The prostate is a gland about the size and shape of a walnut. It surrounds the upper part of the urethra in men, the tube that carries urine from the bladder. The prostate is part of the male reproductive system and produces most of the semen in which sperm travel.

As a man ages, his prostate changes. Inside a changing prostate, groups of cells may form tumors or other growths:

• Noncancerous growths. As a man ages, the prostate may grow larger. This condition is called benign prostatic hyperplasia (BPH). Extra prostate tissue often squeezes the urethra, causing symptoms such as difficulty urinating. But BPH does NOT lead to cancer.
• Atypical cells (prostatic intraepithelial neoplasia or PIN). Some cells don’t appear normal, but they are not cancer. These cells may indicate that cancer is present or is likely to form.
• Cancer. Abnormal cells form a tumor—a lump of cells that grow uncontrolled. Cancer may or may not produce symptoms. Some tumors can be felt during a physical exam; others can’t. Prostate cancer can often be cured or controlled, especially if it is found and treated early. Screening tests help detect it before it causes any symptoms.
• Cancer spread. The cancer may spread to nearby organs. In some cases, the cancer spreads to bones or organs in distant parts of the body. This spread is called metastasis.

Risk factors for prostate cancer include the following:

• Age. As you grow older, your risk of developing cancer increases
• Family history. If your father or brother has had this cancer, your risk of developing it is higher
• Race. African-American men are more likely than other men to develop prostate cancer. They are also more likely to die of this disease than other men with.

Screening for prostate cancer can help to check if you have cancer. Your healthcare provider may recommend regular screening starting at age 50—or earlier if you are at higher risk.

Prostate cancer may not cause symptoms at first. Urinary problems are not often a sign of cancer, but of another condition. The following tests help confirm a diagnosis of cancer and also provide information about a cancerous tumor:

• Prostate specific antigen (PSA) testing: PSA is a chemical made by prostate tissue. The PSA level (amount of PSA in the blood) is tested to evaluate a man’s risk. In general, a high or rising PSA level may mean an increased cancer risk. PSA testing is also used to evaluate the success of cancer treatments.
• Core needle biopsy: This test involves taking tissue samples from the prostate to obtain more information about cancer cells. During the test, a small probe is inserted into the rectum as the patient lies on his side. An image of the prostate is displayed on a video monitor. With this image as a guide, the doctor uses a thin needle to remove tiny tissue samples from the prostate. The patient is given medications so he does not feel pain during the test.

Radical (total) prostatectomy is surgery to remove the entire prostate. Your doctor may decide to do a prostatectomy if diagnostic tests show that the cancer is confined to the prostate.

The surgery may be done through several small incisions in the abdomen, a technique called laparoscopy. In many cases, a technique called robotic-assisted laparoscopy is used. The robotic system provides a 3-dimensional view of the inside the body and also assists the surgeon’s hand movements.

In some cases, your surgeon may decide to perform the surgery through a larger incision in the abdomen. This is called the retropubic approach. Alternatively, your doctor may perform the surgery through an incision behind the scrotum. This is called the perineal approach.

The surgeon may remove and check the lymph nodes near the prostate to see if the cancer has spread. If the cancer has spread, the surgeon may decide not to remove the prostate. If the cancer has not spread, the surgeon will remove the prostate, the seminal vesicles and a portion of urethra. Nerve-sparing techniques may be used to help preserve erectile function (the ability to achieve and maintain an erection).

Your surgeon will give you detailed instructions on preparing for surgery. After surgery, you will be told how to care for yourself at home as you recover. Be sure to ask any questions you have about the procedure and recovery.

Call 504-842-4083 for more information or to make an appointment.

Call 504-842-3910 for more information or to make an appointment.

Kidney cancer, also called renal cancer, forms when cells in the kidney change and multiply abnormally. The cancer can interfere with the working of the kidneys. Kidney cancer may spread beyond the kidneys to other parts of the body. This spread is called metastasis. The more the cancer spreads, the harder it is to treat.

