form of cancer in men. It is found in 8% of men in their 20s and 80% of men over 80.

African-American men, more than any other racial or ethnic group, are at greater risk for prostate cancer. Some studies have indicated that men who have high-fat dietsand/or are obese are also at greater risk.

How serious is it? There are 226 prostate cancer deaths for every 100,000 men,so a man has only a 0.2% chance of dying from the disease. Most men die with the disease, not of the disease.

A common misconception is that men with prostate cancer have symptoms. Usually, they don’t. Many patients are shocked to learn they have the disease because they have no symptoms whatsoever. That is why regular testing for the disease is recommended.

Testing for prostate cancer includes a PSA (prostate-specific antigen) blood test and digital rectal exam. Men should be screened for prostate cancer beginning at age 40. We then recommend being re-tested at age 45, and then yearly from age 50 on. This puts together a long PSA history and provides much more information about when a rising PSA is significant.

It is very helpful to have several PSAs and not make a diagnosis on just one. An elevated PSA doesn’t necessarily mean you have cancer, either. It could be elevated from benign enlargement or prostate infection.

Many doctors consider a PSA below 4 to be normal. This is a good guideline, but not always absolute. Benign enlargement is the most common reason a PSA is elevated. The PSA and size (volume) of the prostate are related. In very rough terms, the prostate volume and PSA are a 10-1 ratio. A prostate size of 40 grams equals to a PSA of 4, 50 grams = 5, 60 grams = 6 and so on. Some men have PSAs over 20 because their prostate is over 200 grams in size.

A very reliable indication of cancer is what we call PSA velocity, or how much the PSA should go up in a year’s time related to benign growth of the prostate. For example: a man has a PSA of 1, then the next year has a PSA of 3 – the value is under 4, but the fact that it went up two points in a year could be significant. We would repeat the PSA test and, if it is still up, do a biopsy. The vast majority of our patients have what we call “yo-yo” PSAs, meaning they go up and down. We can be fairly comfortable it doesn’t mean anything bad if we have several years of PSAs as a basis of comparison.

Prostate cancer is discovered by an abnormal PSA 80% of the time. The other 20% of the time, prostate cancer has a normal PSA, and is then only discovered by identifying a hard area of the prostate on a digital rectal exam.

Once cancer of the prostate is diagnosed, there are several treatment options available, each with its advantages and limitations.

Dr. Hubbard has a great deal of experience and success with a procedure known as Prostate Seeding. The procedure is easy on the patient, and excellent at cancer control. Dr. Hubbard has performed over 120 seedings since in 1997.

The procedure is performed on an outpatient basis, with anesthesia. Anywhere from 70-120 radioactive “seeds” are placed in the prostate. These seeds omit radioactivity over the next four months, killing all the glandular cells which can change to cancerous cells.

Men can resume normal activity the day after the procedure. Common after-effects include frequency and urgency of urination for up to six weeks. Some patients develop a burning sensation when urinating. About 50% of men have some decline in sexual function, but not nearly as severe as after radical surgery. (The Hubbard Clinic refers radical prostate surgery to a trusted local physician, who will remove the prostate laparoscopically.)