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

3. 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

4. No perfect screening test is available at this time

5. 241,000 men will be diagnosed in 2012
24,000 will die from prostate
cancer in 2012

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

7. 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

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

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

12. 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

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

15. 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

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

18. 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

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

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

23. Warren Buffett completes prostate cancer treatment

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

25. 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),

26. 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

27. 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

28. New Clinical Study Demonstrates Reduced Prostate Radiation Side Effects with Calypso

31. 1/11/2012
New Prostate Cancer Gene Mutation Discovered

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

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