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Prostate Cancer

The Cancer Centers of NewYork-Presbyterian have revolutionized the treatment of prostate cancer over the past two decades. Advances in radiation oncology and surgical approaches, among other treatments, have produced remarkable results with fewer side effects and complications.

Despite innovations in treatment, it remains true that the best outcomes result from early diagnosis. When detected early, survival rates for prostate cancer approach 100 per cent.

Knowing the risk of prostate cancer, and having a yearly PSA (prostate-specific antigen) test and digital rectal examination are our best weapons against prostate cancer.

NewYork-Presbyterian Hospital's Departments of Urology lead the way in developing new treatments for prostate cancer, many of which are used nationwide.

Molecular Pathology

Although men with prostate cancer who may need more aggressive therapy can often be identified based on biopsy or pathology evaluation alone, NewYork-Presbyterian's investigtors are performing sophisticated analysis of prostate tumor tissue to help predict how a each individual might respond to certain drugs and other treatments. In this way our investigators may be able to better identify those men who are at highest risk of dying from their disease – who may be candidates for novel treatment approaches – as well as those with less aggressive forms of prostate cancer who could benefit from other treatment options.

Prostate-Specific Antigen (PSA) Testing

PSA is a protein produced by the cells in the prostate gland. Determining PSA density helps distinguish benign from malignant disease. Our physicians perform a number of PSA testing techniques, including reverse transcriptase polymerase chain reaction for PSA, which can provide accurate diagnosis and staging of prostate cancer. Our physicians have used PSA testing to determine the progression of prostate cancerand, to predict prostate cancer outcomes, and to help to determine the best treatment strategy for each patient.

Advances in Prostate Surgery

Robotic-assisted Laparoscopic Prostatectomy (RALP)
NewYork-Presbyterian physicians are among the world's experts in this cutting edge, minimally invasive approach to the treatment of prostate cancer. Using interactive computer technology, laparoscopic surgery, and image enhancement, robotic prostatectomy may make removal of the prostate and its surrounding tissues more precise with minimal impact on quality of life. Additional benefits include:

• Less pain
• Less blood loss; Reduced need for blood transfusion
• Small incisions and less scarring
• Shorter hospital stays
• Faster recovery times
• Excellent likelihood of preserving sexual and urinary function

Robotic Prostatectomy at NewYork-Presbyterian/Columbia.

Robotic Prostatectomy at NewYork-Presbyterian/Weil Cornell.

Cryosurgery
NewYork-Presbyterian urologists use cryosurgery to bring the prostate and nearby tissues to extremely low temperatures. These very low temperatures can kill recurring cancers that are unresponisve to surgery or radiation.

Physicians here also are investigating using a combination of hormonal therapy and cryotherapy as an effective treatment for prostate cancer.

Radical Prostatectomy Surgery
Although a majority of patients are candidates for robotic-assisted laparoscopic surgery, when open radical surgery is necessary, NewYork-Presbyterian Hospital physicians have developed procedures to remove the prostate that help spare the nerves controlling sexual and bladder function.

For example,

• By improving bladder reconstructive methodologies, the Hospital has one of the lowest urinary incontinence rates in the country.
• NewYork-Presbyterian performs a nerve graft procedure that allows patients greater sexual function following the procedure.
• The chance of regaining sexual function can be aided by use of the Cavermap device, a nerve stimulator that can be used to identify the position of nerves that are spared during surgery.

Advances in Radiation Therapy

3-D Conformal Brachytherapy
Brachytherapy is a type of radiotherapy in which a radioactive source – an isotope-containing "seed" – is placed inside the body. NewYork-Presbyterian Hospital is one of the pioneers in the potency-preserving 3-D conformal brachytherapy technique for prostate cancer. This technique customizes the shape and direction of the radiation source to the target tissue, while sparing healthy tissue as much as possible.

Features of 3-D Conformal Brachytherapy include:

• Radioactive pellets or seeds are implanted into the prostate, radiating the prostate with low-level radiation over time while limiting effects on normal surrounding tissues.
• The treatment is made as effective and as safe as possible by using dose optimization methods.
• No surgical incision is needed.
• A sophisticated, computer-generated treatment plan is customized for each patient.
• Patients can undergo planning for seed placement and actual placement during one procedure.

NewYork-Presbyterian continues to gain experience with Cesium-131, a relatively new isotope used for permanent brachytherapy. Cesium-131 combines in one isotope the best features Iodine-125 and Palladium-103, two isotopes commonly used for brachytherapy today.

