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Clinical Services
At the Urologic Oncology Division at Montefiore Medical Center, our board-certified, fellowship-trained urologists and uro-oncologists are among the finest the nation has to offer, and fully understand that the mere prospect of prostate cancer raises countless concerns. They collaborate in a multidisciplinary approach to offer a precise diagnosis, answer all of your questions, and provide unparalleled expertise with every treatment and modality of surgery, should you or a loved one require it.
Since 2001, we have been at the forefront of minimally invasive surgery, when we established one of the first laparoscopic radical prostatectomy programs in the nation. Our years of experience with minimally invasive surgery provided a seamless transition for us to adopt robotic surgery after we acquired the da Vinci Surgical System in 2005. Now the majority of our radical prostatectomy surgeries are conducted via robotics, which offers numerous benefits to patients.
Symptoms
Prostate cancer, which is the abnormal growth of cells that leads to a malignant tumor in a man's prostate gland, is the second most common malignancy among men in the U.S. behind skin cancer. Unfortunately symptoms do not typically arise in the early stages, so it occasionally proposes difficulties with detection during that time. When symptoms do occur they may include:
Symptoms related to urinating could also be due to benign enlargement of the prostate (BEP), also known as benign prostatic hyperplasia (BPH) or nodular hyperplasia. This increased sized of the prostate is quite common, as it affects 60% of men in their sixties and 70% of men by age seventy. It could obstruct the normal flow of urine and may also lead to elevated prostate-specific antigen levels, but is not considered to be a premalignant indicator. However, regular prostate examinations and monitoring any and all symptoms is crucial to men's overall health care, as early diagnosis and treatment is the key to a successful outcome.
Diagnosis
If test results or symptoms suggest a presence of prostate cancer, your physician will ask you about your medical history, conduct a rectal exam, and may order laboratory tests. These may include: a urine test to check for blood or infection, a blood test to measure PSA (prostate-specific antigen) levels, and possibly a PAP (prostatic acid phosphatase) check, which may also be assessed in the blood test.
If a higher than normal level of PSA is detected in the blood or if the level continues to rise over time, it may indicate prostate inflammation, prostate enlargement, or prostate cancer. Some medical professionals will generalize a normal PSA level as anything less than 3 ng/mL. However, evidence suggests that the PSA level naturally increases with age. More specifically, a normal PSA reading will hover around 2.5 ng/mL for men age 40-49, 3.5 ng/mL for men age 50-59, 4.5 ng/mL for men age 60-69, and 6.5 ng/mL for men 70 and older.
A rectal exam or digital rectal exam (DRE) and PSA tests cannot accurately diagnose prostate cancer, but they can signal a need for a biopsy to determine if the prostate cells are cancerous and the precise cause of a high PSA. The biopsy procedure may cause some discomfort, but it is brief and does not typically require an overnight hospital stay. Needles are inserted into the prostate during the biopsy to gather small samples of tissue via the guidance of ultrasound imaging. The cells are then evaluated under a microscope and a Gleason score is assigned to predict the aggressiveness of the disease and how it will behave. The higher the grade, the more aggressive the tumor is. If the biopsy confirms cancer cells, your urologist may request further testing, such as a bone scan, CT scan, and MRI to assess if the cancer has spread and chart a path of treatment.
Treatment Options
Montefiore Medical Center offers all the latest advancements and surgical modalities available for prostate cancer treatment, including robotics via the da Vinci Robotic Surgical System. Our internationally recognized fellowship-trained urologists and uro-oncologists have years of expertise with every stage of the disease, as well as every possible type of surgery.
Patients from all over the globe come to Director of the Division of Urologic Oncology and the Urologic Robotics Program Dr. Reza Ghavamian, fellowship trained at the Mayo Clinic, who conducts every prostate operation in every possible method - traditional/open, laparoscopic, and robotic. His unparalleled expertise are essential for optimizing each patient's outcomes, as no two cases are precisely the same. Treatment for prostate cancer depends on several factors, such as how fast the tumor is growing, how much it has spread and the patent's age and health, which is why it is so imperative to have a distinguished, multidisciplinary team like ours customizing a plan for you or your loved one.
Some of the most common treatment options include:
