Prostate cancer is one of the most common types of cancer affecting men, with one in six American males receiving the diagnosis in their lifetime. In most cases, the disease grows slowly and may need minimal or no treatment. But some prostate cancers are fast-moving and can spread quickly.
Listen to City of Hope Radio as Dr. Timothy Wilson, a nationally-recognized leader in urologic oncology and director of City of Hope's Prostate Cancer Program, comes on the show to provide simple strategies to help men better understand this important gland and discusses how technology plays a role in some of the newest, advanced prostate cancer treatment options available.
Selected Podcast
Prostate Cancer: World Leaders in Prostate Cancer Surgery
Featured Speaker:
Timothy Wilson, M.D.
Timothy Wilson, M.D., is a nationally recognized leader in urologic oncology with expertise in prostate cancer, bladder cancer, testis cancer, kidney cancer, and urinary reconstruction. He is highly experienced with minimally invasive, laparoscopic and robotic-assisted urologic oncology, and is a renowned expert in robotic-assisted laparoscopic prostatectomy being one of the top six surgeons worldwide in terms of volume performing this type of surgery. His research interests focus on the early diagnosis and prevention of prostate cancer patients, identification of high-risk prostate cancer patients, and quality-of life-issues involving prostate and bladder cancer treatment. Working with other doctors and scientists, he participated in translational research that was awarded a National Institutes of Health R01 research grant. This research is directed at discovering improved techniques for diagnosing prostate cancer. Transcription:
Prostate Cancer: World Leaders in Prostate Cancer Surgery
Melanie Cole (Host): City of Hope is actively developing tomorrow’s treatment protocols today for prostate cancer. As a patient of City of Hope, you have a highly-experienced and dedicated team to treat you and help you cope with cancer. My guest today is Dr. Timothy Wilson. He’s a professor and Chief of the Division of Urology and Urologic Oncology and the Director of the Prostrate Cancer Program at City of Hope. Welcome to this show, Dr. Wilson. Tell us about your approach to treatment for prostate and neurologic cancer care at City of Hope.
Dr. Timothy Wilson (Guest): Well, thank you, and thank you for inviting me to speak today. I think the most important thing to note about our treatment at City of Hope in evaluating patients is that no treatment fits all men. In other words, we like to think of each patient as an individual and we like to tailor the treatment plan based on the characteristics of that patient’s cancer.
Melanie: So tell us a little bit about prostate cancer, because we know, Dr. Wilson, that we women are who send our men into the doctor in the first place, whether they have symptoms or not. We force them in there. So tell us a little bit about some symptoms that men might notice themselves that would send them to see you.
Dr. Wilson: Okay. Well, that’s an important question because most men, in fact, that have prostate cancer don’t have any symptoms. Prostate cancer is the most common cancer in men in the United States and is the second leading cause of cancer death in men. So it is, it’s an important cancer, because it impacts so many men’s lives and their families. But as I said, most men don’t have any symptoms, although some symptoms could include problems with the urination, such as slow stream, getting up at night; so difficulty emptying one’s bladder. One unusual symptom that happens occasionally is also having blood in the semen. So, urinary symptoms are not uncommon when men are, you know, for a variety of reasons that can be an early sign of prostate cancer. But when men have later stages of prostate cancer, if there is spread of prostate cancer, then pain, bone pain can be a presenting symptom.
Melanie: What’s involved in screening, Dr. Wilson? Is PSA still the standard and the gold standard? Are there new genetic markers? Tell us about screening for prostate cancer.
