UROLOGICAL CANCER CMT
NEW BENCHMARKS OF MULTI-DISCIPLINARY EXCELLENCE
APCC radiation oncologists, surgical oncologists, medical oncologists, urologists, and other cancer specialists explore medical and surgical options to ensure the best possible outcome for each patient. Our doctors include fellowship-trained and internationally-recognized leaders in bladder, kidney, prostate, and testis cancer who are supported by an integrated team of experienced nurse practitioners and physician assistants.
While there are many bladder, kidney, prostate and testis cancer treatment options, the experience of the cancer program is also important. APCC surgeons perform robotic and open procedures to treat urologic cancers, often in a multi-disciplinary team approach which may include Medical Oncology and/or Radiation Oncology, Pathology, Radiology, and Anaesthesia.
With a rich history of technical innovations, our specialists have transformed the management of these cancers using advanced surgical techniques such as open partial nephrectomy, laparoscopic/robotic partial nephrectomy, radical nephrectomy and venous thrombectomy for advanced kidney cancer, open/robotic radical prostatectomy and robotic radical cystectomy. We have also been at the forefront of pioneering less-invasive treatment alternatives, where appropriate, for urologic cancers such as active surveillance, cryotherapy, focal therapy for localized prostate cancer, and percutaneous ablative procedures for small renal masses.
APCC has unique expertise in managing rare urologic cancers, such as cancers of the penis, urethra, adrenal gland, and genitourinary sarcomas, and salvage procedures for recurrent cancers of the bladder and prostate that has failed initial therapy with radiation or other treatments.
About Prostate Cancer
The prostate gland is vital cog in the male reproductive system; its primary task is the production of seminal fluids that help protect and transport sperm. Cancer in the prostate is a commonly occurring form of cancer, with a rising global incidence. Prostate cancer begins when healthy cells mutate and proliferate rapidly. This leads to a tumour which could be either benign or malignant.
Prostate cancer exhibits certain unique characteristics – the growth rate of prostate tumours is significantly slower than in the case of other cancers; also prostate cancers are less aggressive in the sense that they rarely spread to other parts.
The Urology CMT at APCC is a highly skilled forum that has expert abilities in the end-to-end care for prostate cancer. Skilled clinicians are very important in the treatment of prostate cancer because there are times when the treatment procedure may cause more discomfort that the disease itself; it becomes critical to have experts to decide when treatment should be pursued and when observation is quite enough. Quality of life, post treatment, is also a key area of concern in prostate cancer – our team of oncologists and allied staff are pushing the envelope to ensure maximum cure with minimum side effects.
Prostate Cancer Risk Factors
Most men who develop prostate cancer are over age 50, and about 2 out of every 3 prostate cancers are diagnosed in men over age 65. The probability of African-American men being diagnosed with the disease is twice as much as Caucasian men.
A family history of prostate cancer, especially including close family members such as father, brother or son, increases your chances of developing the disease. Another known cause is a diet high in fats, particularly animal fats. In order to lower your risk of prostate cancer, one must decrease fat intake and consumption of red meat. A diet rich in fruits and vegetables, regular exercise and a healthy weight also helps lower the risk of prostate cancer.
Most patients have no symptoms to act as warning signs of prostate cancer. However, they can sometimes experience the following:
The patient journey at the Urology CMT starts with world-class diagnostics. A highly skilled team of doctors, pathologists and technicians perform at a multi-stage battery of tests to determine stage and grade of the cancer. Our Diagnostic cycle is made up of three stages :
Prostate-Specific Antigen (PSA) is a protein produced by cells in the prostate gland. In this test, PSA levels are evaluated and the need for further testing can be escalated in the case of elevated levels. Typically, PSA levels are raised when there is abnormal activity in the prostate, including prostate cancer, BPH, or inflammation of the prostate. Our specialists evaluate features of the PSA value, such as absolute level, change over time, and level in relation to prostate size, to decide if a biopsy is needed.
Biomarkers are substances produced by the tumour or by the body in response to the cancer. These are highly prevalent in the blood, urine, or body tissues of a person with cancer. Biomarker tests for prostate cancer include the 4Kscore, which predicts the chances a man will develop high-risk prostate cancer; Prostate Health Index (PHI) is the other marker that is used to investigate and estimate the probability of the person developing prostate cancer.
TRUS aided Biopsy
Transrectal Ultrasound (TRUS) is a rectal probe that uses sound waves to generate a picture of the prostate. It is often used in combination with biopsy tools; these tools extract tiny slivers of tissue from multiple areas of the prostate, which are then investigated in microscopic detail by our pathologists. Biopsy is one of most effective ways to determine the nature of the prostate tumour.
MRI fusion biopsy
In an MRI fusion biopsy, the patient first receives an MRI scan to identify suspicious areas of the prostate that require further evaluation. The patient then has an ultrasound of the prostate. Computer software combines these images to produce a 3D image that helps target the precise area to be biopsied. Once the area is identified, tissue sliver are collected and studied to evaluate the nature of the tumour.
The third stage of testing is done when there is significant grounds to assume that the cancer might have spread to other part of the body (also known as Metastasis). In such circumstances the following tests are done to understand the scale of metastasis.