Real Time Prostate Treatment Planning
In 2006, NewYork-Presbyterian began using an innovative Real Time Treatment Planning system for the performance of prostate implants (seeds). After each seed is placed, this new system allows physicians to determine the best location to place the next seeds. Real Time Treatment Planning allows for superior outcomes and fewer side effects.

Combination Hormone-Radiation Therapy
Physicians have also developed a method for predicting a patient's response to radiation treatment; they are able to offer a highly effective regimen that combines external beam therapy with hormone therapy.

Intensity Modulated Radiation Therapy (IMRT)

NewYork-Presbyterian Hospital uses IMRT technology, a special type of 3-D conformal external beam radiation, to treat prostate cancer patients. With IMRT,

• Higher doses of radiation to can be targeted to diseased portions of the prostate gland while sparing nearby healthy tissue
• An ultrasound system determines whether the patient is positioned correctly and, if not, it will then determine the adjustment so that the radiation therapy can be delivered with great precision.

Clinical trials at NewYork-Presbyterian Hospital are evaluating the use of specific ultrasound technologies to identify tissues within the prostate to guide intensity modulated radiation therapy and brachytherapy (radioactive seed implantation) for the treatment of localized prostate cancer. Ultrasound tissue typing enables doctors to concentrate higher doses of radiation on the tumor, sparing healthy tissue.

Advances in Non-surgical Treatments for Prostate Cancer

Hormone Therapy
If prostate cancer has metastasized, the first-line treatment remains hormone therapy. Physicians of the NewYork-Presbyterian Cancer Centers have validated the effectiveness of a long-term hormone implant. This implant – which can be given as infrequently as once a year – contains medication that is 10-fold more potent than standard hormone injections.

Chemotherapy
Physicians at NewYork-Presbyterian pioneered – and were the first two report on – the combination of chemotherapy agents estramustine and docetaxel for men with treatment-resistant prostate cancer. The drug therapy has been evaluated in a national trial, the third phase of a four-phase process, with results soon to be available.

Complementary Therapies

The Center for Holistic Urology at NewYork-Presbyterian Hospital is the only program in the country that treats prostate cancer patients using complementary therapies. These approaches are used to slow the progression of cancer in patients who have not had success with traditional treatments or are preferred by patients seeking an alternative route. Treatments that are available at the Holistic Center include:

• nutrition
• biofeedback
• acupuncture
• exercise therapy
• herbal remedies

Investigators here are also evaluating the effects of a low-fat, high-fiber diet with soy supplementation on men who have previously undergone radical prostatectomy and whose pathological analysis indicated a high risk for recurrence.

GCP Supplementation
Researchers at the Center for Holistic Urology recently launched a study to examine the effects of Genistein Concentrated Polysaccharide (GCP™) supplementation in men diagnosed with prostate cancer who will undergo radical surgery.

GCP™ is a nutritional supplement made by the Amino Up Chemical Company in Japan that contains a mixture of mushroom and soybean extracts. Research on GCP™ has shown it can reduce prostate cancer cell growth and the formation of blood vessels in prostate tumors.

Selenium and Vitamin E Prevention
Past studies of these two supplements suggest that that they may reduce the incidence of prostate cancer. A trial is underway to examine the effect of taking each, both singly and simultaneously.

Investigational Therapies

Antibody Therapy
Physicians at NewYork-Presbyterian Hospital have developed HuJ591, the first monoclonal antibody to target prostate-specific member antigen (PSMA), a protein that is expressed on prostate cancer cells. Several completed and ongoing clinical trials have evaluated the attachment of a radioactive metal or chemotherapy drug to HuJ591 in an attempt to deliver radioactivity or chemotherapy directly to the prostate cancer cells. Results of a variety of clinical trials treating patients with advanced prostate cancer have been promising.

Interestingly, the antibody may prove useful with other cancers because it targets the blood supply of many other types of cancer. Additional laboratory and clinical research is exploring this interesting finding.

Prostate Cancer Prevention

The Cancer Prevention Center of NewYork-Presbyterian Hospital offers a comprehensive prostate cancer prevention program, including chemoprevention and dietary therapy. Diet is a possible risk factor that can be controlled, with recommendations including following a diet low in fat and adding vegetables, fruits, and grains.

A clinical study is ongoing in patients who are diagnosed with high-grade prostatic intra-epithelial neoplasia (PIN), a condition in which the prostate cells have undergone changes that may predispose to cancer. These patients are prescribed a high fiber, low-fat and soy diet with supplements of antioxidants, vitamin-like substances that help prevent damage to DNA and may lower prostate cancer risk.