Ralph A. Highshaw, M.D.

Provenge is now approved by the FDA for use in patients with metastatic, hormone refractory prostate cancer. These are patients who do not respond to androgen deprivation therapy. Androgen deprivation therapy involves lowering testosterone levels in the body to below castration levels. This is done because prostate cancer cells feed by testosterone. In a clinical trial of 512 patients across multiple institutions, Provenge was shown to improve the overall survival of prostate cancer patients by 4.1 months.

There are several methods of treatment for prostate cancer. Choosing the right treatment for you is based on your PSA, gleason score, clinical stage, and volume of disease. Two of the important issues one should think about when choosing a treatment for prostate cancer are cure rate and quality of life.

After a diagnosis of prostate cancer has been made through a transrectal ultrasound biopsy of the prostate, a man has a wide spectrum of treatment options. These options include radical retropubic prostatectomy, robotic radical prostatectomy, laparoscopic radical prostatectomy, radiation treatment (external beam, proton beam, brachytherapy or radioactive seed therapy, and IMRT), cryoablation (freezing the prostate), androgen deprivation therapy, HIFU ( High Intensity Focused Ultrasound, which is non-FDA approved), clinical trials, and active surveillance.

PSA means Prostate Specific Antigen. It is an enzyme secreted mainly by the prostate and is involved in liquefaction of the semen.  PSA has been used for over two decades to screen and follow PSA post- treatment of prostate cancer. PSA drawn from the bloodstream and the digital rectal exam are the two methods used for screening prostate cancer. The AUA, American Urological Association, recommends a baseline PSA begin at age 40. Screening for prostate cancer should also start at age 40 for men with a positive family history of a first -degree relative or African- American heritage. Both are associated with an increased risk of prostate cancer incidence. An example of a first-degree relative would be a father diagnosed with prostate cancer. In addition, the person being screened should have a life expectancy of 10 years or more.  Other men with an average risk, should start screening at age 50.