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Prostate

Prostate Conditions

In their focus, training and practice, Lourdes urologists have a special concentration in both benign and cancerous conditions of the prostate.   Tools for evaluating and treating such conditions have significantly improved in the recent past, allowing Lourdes specialists to offer more choices, including care that is more targeted and less disruptive of urologic function.

Emphasis on preventive care

Lourdes urologists recommend that men get a single baseline PSA at 40 years of age. If it is normal, then at age 50 men should begin getting an annual PSA test and digital rectal exam. But a man who is at high risk (elevated PSA, African-American or has a father or brother who had prostate cancer) should get annual rectal exams and a PSA test starting at 40.

By far the most common prostate condition is prostate enlargement, which becomes more likely as men advance in age.   If left untreated, BPH can impact quality of life and cause complications such as severe urinary tract infections, urinary retention or even renal failure.

Prostate Enlargement

Image courtesy of American Medical Systems

Image courtesy of American Medical Systems

Most men have some degree of prostate enlargement by middle age and certainly by the time they are seniors. Many men who have an enlarged prostate have no symptoms but, because the prostate surrounds the urethra below the bladder, prostate enlargement can disrupt urinary function.

If a man has trouble urinating, weak stream, frequent urination, urgent need to urinate, difficulty holding urine, or other symptoms the patient may undergo additional urologic testing, beyond a digital exam and prostate specific antigen (PSA) test.   Steps to detect prostate growth may include include cystoscopy to directly examine the urinary tract or transrectal ultrasound to measure the size of the prostate.

So long as the prostate symptoms are not accompanied by elevated PSA count in the blood or other signs of cancer, the gland enlargement is usually considered to be benign (benign prostatic hyperplasia or BPH), a noncancerous condition that can often be addressed conservatively.   Changes in personal habits that affect urination can help, as can medications that relax the muscles of the urinary tract or that reduce the size of the prostate.   The Lourdes urologist uses careful evaluation of symptoms and other medical factors as well as patient preferences to recommend an approach.   Medications that relax the bladder muscles or shrink the size of the prostate can often help to control moderate BPH symptoms.   If conservative and medical care is not the solution, the staff can offer a number of other interventions that are either office or hospital based.

Endoscopic vaporization of prostate-tissue overgrowth. Image courtesy of Olympus

Endoscopic vaporization of prostate-tissue overgrowth.
Image courtesy of Olympus

For less extensive symptoms of overgrowth, the team can provide treatment that does not require operating room procedures.   Special tools introduced through the ureter use microwave or radiofrequency energy to produce heat that reduces prostate tissue.   The Lourdes specialists can perform this thermotherapy in the office with only local anesthesia or a mild oral sedative (or both), and a short period, if any, needed for a urinary catheter afterwards.   Patients return to normal activities in days and to appreciate symptom relief with a few weeks.

The Lourdes team also provides the most up-to-date surgical treatment for BPH, most often using transurethral procedure in which the surgeon inserts a small scope through the ureteral opening of the penis to surgically open the urethral passage and usually to remove prostate-tissue overgrowth. With the ability to offer transuretheral operations, urology teams much less commonly perform open prostatectomy surgery to remove the benign enlarged prostate.   (These conventional operations require a lengthy stay in the hospital and may have negative effects on sexual function and continence.)

Until recently, a version of the operation referred to as TURP (transurethral prostate resection) was the standard of care.   In TURP, the urologic surgeon uses various endoscopic tools to cut away and cauterize the overgrown portion of the prostate.

Prostate evaluation and prostate procedures of all types are a primary focus of Lourdes urologists, who have helped to lead advances in this care within the Lourdes service area.

But at advanced urology services such as that at Lourdes, the urologic surgery team most often uses cystoscopes equipped with devices that apply various types of energy to vaporize prostate tissue and cauterize the treated area.  The surgeon introduces the tool through the urethra and removes overgrown prostate tissue in a safe and controlled manner.   Most often the Lourdes team uses a tool that applies plasma energy via an electrode to destroy prostate tissue and seal the treated area.   Alternatively, and depending on the case and the size of the prostate, the team may use a “green light” laser to accomplish the same task of vaporizing unwanted tissue and coagulating the bleeding at the treated area.

These operations are even easier to perform and undergo than conventional transurethral resection of prostate tissue.   They offer the opportunity for faster recovery and potentially shorter time needed for bladder catheterization; thus, patients may return to normal activities more quickly.   Most often Lourdes urologists perform these treatments as outpatient procedures in the hospital or surgical center, with the patient under general or regional (spinal) anesthesia.

Lourdes urologic surgeons can usually perform minimally invasive means of removing obstructing prostate tissue on an outpatient basis.   Transurethral removal of prostate overgrowth has been a major advance over open surgery; and now, transuretheral vaporization means even further improvement with:

  • virtually no blood loss;
  • less risk of side effects (sexual dysfunction or incontinence very rare);
  • less damage to surrounding tissue and thus less pain, blood in the urine (hematuria), swelling, and post-operative infection;
  • less time needed, if any, with an indwelling Foley urinary catheter after the operation;
  • rapid relief of symptoms and restoration of urine flow;
  • and faster healing time and return to normal activities.

