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Patrick E. Wherry, MD Inc.
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San Jose, CA 95124-4009

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American Medical Systems
Northern California Prostate Cancer Center
Urological Surgeons of Northern California
Prostate Cancer

Prostate Cancer

This is a disease process that is undergoing constant change ...change in detection, change in treatment and change in outcome results

Early detection has made the most impact and is mission-critical

Appropriate therapy almost always successful usually very obvious when results are compared

Important considerations are:

  • prevention ...both of cancer development and of cancer progression
    • many different choices
    • individually, and cumulatively, make a significant difference
  • diagnosis ...only a few clinical tools are available
    • DRE (digital rectal exam) ...consider yearly > age 40
    • PSA ...some discretion is required for the interpretation of its significance
    • prostate biopsies are also essential
  • clinical grading and staging
    • Grade
            ...the Gleason score is used to quantify the biological potential
            ...this is derived from the microscopic appearance
    • Stage
            ...the TNM system is the most widely used and accepted
            ...categorizes the extent of spread based on microscopic, and other, testing
    • Combined assessment methods
            ...newer techniques that try to more accurately predict and quantify risk
            ...usually based on the presence of multiple tumor markers
   exciting direction – but not yet “prime time”
  • treatment...this is partly based on the results from the grading and staging systems
    • the above results are then used to help classify the findings into low-, intermediate- or high-risk disease
    • within each of these categories there are several choices ...ideally these should be determined by
            ...patient requirements
            ...the availability of treatment options

At any one time one treatment modality usually proves to be the most effective. At present this is IMRT/IGRT (image-modulated radiation therapy/ image-guided radiation therapy). The former sculpts the radiation dose to fit the individual contours of each man’s prostate while the latter constantly localizes the position so as to make the radiation as precisely targeted as possible. This can be used alone, or in combination with other treatments (androgen deprivation therapy, brachytherapy), in all of the therapeutic categories. And this represents the state of the art when combined with the use of OBI (on-board imaging). A nearby specialized treatment center (Northern California Prostate Cancer Center) is used. The superior outcome results have made it very difficult to suggest any of the other choices.

Early detection + non-, and/or minimally invasive, treatment have changed prostate cancer into a curable, semi-chronic, disease.

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