What is Prostate Cancer?
Prostate cancer is the second-leading cause of cancer death for men in the United States. About 1 in 6 men will be diagnosed with this malignancy within their lifetime.
The prostate is the size of a walnut and goes all the way around the urinary tube called the urethra. The main job of the prostate is to make fluid for semen. Prostate cancer cells can spread by breaking away from a prostate tumor. They can travel through blood vessels or lymph vessels to reach other parts of the body.
To check for prostate cancer, Dr. Steinberg will examine your prostate (digital rectal exam) and perform a prostate specific antigen (PSA) blood test. If either of these tests is abnormal, Dr. Steinberg may recommend other tests to determine your risk of prostate cancer.
What Causes Prostate Cancer?
According to the American Cancer Society, researchers do not know exactly what causes prostate cancer. However, they have found some risk factors and are trying to learn just how these factors may cause prostate cells to become cancer. These associations may increase the risk of developing prostate cancer:
- Age: Most common in men ages 55-79 years
- Ethnicity: African–Americans are in the highest risk group.
- Family history: 2 to 11 times more at–risk
- Smoking: Risk may double for heavy smokers
- World Geography: Higher in North America and Northern Europe
- Diet: Diets higher in fat may increase risk
What Are the Symptoms of Prostate Cancer?
In the early stages, prostate cancer often causes no symptoms. When symptoms do occur, they can be similar to symptoms experienced with an Enlarged Prostate or BPH.
How is Prostate Cancer Diagnosed?
Dr. Steinberg is an expert at diagnosing, monitoring, and developing treatment plans for prostate cancer. Diagnosis of prostate cancer is a multi-step process:
Medical History and Physical Exam
During an initial office visit, Dr. Steinberg will perform a Digital Rectal Exam (DRE), inserting a gloved, lubricated finger into your rectum to examine your prostate. If any abnormalities in the size, shape or texture of the gland are found, further diagnostic tests may be needed to determine if you have prostate cancer. In addition, Dr. Steinberg may ask you about any symptoms you are having, such as any urinary or sexual problems, and how long you have had them. You might also be asked if you have possible risk factors for prostate cancer, including your family history.
PSA Test
The prostate-specific antigen (PSA) blood test is the main method for screening for prostate cancer. This blood test measures the level of prostate-specific antigen (PSA) in the blood. PSA is a protein made only by the prostate gland. Elevated PSA levels can be an early indication of prostate cancer as well as other benign prostate disorders. PSA levels of 4ng/ml and above are typically considered elevated, however there is no specific level that indicates cancer. Results from regular PSA screenings will show whether your PSA levels have changed year to year, and whether that change is cause for concern.
In men diagnosed with prostate cancer, the PSA test, along with other diagnostic testing performed by Dr. Steinberg, is used to help determine the stage of prostate cancer and can also help indicate if your cancer is likely to be confined to the prostate gland. PSA tests are also an important part of monitoring prostate cancer during and after treatment.
Other Diagnostic Tests
4K Score
Dr. Steinberg often utilizes the 4K Score, a blood test drawn in the office, which combines four prostate-specific biomarkers with clinical information, to provide men with an accurate and personalized measure of their risk for aggressive prostate cancer. The 4K score can be used to help determine the need for a prostate biopsy. After a negative biopsy, the 4K Score can predict the likelihood of cancer spreading to other parts of the body in the next 20 years. The blood sample is sent overnight to a reference lab and results are usually available and discussed with patients within one week.
Exosome DX Urine Test
This simple urine test performed in the office is often used to determine the risk of high-grade cancer on a subsequent prostate biopsy. This information can help guide the decision for recommending a biopsy. Results of the test are usually available in 24 hours. To learn more about the test, visit here.
Prostate MRI
An MRI of the prostate may be recommended if prostate cancer is suspected in order to detect hidden tumors within the prostate in advance of a biopsy.
BIOPSY
Dr. Steinberg considers several diagnostic factors before recommending a prostate biopsy. If the results of a digital rectal exam, PSA test, 4-K score, Exosome DX test, or Prostate MRI suggest cancer, Dr. Steinberg may recommend a prostate biopsy to definitively determine the presence of cancer.