Prostate Cancer

If testing indicates the possibility of cancer in the prostate gland, the Lourdes team may elect to perform a prostate biopsy.   The specialist will remove small tissue samples from several locations of the prostate, using a fine needle inserted through the perineum, the area located between the scrotum and anus.   The patient receives local anesthetic to minimize any discomfort.   Lourdes pathologists examine the samples under a microscope.   Studies such as a bone scan and CT scan of the abdomen and pelvis can help to confirm and stage the cancer if present.

Lourdes has the most experience in southern New Jersey in robotic-assisted surgery for prostate removal. The procedure brings effective cancer control and improved and early return of sexual function and continence.

Lourdes urologists confer closely with Lourdes cancer specialists to determine the best course of care for any patient diagnosed with prostate cancer.   They base treatment recommendations on the stage and rate of growth of the cancer, as well as the patient’s age and overall health.   Today, more prostate cancers are discovered at an early stage, before they have spread.   Care can sometimes mean a watch-and-wait approach (active surveillance involving periodic testing) with this normally slow-growing type of cancer , or treatment may involve surgery, radiation, or sometimes hormone therapy or cryotherapy.   Men with early-stage prostate cancer have a high chance of successful treatment with few side effects.

Clinical Trials

Patients treated for urologic cancers at Lourdes have the opportunity to enroll in clinical trials of new therapies and treatments. Lourdes urologists and cancer-care specialists are actively involved in such trials with sponsoring companies, clinical research organizations, and national cooperative research groups.

Lourdes urologists offer surgical treatment in the form of prostatectomy, which is complete removal of the prostate gland and some of the tissue around it, also referred to as radical prostatectomy.   The urology team will explain the choice between this treatment and radiation therapy.   Surgery has the advantage that patients who have a recurrence after prostatectomy may still avail themselves of radiation treatment as a secondary treatment; the reverse is not usually the case.

Based on the specifics of the cancer and patient preferences, the team may pursue traditional open retropubic surgery, laparoscopic surgery, or, increasingly – and now predominantly, at Lourdes – the newer robotic surgery.   Prostatectomy is the primary use of robotic technology in urologic surgery.   Via any approach, the team always uses the most advanced nerve-sparing techniques to prevent damage or side effects from the surgery.

surg sitePatients considered for robot-assisted prostatectomy  should meet the same criteria as those considered for conventional or laparoscopic surgery. This includes patients whose prostate cancer is local, meaning it has not spread to the pelvic lymph nodes, nor has it spread (metastasized) to anywhere else in the body. Patients are not likely candidates if they are morbidly obese (BMI > 40); have a previous history of (trans-urethral resection of the prostate) or radiation therapy; or have had extensive abdominal surgery, among other conditions.

Prostate removal typically requires the surgeon to reconnect the bladder to the urethra, and insert a catheter to stabilize the repair during healing.   With the more precise repair possible via the robotic procedure, the period needed for this indwelling catheter is reduced (to approximately one week).

Surgical procedures for the prostate have always carried the risk of injury to the urologic musculature or nerves with the accompanying risk that the patient will suffer from incontinence or erectile dysfunction.   But robotic technique permits the surgeon an improved view of the complex network of tissues and nerves, which helps reduce this risk.

Almost all Lourdes patients operated on with the robotic system are continent (defined as not requiring any pads) one year after the surgery, provided they had no issues of incontinence prior to the surgery.   The chance of retaining potency depends on a number of variables, including the patient’s age, presurgical erectile function and the nature of the surgery.   Most men receiving prostatectomies at Lourdes have successful erectile function at two years after the procedure.   Best erectile-function outcomes are seen in men less than 50 years of age who have healthy erectile function prior to surgery and who undergo a bilateral nerve-sparing procedure.

As with any operation, the amount of experience a program has in prostatectomy is important.   Lourdes is among centers in greater Southern New Jersey that perform the most number of robotic prostatectomies.

Finally, the prostatic stent is an additional option occasionally used when other care is not possible for reopening urethral flow through the prostate.   The specialist inserts this tube in the portion of the urethra encircled by the prostate to press out against the sides of urethra and keep the flow of urine open.   Urologists use this temporary measure for patients who are elderly, frail, or have medical problems that prohibit other kinds of interventional treatment for significant urinary symptoms from urethral strictures (due to scarring, trauma or infections) or from prostate enlargement.

Lourdes urologists work in close coordination with Lourdes medical and radiation oncologists to integrate chemotherapy and radiation therapy into the treatment sequence, as appropriate.   Radiation therapy can sometimes be delivered in the physician-office urology center.  

Prostatitis

An otherwise healthy prostate can become inflamed due to injury, infection, unknown causes or sometimes as a result of BPH.   For example, activities that cause repeated or traumatic impact in the perineal area, such as strenuous or extensive biking, can result in a sore, painful prostate.  Sometimes this dull, indeterminate discomfort is a cause of pelvic pain.  Lourdes urologists may prescribe antibiotics to treat acute or chronic prostatitis.  Some men note relief of their BPH symptoms after a course of antibiotics.  

To learn more, call  1-888-LOURDES.

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