Comprehensive Prostate Program

It is estimated that prostate cancer will affect 1 in 6 American men. After skin cancer, it is the most common cancer and is the second leading cause of cancer death in men. About 230,000 men are diagnosed with prostate cancer annually and about 30,000 men die of the disease each year.

Introduction

I have been diagnosing and treating prostate cancer for over 25 years and in February of 2004 opened Prostate Solutions of Arizona ("PSA"), which is solely dedicated to the diagnosis and treatment of benign and malignant disorders of the Prostate. Over the years I have witnessed great advances in the early diagnosis and treatment of prostate cancer. The Prostate Specific Antigen (PSA) blood test has clearly been the most significant advance in the past 20 years. In addition, improved prostate imaging and biopsy techniques have advanced early detection and earlier treatment for prostate cancer. Most experts therefore recommend annual PSA blood testing and Digital Rectal Examinations (DRE) beginning at age 50 (and earlier for people at increased risk such as African-Americans or those with a family history of prostate cancer). And yet, a more comprehensive approach to prostate health is available.

The Problem

Controversy exists in the urologic community as to what is a "normal" PSA value. It has become clear that "normal" PSA levels are age dependent and that PSA levels can fluctuate dramatically (even from day to day). We also know that PSA "Velocity" (the rate of change in the PSA over time) is an important factor in determining relative risk of prostate cancer and that the "percent free" PSA (the amount in the blood stream that is not bound to other proteins in the blood) is statistically important in determining risk.

In the past, imaging of the prostate has not been helpful in localizing or diagnosing prostate cancer in a large percent of cases. Today we have improved ultrasound equipment including Color Flow Doppler technology, which in some cases can localize cancers in deeper regions of the prostate (such as the transition zone) and therefore may detect cancer earlier. In addition, endorectal MRI scanning with spectroscopy is advancing and promises to be beneficial in the diagnosis of prostate cancer as well as aiding in treatment plan options. I have been using MRI now for several years.

We have long suspected that some forms of prostate cancer are genetic and there is now a simple urine test that can be utilized in select cases to determine if the PCA-3 gene is present in cells from the prostate. Although still controversial, if this gene is present, it appears that there is a significant probability that prostate cancer may be present. Finally, it is quite obvious that men are interested and involved in "alternative" approaches related to prostate health. It has become increasingly common for my patients to inquire as to the potential benefits of diet, vitamins, minerals, supplements, "nutraceuticals", etc. in relationship to their prostate. While many people take various substances on blind faith that they are potentially beneficial, it is important to continue to pursue the science of these issues. For example, I have numerous patients in my practice who take selenium because it may be beneficial in preventing prostate cancer. Unfortunately, high or toxic levels of this may actually be harmful with potential neurological toxicity or DNA damage. High levels might be associated with a higher risk for other cancers, possibly bladder cancer. Currently, there is a simple test (that can be done on a toenail) that can determine one's selenium level. If this level is deficient, perhaps supplementation may be beneficial; however, if high, supplementation could be harmful.

The Solution

Obviously, we have come a long way in the diagnosis and treatment of prostate cancer. My goal is to establish an advanced standard of care for monitoring prostate health, beyond the current PSA and DRE. The Comprehensive Prostate Program™ utilizes state-of-the-art technology and innovative concepts to expand the science related to prostate health. Its goal is to establish "baselines" and to follow one's prostate over years and decades so that the disease may be diagnosed and treated early. Some aspects of the program will be analogous to breast screening with annual mammography, where we have learned that CHANGES from year to year are important in the early detection of breast cancer. Because some of this technology and testing is new, certain aspects of this program have not been tested scientifically. My patients who wish to be involved in this type of program need to be aware that insurance programs may not pay for some of these tests or services. Therefore, the program is ideal for the highly motivated health conscious man who wishes to be proactive with his prostate health.

The Comprehensive Prostate Program™ has been designed as a logical state-of-the-art approach to maintaining one's prostate health. It offers the ability to track one's PSA Velocity, PSA Density, Prostate Anatomy and Benign Prostatic Hyperplasia (BPH) over time and to make educated decisions regarding further evaluation or intervention as needed. More importantly, it is a flexible program that can be modified to best serve the needs of each individual patient.

Risk Factors

Family History of Prostate Cancer

If one brother has prostate cancer your risk is 2X average.
If one brother and your father have prostate cancer, your risk is 5X average.
If two brothers and father (or three brothers) have prostate cancer, your risk is 11X average.

African Americans

African Americans have a higher incidence of prostate cancer compared to Caucasians.

Common Diagnostic Tests and Terminology

TRUS
Transrectal Ultrasound of the Prostate
(Digital Color Flow Doppler Technology employed).

TRUS/NBP
Transrectal Ultrasound with Needle Biopsies of the Prostate

MRI
Endorectal MRI with Spectroscopy

PSA Velocity
This is a measure in the rate of change of PSA over time. A PSA increase of greater than 0.75/yr is abnormal and may be an indication for TRUS/NBP or other diagnostic tests.

PSA Density
The PSA level per unit volume of prostate tissue.

Genetic Studies
The uPM3 test is utilized in patients with previously negative biopsies to help determine if further biopsies are indicated.

Upon request, patients will be given copies of digital studies such as TRUS' and MRI's for their records.