Dr. John Lynch: Prostate Cancer and the Latest Treatments - [Video Transcription]

  1. Who should be screened?
    In general, we believe that men over the age of 50 should be screened for prostate cancer. The exceptions to that would be men who have a family history of prostate cancer or African-Americans. At that point, the screen should start over the age of 40. By screening, we mean both the PSA (blood test) and digital rectal exam. It is extremely important that they have both every year.
  2. What do the tests involve?
    The testing involves first the blood test (prostatic specific antigen). It is taking a very small amount of blood from a vein in your arm. The second test is called the DRE or digital rectal exam. In that test, the doctor feels the back portion of the prostate.
  3. What is an elevated PSA level?
    The definition of an elevated PSA has changed over the last several years. We used to think that anything over 4.0 was abnormal. Now, we think that anything above 2.5 is abnormal.
  4. Why has the accepted "normal" PSA level changed?
    A study was done in which men with PSAs between 2.5 to 4.0 underwent biopsies. About 25% of those patients were found to have cancer.
  5. What do you do if there's an elevated PSA?
    A study was done in which men with PSAs between 2.5 to 4.0 underwent biopsies. About 25% of those patients were found to have cancer.
  6. What does a biopsy involve?
    In general, biopsies are done under local anesthesia as an outpatient in the office. The procedure takes about 5 to 10 minutes and is mildly uncomfortable. It involves an ultrasound examination of the prostate with a probe that is placed into the rectum. Then utilizing that gun, we have a
  7. What if there's an increased PSA but biopsy is negative?
    If you have an elevated PSA, but the biopsy is negative it doesn’t necessarily mean that there is cancer there. Not every biopsy is 100% accurate. It is possible to miss some early cancer on the first biopsy. We generally recommend that men have their digital rectal exams and PSAs checked at more frequent intervals than normal yearly screenings. By more frequent, I mean every three to six months. We are looking to see if there are any changes in either the blood test or the rectal exam.
  8. If a patient has prostate cancer how do you determine the best treatment option?
    The best treatment option for prostate cancer depends in great measure on the age of the patient, the general medical condition of the patient, and such factors as the Gleason Score. The Gleason Score has to do with the aggressiveness of the cancer and that is determined by the pathologist on the biopsy.
  9. How is the gleason score determined?
    The Gleason Score is determined by the pathologist in viewing the biopsy slides. Prostate cancer has a variety of forms to the pathologist when he looks at it. The pathologist picks the most predominant form and gives that a number from one to five and the second most predominant form and gives that a number from one to five. He adds that up to give the Gleason Score. The lower the Gleason Score the less aggressive the prostate cancer. The higher the Gleason Score the more aggressive the prostate cancer.
  10. What is the typical surgical procedure available?
    The most common surgical procedure that is done today to treat prostate cancer is called a radical retropubic prostatectomy. There are a variety of ways to perform this procedure. One is through a standard incision and the other is laparscopically with a robotic device. They each have advantages and disadvantages. So in the individual patient, one may be recommended over another.
  11. What is the recovery after prostate cancer surgery?
    Patients who undergo prostate cancer surgery are generally in the hospital for one to two days. The catheter is generally left in the bladder from seven to ten days. Once the catheter comes out, every patient is incontinent. It can take weeks to months to recover their continence or the ability to control urination. Most men are out of work about three weeks after prostate cancer surgery.
  12. Talk about surgery vs. radiation?
    Surgery is generally recommended for men with prostate cancer if they are young, healthy, have a greater than ten years of life expectancy, and if the disease is confined to the prostate.
  13. When is radiation recommended?
    Radiation is generally recommended for older men who may have prostate cancer even if it is localized or for younger men who may have some medical conditions that would make surgery difficulty. Certainly if there is a high risk of locally advanced disease, then radiation would be the preferred choice over surgery.
  14. How do I figure out which treatment is best for me?
    There are many treatment options available for patients with prostate cancer. No one individual can say that this specific treatment is the best for each patient. So, the patient really does have treatment options to choose from. It is important that they get as much information about those different treatment options and talk to specialists.
  15. What is the advantage to the multi-disciplinary team approach offered at Georgetown University Hospital?
    The advantage of our multidisciplinary clinic is that patients have the opportunity to see not only the urologist, but the also the radiation oncologist and the medical oncologist if indicated. So, they can basically see all three specialists in one visit.
  16. Do other centers use this kind of teamwork?
    I think we are unique in the Washington metropolitan area for providing this service to patients.
  17. What is the outlook for fighting prostate cancer?
    The diagnosis of cancer is frightening for any patient especially for young men or any man because most men with prostate cancer who are diagnosed have absolutely no symptoms. They feel very healthy. So, they are very much afraid of how can I feel healthy on one hand and have a doctor tell me that I have cancer on the other. The diagnosis of prostate cancer is not a death note. Most prostate cancers are diagnosed in the early stages when cure is highly likely. Even when it is advanced, prostate cancer is clearly treatable.
  18. How much progress has been made in the area of prostate cancer in recent years?
    There has been a tremendous amount of progress in prostate cancer over the years and we can see that by the death rates. Back in the late eighties and early nineties about 42,000 to 43,000 men a year died from prostate cancer. That number is now down to about 27,000. Why that drop has occurred has been the result of PSA screening and testing. We now have the ability to diagnose prostate cancer three to five years earlier than we could before. We have better treatment options in terms of surgery because the complications and side effects are significantly improved over what they were ten to fifteen years ago. We have new and better forms of radiation such as the CyberKnife that allows a higher dose of radiation to be delivered to the prostate with less scatter effect and therefore less complication in a much more convenient fashion. Instead of forty days, it is five days.