Dr. Wilson: Okay. So, screening for prostate cancer really began to become widespread in the early 1990s when PSA first became clinically available. So PSA, which stands for Prostate Specific Antigen, is a protein effectively only made by prostate tissue. It turns out it is the best screening test we have for any one cancer. So it’s very accurate in that regard, but it’s not necessarily very specific. In other words, an elevated PSA -- this is part of the probable PSA -- an elevated PSA can be a sign of prostate cancer, but also be a sign of an enlarged prostate, or can be a sign of an enflamed prostate. Screening for prostate cancer, as I said, began in early 1990s and at that time, and since that time I should say, we’ve seen a decline in the death rate from prostate cancer of about 30 percent. But controversy has come up with prostate cancer screening because of PSA inaccuracies. In other words, as I alluded to earlier, an elevated PSA may not represent prostate cancer, but could be a sign of an enlarged prostate only, and not cancer, but also an inflamed prostate. So it’s up to the urologist to distinguish what the meaning of an elevated PSA is. So we still think PSA is an important test. We still use it. I still advocate it. There’s controversy because it’s that we may be over-diagnosing prostate cancer in men that may not need treatment. But the important thing, I think, is for men to work, and for doctors to work with a foundation of knowledge. In other words, we’d much rather know if someone has prostate cancer and the characteristics of it, and that can tell us, based on that and other factors about that individual’s health history, whether they need treatment, and if they do, what kind of treatment is best for them.
Melanie: Then, how really is it diagnosed and then you stage it; and then go on and tell us a little bit about some of the latest and hottest treatments that you’re doing out there for prostate cancer.
Dr. Wilson: Sure. So today, when men see their primary care physician, it’s still our recommendation that men be screened for prostate cancer on an annual basis and that screening typically uses the PSA blood test, as well as a physical examination of the prostate by the physician. If either one of is abnormal, again, it doesn’t mean that someone has prostate cancer but it means that they need further testing. Today, if men have either one of those two findings — an elevated PSA or an abnormal exam, such as a nodule that’s palpated on the prostate by the doctor -- then we recommend a prostate biopsy. And today, one of the significant advancements has been that MRI of the prostate is commonly used to evaluate the prostate in order to help direct the biopsies. And what we do today is fuse digitally the two technologies – MRI and Ultrasound – to help guide where the needle biopsies should go. So the standard of care today has become using ultrasound and MRI together to help the biopsy. It’s only with a biopsy or a small piece of tissue that’s collected from a needle biopsy of the prostate that pathologists can then look under the microscope at that tissue, and determine whether or not prostate cancer is there. And once we determine the prostate cancer is there, important factors are things like: how many of the needle biopsies that were done are positive for cancer, how much of those needle biopsies are actually involved in terms of kind of the percentage of the core of tissue. And also, what’s most important is the aggressiveness of the cancer; something that’s referred to as the Gleason Score. So, based on those factors, we then go on to stage the cancer; in other words, we try to find out whether or not it’s confined to the prostate or not. And those tests include things like bone scans, perhaps a CT scan, the MRI, not only of the prostate but of the abdomen and pelvis sometimes are done. Those are the primary things. Sometimes, PET Scans will be used, but they’re not so successful yet in prostate cancer. But again, staging really means, and is defined, is defining the extent of the cancer, whether or not it’s spread or not. And we use -- the PSA as an important predictor. How the prostate feels to physical exam is an important predictor, as well as the Gleason score. And then, these other sorts of radiographic or imaging scans that I have mentioned earlier.
Melanie: We don’t have a lot of time left, but tell us a little bit about Tomotherapy and that your team of experts was the first in the Western United States to offer this treatment.
Dr. Wilson: Correct. So, Helical Tomotherapy is a kind of radiation energy that’s used to focus a beam of radiation energy onto the prostate to pinpoint it. Day by day, combined with a small imaging scans, we know exactly where the prostate’s sitting and it’s roughly an eight-week course of treatment that can be accurately delivered over that period of time, typically with minimal side effects. It is true that City of Hope has become best known for our work with minimally invasive treatments, such as robotic prostatectomy. So we’ve become experts and have probably performed more robotic prostatectomies than any other institution, certainly in California and probably this side of the Mississippi. We have some innovative things going on, such as actually visualizing prostate cancer cells during the surgery to help make sure that we can get all the cancer out, but also help define whether or not additional tissues such as lymph nodes need to be removed, or whether or not we can safely spare very important structures around the prostate, such as these nerve bundles that are important for bladder and sexual function.
Melanie: Dr. Wilson, please tell why patients should come to City of Hope for their prostate and urologic cancer care.
Dr. Wilson: I think the important thing about City of Hope is that we approach each patient as an individual and we try to tailor the treatment plan for each patient. In other words, we don’t think that any one treatment fits all men necessarily. And we have a team of experts that work together for each patient to help develop that plan. This would include the urologist, such as myself, the medical oncologist and the radiation oncologist. So they get the team approach and the individual approach to that care. It really sets us apart from other institutions, not only inside of California, but around the world.
Melanie: Thank you so much, Dr. Timothy Wilson. You’re listening to City of Hope Radio. For more information, you can go to cityofhope.org. That’s cityofhope.org. This is Melanie Cole. Thanks so much for listening.
Prostate Cancer: World Leaders in Prostate Cancer Surgery
Melanie Cole (Host): City of Hope is actively developing tomorrow’s treatment protocols today for prostate cancer. As a patient of City of Hope, you have a highly-experienced and dedicated team to treat you and help you cope with cancer. My guest today is Dr. Timothy Wilson. He’s a professor and Chief of the Division of Urology and Urologic Oncology and the Director of the Prostrate Cancer Program at City of Hope. Welcome to this show, Dr. Wilson. Tell us about your approach to treatment for prostate and neurologic cancer care at City of Hope.
Dr. Timothy Wilson (Guest): Well, thank you, and thank you for inviting me to speak today. I think the most important thing to note about our treatment at City of Hope in evaluating patients is that no treatment fits all men. In other words, we like to think of each patient as an individual and we like to tailor the treatment plan based on the characteristics of that patient’s cancer.
Melanie: So tell us a little bit about prostate cancer, because we know, Dr. Wilson, that we women are who send our men into the doctor in the first place, whether they have symptoms or not. We force them in there. So tell us a little bit about some symptoms that men might notice themselves that would send them to see you.
Dr. Wilson: Okay. Well, that’s an important question because most men, in fact, that have prostate cancer don’t have any symptoms. Prostate cancer is the most common cancer in men in the United States and is the second leading cause of cancer death in men. So it is, it’s an important cancer, because it impacts so many men’s lives and their families. But as I said, most men don’t have any symptoms, although some symptoms could include problems with the urination, such as slow stream, getting up at night; so difficulty emptying one’s bladder. One unusual symptom that happens occasionally is also having blood in the semen. So, urinary symptoms are not uncommon when men are, you know, for a variety of reasons that can be an early sign of prostate cancer. But when men have later stages of prostate cancer, if there is spread of prostate cancer, then pain, bone pain can be a presenting symptom.
Melanie: What’s involved in screening, Dr. Wilson? Is PSA still the standard and the gold standard? Are there new genetic markers? Tell us about screening for prostate cancer.
Dr. Wilson: Okay. So, screening for prostate cancer really began to become widespread in the early 1990s when PSA first became clinically available. So PSA, which stands for Prostate Specific Antigen, is a protein effectively only made by prostate tissue. It turns out it is the best screening test we have for any one cancer. So it’s very accurate in that regard, but it’s not necessarily very specific. In other words, an elevated PSA -- this is part of the probable PSA -- an elevated PSA can be a sign of prostate cancer, but also be a sign of an enlarged prostate, or can be a sign of an enflamed prostate. Screening for prostate cancer, as I said, began in early 1990s and at that time, and since that time I should say, we’ve seen a decline in the death rate from prostate cancer of about 30 percent. But controversy has come up with prostate cancer screening because of PSA inaccuracies. In other words, as I alluded to earlier, an elevated PSA may not represent prostate cancer, but could be a sign of an enlarged prostate only, and not cancer, but also an inflamed prostate. So it’s up to the urologist to distinguish what the meaning of an elevated PSA is. So we still think PSA is an important test. We still use it. I still advocate it. There’s controversy because it’s that we may be over-diagnosing prostate cancer in men that may not need treatment. But the important thing, I think, is for men to work, and for doctors to work with a foundation of knowledge. In other words, we’d much rather know if someone has prostate cancer and the characteristics of it, and that can tell us, based on that and other factors about that individual’s health history, whether they need treatment, and if they do, what kind of treatment is best for them.