APCC’s definitive edge in treating prostate cancers comes from our ability to create a treatment tapestry that leverages the strengths and capabilities of a multi-disciplinary team. Our CMT-driven overall treatment plans address every vital facet of prostate cancer care and deliver bespoke, best-in-class care.
Several parameters play a crucial role in drawing up the treatment roadmap. Our prognosis takes into account, the type and stage of cancer, possible side effects, the patient’s preferences and overall health.
If prostate cancer is detected at an early, passive state then a wait and watch approach is often the preferred option. The treatment of the cancer at this stage could lead to larger complications than the tumour itself; this is the reason our team could postpone treatment for later and recommend active surveillance of the tumour. During active surveillance, the cancer is closely monitored for signs that it is worsening. The monitoring routine include regular PSA test, physical examination and a biopsy every 2-4 years.
With watchful waiting, routine PSA tests, DRE, and biopsies are not usually performed. This treatment option is suitable for older men, and those who suffer from other life-threatening illnesses. However, if a patient develops symptoms from the prostate cancer, such as pain or blockage of the urinary tract, then other treatments are recommended.
We use surgery to counter prostate cancer and remove the tumour either through conventional or robotic surgery. At the Prostate Cancer CMT we have highly skilled urologic oncologists to steer the procedure.
This is the surgical removal of the entire prostate and the seminal vesicles. While the surgery eliminates the tumour, it usually has serious effects on the patient’s sexual health. Erectile dysfunction and urinary incontinence are not uncommon after a prostatectomy. Nerve-sparing surgery, which is an advancement, can control the side effects of the surgery.
Robotic or laparoscopic prostatectomy
Robotic/Laparoscopic prostatectomy is possibly much less invasive than a radical (open) prostatectomy and may reduce the time a patient would take to recover. For the surgery, a camera and required robotic instruments are inserted in the patient’s abdomen through a small keyhole incision. The surgeon then directs the robotic instruments to remove the prostate gland, along with some surrounding healthy tissue. When compared to a radical prostatectomy, robotic prostatectomy causes less bleeding and less pain. However, both surgeries have similar sexual and urinary side effects.
The aftermath of the treatment for prostate cancer has traditionally never been very good; most conventional treatment – surgical, radiation or medical – lead to a serious compromise of the quality of life in the long run. Post-treatment emotional has been typically high. Proton Therapy is now changing this. It has emerged a true game-changer in treating prostate cancer.
Proton radiation for prostate cancer delivers precise doses of radiation with a lower risk of side effects. The difference is in the protons themselves. Our oncologists have greater control over the distribution of the proton radiation dose, higher, more effective doses can be used.
Using the Braggs Peak phenomenon we ensure there is no exit dose and a significantly lower entrance dose than conventional X-rays; damage to critical tissue near the prostate is dramatically reduced, which in turns lessens the likelihood of typical prostate cancer side effects like impotence, incontinence and gastrointestinal disorders.
Hormone therapy is used to help control prostate cancer that is not treatable with surgery or radiation therapy. Hormone therapy blocks testosterone production or interaction with the tumour cells to reduce the tumour size or slow its growth.
Androgen deprivation therapy (ADT)
Lowering the male sex hormone called Androgen is effective in treating prostate cancer because this hormone is the primary driver of growth for prostate tumours. Testosterone is the common androgen and the ADT focuses on lowering the testosterone levels in the body through a sustained drug plan. ADT is used to treat prostate cancer in different situations, including locally advanced, recurrent prostate cancer, and metastatic prostate cancer.
ADT comes in a range of options:
LHRH agonists. LHRH stands for Luteinizing Hormone-Releasing Hormone. Medications known as LHRH agonists prevent the testicles from receiving messages sent by the body to make testosterone; thereby reducing the levels of the hormone in the body.
LHRH antagonist. This class of drugs, also stops the testicles from producing testosterone like LHRH agonists, but they reduce testosterone levels at a more rapid rate.
Anti-androgens. While LHRH agonists and antagonists lower testosterone levels in the blood, anti-androgens block testosterone from binding with androgen receptors in the cancer cells. By blocking this chemical process testosterone and other male hormones cannot enter and fuel the cancer cells.
Our team of medical oncologists prepare and administer detailed drug plans to treat prostate cancer. Systemic drugs are let into the bloodstream to target cancer cells throughout the body. Chemotherapy for prostate cancer is given directly through an intravenous (IV) tube. There are several standard drugs used for prostate cancer. Typically, the standard chemotherapy is kick-started with the drug Docetaxel, usually in conjunction with the steroid called Prednisone.
Targeted therapy uses drugs or other substances to identify and attack specific types of cancer cells, blocking their growth and spread.
Throughout the prostate cancer treatment, our rehabilitation therapists work with the patient to help improve their physical functioning and sense of well-being. Prostate Cancer is physically and mentally draining on the patient; there is often high levels of distress associated with it. Our Care team is equipped to provide patients the expert counsel and guidance they need. The Prostate Cancer CMT offers rehabilitation programs in key areas like: