Understanding Prostate Myths David Spellberg, MD, FACS Naples Urology Associates

What is the Prostate? A chestnut-sized gland that produces fluid for semen Located just below the bladder, in front of the rectum, and wraps around the urethra, the tube that carries urine from the bladder to the tip of the penis

No perfect screening test is available at this time

241,000 men will be diagnosed in 2012 24,000 will die from prostate cancer in 2012

Researchers don’t know exactly what causes this damage, but have identified some risk factors: Race Environment Diet Genetics and family history

Wall Street Journal Report: Big Issues in Health Care 9/17/2012 Should Men Get PSA Tests to Screen for Prostate Cancer? Journal Report: Big Issues in Health Care

University of Arizona RICHARD ABLIN: 'There's no PSA level that definitely indicates that prostate cancer is present.’

Four important components PSA Free % PCA-3 Rectal exam of prostate

What is PSA (prostate-specific antigen)? A substance produced by prostate cells1 The PSA test measures the amount of PSA in the blood Very little PSA escapes from a healthy prostate Some prostate conditions can cause a large amount of PSA to leak into the blood

Free % PSA Bound and Unbound More specific Very Useful when Total PSA is between 4.0-10.0 and previous negative biopsy Ideally % greater than 15, though the higher the better

PCA-3 Urine test Prostate exam required prior to obtaining urine specimen The greater amount of prostate cells found in the specimen the greater the risk of cancer

ALWAYS OBTAIN A SECOND OPINION OR A THIRD OR FOURTH MOST IMPORTANT ALWAYS OBTAIN A SECOND OPINION OR A THIRD OR FOURTH

What is a biopsy? A test that may be necessary if the results of the PSA or DRE tests suggest prostate cancer A needle is used to remove a small amount of tissue from the prostate Typically, multiple samples are taken Only a biopsy can definitely confirm prostate cancer It is still possible to have cancer even if the biopsy is negative

TREATMENT OPTIONS WATCHFUL WAITING SURGERY RADIATION THERAPY CRYOTHERAPY HIFU PROTON HORMONAL MANIPULATION CHEMOTHERAPY EXPERIMENTAL

Naples Urology Associates mission statement is to provide concierge Urological services without additional cost.

Warren Buffett completes prostate cancer treatment

ASTRO criticizes urologist self-referral for IMRT–ModernMedicine Increased treatment vs. active surveillance Purchasing of older, inferior quality machines Decreased use of new technology

PROSTATE MOVEMENT 0.2mm -7.3mm Nov 2001 Radiotherapy & Oncology, volume 61 issue 2, Wu et al. 30 seconds over 2mm Sept 2008 Intl J Rad Oncol Bio, 72(1), 236-246

Why movement is important? Radiation cystitis and proctitis are serious complications Local hyperbaric chamber director has commented about the lack of cyberknife patients seen but a dramatic rise in prostate cancer patients treated with rapid arc

CyberKnife Treatment Delivery Patient lies comfortably on the couch while the CyberKnife robot moves, images and treats. Treatments typically last 1 hour Most patients require no sedation allowing them to depart at the completion of their treatment

New Clinical Study Demonstrates Reduced Prostate Radiation Side Effects with Calypso

1/11/2012 New Prostate Cancer Gene Mutation Discovered

REQUIRED INFORMATION STAGE ( T1, T2, T3, T4) GLEASON SCORE ( 2- 10) VOLUME OF DISEASE

ALWAYS OBTAIN A SECOND OPINION OR A THIRD OR FOURTH MOST IMPORTANT ALWAYS OBTAIN A SECOND OPINION OR A THIRD OR FOURTH