Prostate Information for Men

with Urinary Problems and Men over Age 50

Dr. Kenneth M. Tokita is a Radiation Oncologist at Cancer Center of Irvine in Irvine, California. Dr. Tokita has been practicing Radiation Oncology for over 25 years. He has performed over 1000 prostate radioactive seed implants using the modern technique and over 200 prostate radioactive seed implants using the "old" open abdomen surgical technique.

If you have prostate problems or have been diagnosed with prostate cancer, you will be interested in the information that follows. You may wish to discuss this information with your own Radiation Oncologist or Urologist.

You may contact us by telephone at (949) 417-1100 for additional information. Please ask for Karl or Dr. Tokita.

 

Men with Urinary Problems

Under Age 50 and All Men Over Age 50

 

 

I.   Consultation with the Radiation Oncologist

During your consultation with the doctor, he/she will

All of your test and laboratory results are important in order to make the best decision in outlining your treatment options. If you were not able to obtain all your information prior to the consultation, it is important to make sure that the results of your tests are still forwarded to the doctor.

 

II.   Terms you should know

Palliation – Course of treatment for patients whose cancer has spread. Goal of palliation is to control the pain or other symptoms of the spread cancer.

Salvage Treatment – Treatment for failed initial course of treatment.

Hormonal Therapy – Medication prescribed by your urologist for the purpose of blocking testosterone production. Hormonal therapy may be used before primary treatment or for palliation.

Orchiectomy – Surgical removal of the testes to block production of testosterone.

DRE – Digital (finger) Rectal Exam

BPH – Benign Prostatic Hypertrophy. Noncancerous tumors that are likely to grow in prostate glands of men after the age of 40. These benign tumors squeeze the urethra, causing difficult urination. Sometimes the word hyperplasia is substituted for the word hypertrophy.

PSA-Prostate Specific Antigen*

I.   Definition

*Antigen = Proteins that are made by cells. PSA means antigens (proteins) that are specifically made by the prostate gland.
II.   Problems with Prostate that cause elevated PSA results
  1. Infection
  2. Benign Hypertrophy
  3. Cancer

  
III.   Detection

The Level of PSA production is measured by a blood test.
IV.   Interpretation of PSA results

If the PSA level is above 4.0 the results are abnormal. In the range of 4.0-10.0 we are unsure if it is indeed cancer. When the level is elevated above 10.0 we are quite certain the outcome is carcinoma but, as always, we need a biopsy to confirm the diagnosis of cancer.

V.   Biopsy

A biopsy must always be performed to confirm diagnosis. A PSA test alone is not enough information.

If the biopsy is positive for cancer, the pathologist will "grade" the tumor. This is called Gleason’s grading.

 

Grade

Grading is done on a scale of 1-5. One is the mildest change in characteristic from the original, healthy prostate cell to the tumor cell and five is the wildest change in characteristic.

First, the prevalent (primary pattern) tumor type is scored and then any secondary tumor type cell (if seen) is scored. These two numbers are then added together for a Gleason’s grade. A score may look something like a Gleason’s grade of (4+3) = 7. This means the primary tumor pattern was a 4 but there are also secondary type 3 cancer cells found in the specimen reviewed.

Range of Gleason’s Score

The lowest Gleason’s grade is a 2 and the highest Gleason’s grade is a 10.

Your Gleason’s score is __________________________.

 

 

 

Staging

 

 

Staging tells us the progression of the tumor. The staging is determined by the digital rectal exam, core biopsies, pelvic scans and bone scans.

Tumor classification is T1-4 a-c for the International Staging and A-D for the "Old" Staging system.

Your tumor classification is ________________________.

 

Treatment Options

1. Watchful Waiting – Socialized medicine in other countries has given us an enormous amount of information to follow prostate cancer through the natural course of its disease.

2. Cure

Modalities Cure Rate Complications
External Beam Radiation--
Conformal Therapy		   Rectal injury
Urinary Obstruction
Impotence
Surgery   Incontinence
Impotence
Permanent Radioactive seed implant   Rectal injury
Urinary Obstruction
Impotence
Combined External Beam and Temporary Seed Implant   Rectal injury
Urinary Obstruction
Impotence
Cryosurgery (freezing)

?
no data available yet

?
no data available yet
Proton Beam Radiation (Cyclotron)

?
no data available yet

?
no data available yet

 

As seen in the table above, there are many treatment options for patients with Prostate Cancer. Dr. Tokita offers:

  1. Full Course External Beam Radiation - Conformal Therapy
  2. Permanent Radioactive Seed Implant Using Palladium-103 or Iodine-125
  3. Short Course External Beam Radiation followed by Permanent Radioactive Seed Implant Using Palladium-103
  4. Temporary Radioactive Seed Implant Using Iridium-192 Followed by External Beam Radiation

 

 

 

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