MRI/Ultrasound Fusion Prostate Biopsy
Dr. Steinberg has trained in this new technique which provides greater accuracy for prostate biopsy, which fuses ultrasound images with high-resolution pictures of the prostate made by a newer technology called multi-parametric magnetic resonance imaging (mp-MRI). Prostate tumors show up on mp-MRI as discrete dark areas. By adding mp-MRI images taken beforehand to the real-time ultrasound images, Dr. Steinberg can more accurately target suspicious regions of the prostate while steering clear of healthy tissue. Your biopsy will be performed by Dr. Steinberg under IV Sedation in the operating room. The procedure usually takes about 15 minutes or less and a local anesthetic and sedation is given to reduce any discomfort. While lying on your side, an ultrasound probe will be inserted into the rectum. This probe provides a clear visual of the prostate and allows the physician to guide the very fine biopsy needle into the prostate. Using the needle, Dr. Steinberg will take several tiny tissue samples (“cores”) from different areas of the prostate. These cores are the width of dental floss. The samples are sent to a pathologist, who determines if there is cancer present. Dr. Steinberg routinely meets with the patient and family within 1 to 2 weeks to discuss the results of the biopsy and make further recommendations.
Genetic Testing After Positive Biopsy:
Oncotype DX and Prolaris Test
If prostate cancer is detected on a biopsy, Dr. Steinberg may order an Oncotype DX or Prolaris test. These tests, performed on the biopsy tissue, were developed to help men with newly diagnosed early-stage prostate cancer make the most informed treatment decision for their individual disease, including active surveillance.
Oncotype DX and Polaris testing are helpful in identifying those men who need treatment versus those who can confidently choose active surveillance. Using minimal tumor tissue from the original needle biopsy, the test builds on traditional clinical and pathologic factors to provide additional, clinically relevant insight into the underlying tumor biology of an individual patient before the prostate cancer is treated. The result is a more precise and accurate assessment of future risk, which helps more men avoid the lifelong complications associated with treatments they do not need, while directing aggressive therapy to those men who require immediate treatment. The information gathered from these tests helps Dr. Steinberg recommend and discuss treatment options for patients.
Learn More About Genetic Testing with Oncotype DX here and Prolaris here.
Prostate Cancer Treatment In Milford, MA
Approximately 1 in 6 men will be diagnosed with prostate cancer within their lifetime. After performing a complete evaluation and diagnostic testing, Dr. Steinberg discusses in depth the treatment options for prostate cancer, as well as his recommendations for treatment with patients and their families.
Watch Dr. Steinberg Discuss Treatment Options for Prostate Cancer here.
Active Surveillance
Active surveillance is a protocol used for monitoring prostate cancer closely if the cancer is low grade and felt not to be potentially aggressive nor immediately threaten the patient’s health. After a detailed discussion with Dr. Steinberg and, depending upon the specific characteristics of the patient’s prostate cancer and other recommended diagnostic tests, the patient may opt for this approach which includes an office visit with a prostate-specific antigen (PSA) blood test and digital rectal exam (DRE) every 3 months. MRI may be recommended at regular interals as well. If test results change, Dr. Steinberg would then discuss further diagnostic tests and treatment options.
Radioactive Seed Implant (Brachytherapy)
Brachytherapy (also called seed implantation or interstitial radiation therapy) uses small radioactive pellets, or “seeds,” each about the size of a grain of rice. These pellets are placed directly into the prostate under general anesthesia. Brachytherapy alone is generally used only in men with early-stage prostate cancer that is relatively slow growing (low-grade). Dr. Steinberg partners with world renown Radiation Oncologists from Brigham and Women’s/Dana Farber Cancer Center to provide this state-of-the-art therapy in Milford.
External Beam Radiation Therapy
Dr. Steinberg also partners with Radiation Oncologists/Brigham and Women’s/Dana Farber Cancer Center in Milford to coordinate external beam radiation where a small amount of radiation is focused on the prostate over several weeks to treat the cancer. Patients may go about their usual activities during this outpatient treatment. This treatment is conveniently offered at the BWH/Dana Farber Cancer Center in Milford, MA, eliminating the need to drive to Boston for this advanced care.
Barrigel Hydrogel And Gold Fiducial Placement
In preparation for External Beam Radiation Therapy, Dr. Steinberg may advise the patient to have a BARRIGEL Hydrogel implant and Gold Fiducials placed into the prostate. Performed under IV sedation, BARRIGEL is a revolutionary material that is placed by a simple needle injection to push the prostate away from the rectum to minimize any potential side effects from radiation. During the same procedure, tiny small gold “seeds” are implanted into the prostate to enable the radiation device to precisely focus upon the prostate during the course of radiation treatment. Both procedures take approximately 15 minutes and are performed on an outpatient basis.
If you would like to make an appointment with Dr. Steinberg, please contact Urology Specialists of Milford at (508) 473-6333 to schedule a consultation in our Milford, MA office.