Melanie: Then, how really is it diagnosed and then you stage it; and then go on and tell us a little bit about some of the latest and hottest treatments that you’re doing out there for prostate cancer.
Dr. Wilson: Sure. So today, when men see their primary care physician, it’s still our recommendation that men be screened for prostate cancer on an annual basis and that screening typically uses the PSA blood test, as well as a physical examination of the prostate by the physician. If either one of is abnormal, again, it doesn’t mean that someone has prostate cancer but it means that they need further testing. Today, if men have either one of those two findings — an elevated PSA or an abnormal exam, such as a nodule that’s palpated on the prostate by the doctor -- then we recommend a prostate biopsy. And today, one of the significant advancements has been that MRI of the prostate is commonly used to evaluate the prostate in order to help direct the biopsies. And what we do today is fuse digitally the two technologies – MRI and Ultrasound – to help guide where the needle biopsies should go. So the standard of care today has become using ultrasound and MRI together to help the biopsy. It’s only with a biopsy or a small piece of tissue that’s collected from a needle biopsy of the prostate that pathologists can then look under the microscope at that tissue, and determine whether or not prostate cancer is there. And once we determine the prostate cancer is there, important factors are things like: how many of the needle biopsies that were done are positive for cancer, how much of those needle biopsies are actually involved in terms of kind of the percentage of the core of tissue. And also, what’s most important is the aggressiveness of the cancer; something that’s referred to as the Gleason Score. So, based on those factors, we then go on to stage the cancer; in other words, we try to find out whether or not it’s confined to the prostate or not. And those tests include things like bone scans, perhaps a CT scan, the MRI, not only of the prostate but of the abdomen and pelvis sometimes are done. Those are the primary things. Sometimes, PET Scans will be used, but they’re not so successful yet in prostate cancer. But again, staging really means, and is defined, is defining the extent of the cancer, whether or not it’s spread or not. And we use -- the PSA as an important predictor. How the prostate feels to physical exam is an important predictor, as well as the Gleason score. And then, these other sorts of radiographic or imaging scans that I have mentioned earlier.
Melanie: We don’t have a lot of time left, but tell us a little bit about Tomotherapy and that your team of experts was the first in the Western United States to offer this treatment.
Dr. Wilson: Correct. So, Helical Tomotherapy is a kind of radiation energy that’s used to focus a beam of radiation energy onto the prostate to pinpoint it. Day by day, combined with a small imaging scans, we know exactly where the prostate’s sitting and it’s roughly an eight-week course of treatment that can be accurately delivered over that period of time, typically with minimal side effects. It is true that City of Hope has become best known for our work with minimally invasive treatments, such as robotic prostatectomy. So we’ve become experts and have probably performed more robotic prostatectomies than any other institution, certainly in California and probably this side of the Mississippi. We have some innovative things going on, such as actually visualizing prostate cancer cells during the surgery to help make sure that we can get all the cancer out, but also help define whether or not additional tissues such as lymph nodes need to be removed, or whether or not we can safely spare very important structures around the prostate, such as these nerve bundles that are important for bladder and sexual function.
Melanie: Dr. Wilson, please tell why patients should come to City of Hope for their prostate and urologic cancer care.
Dr. Wilson: I think the important thing about City of Hope is that we approach each patient as an individual and we try to tailor the treatment plan for each patient. In other words, we don’t think that any one treatment fits all men necessarily. And we have a team of experts that work together for each patient to help develop that plan. This would include the urologist, such as myself, the medical oncologist and the radiation oncologist. So they get the team approach and the individual approach to that care. It really sets us apart from other institutions, not only inside of California, but around the world.
Melanie: Thank you so much, Dr. Timothy Wilson. You’re listening to City of Hope Radio. For more information, you can go to cityofhope.org. That’s cityofhope.org. This is Melanie Cole. Thanks so much for listening.