Treatment options for kidney cancer include the following:

• Surgery to remove the cancerous kidney and, in some cases, the surrounding tissue
• Radiation therapy that uses directed rays of energy to kill cancer cells
• Chemotherapy that uses strong medications to kill cancer cells
• Immunotherapy that strengthens the body’s immune system to help fight cancer

If you need surgery, Ochsner has the newest technology for kidney procedures: Firefly, used in conjunction with robotic laparoscopy. Robotic laparoscopy involves inserting a tube through a small incision and removing the tumor with a remote-controlled unit. Firefly uses infrared imaging to illuminate exactly where the kidney and its blood supply are. The kidney and arteries glow green, but the tumor does not light up, making removal of the tumor easier and more precise. Firefly eliminates the complications of older procedures: blood loss and disruption of the blood supply to the kidney. With the more precise Firefly, doctors can see and accurately control blood flow to keep the body functioning as normally as possible.

As cancer cells multiply, the tumor grows. Bladder cancer begins in the lining of the bladder and often doesn’t grow beyond that layer. As the tumor gets larger, however, it may invade (grow into) deeper layers of the bladder. It may also invade nearby organs, such as the prostate in men or the uterus in women.

Cells can break off from the main tumor and enter the bloodstream or lymph nodes. Blood or lymph then carries the cells to other areas of the body, such as the bones, liver or lungs, where a new growth may form. This process is called metastasis.

Once cancer has been diagnosed, your doctor will check to see how deep the cancer has grown and whether it has spread. In other words, your doctor will determine the cancer stage by looking inside the bladder during cystoscopy and using tests that show images of the bladder, the areas around it and parts of the body to which the cancer may spread.

• Superficial Stage: At the superficial stage, the tumor is confined to the bladder lining and the submucosal layer of the bladder
• Invasive Stage: At the invasive stage, the tumor has begun to grow into the muscle or fat layers of the bladder
• Metastatic Stage: At the metastatic stage, cancer cells from the main tumor have spread to other areas of the body

Currently there are three Approaches to Radical Prostatectomy surgery:

• Open
• Laparoscopic
• Robotic-Assisted Laparoscopic (da Vinci® Prostatectomy) An open prostatectomy requires an 8-10 inch incision on the patient's abdomen for direct access to the operative site. Conventional laparoscopic and robotic-assisted laparoscopic approaches require several dime-sized incisions, or operating "ports," which are used to introduce narrow-shafted instruments. The surgeon and assistants maneuver the instruments from outside the body, under vision provided by a surgical camera.

The potential advantages of laparoscopic and robotic-assisted laparoscopic prostatectomy over conventional open surgery include:

• Smaller incisions
• Less post-operative pain
• Improved cosmetics
• Reduced blood loss
• Less need for blood transfusions
• Faster return to normal activities

The two major drawbacks of conventional laparoscopy are that it relies on the use of rigid, hand-held instruments and visualization provided by a standard 2D video monitor. While these technologies enable smaller incisions, they can limit the surgeon's sense of depth of field, his/her dexterity and precision. Standing at the patient's side, the surgeon must operate in a counterintuitive fashion, moving the long-shafted instrument handle in precisely the opposite direction as he or she intends to move the instrument tip. The surgeon maneuvers the instruments while looking up at the 2D view of the operating field projected on a tableside video monitor and while instructing an assistant on how to position the surgical camera.

Call 504-842-3910 for more information or to make an appointment.

Innovative therapies are available through various research protocols, including on-going trials in the prevention and treatment of early disease as well as advanced or metastatic disease. For example, Ochsner has been a pioneer in the implantation of radioactive seeds for the treatment of prostate cancer.

For patients with other types of cancer, members of the Urology Department are available to help with incontinence or impotence, which may result from various cancer treatments. Ochsner’s urologists can offer the full range of medical and surgical options.

• Prostate Cancer, including radical nerve-sparing prostatectomy, brachytherapy (radioactive seed implants), external beam radiation therapy, laparoscopic and robotic surgery
• Bladder Cancer, including continent urinary diversion and laser surgery
• Renal Cell Carcinoma, including robotic and laparoscopic partial nephrectomies, cryoablation and tumors of the vena cava
• Testicular Cancer with Retroperitoneal Node Dissection
• Adrenal Tumors

High-Intensity Focused Ultrasound (HIFU) is a minimally invasive treatment for localized prostate cancer that uses high-frequency sound waves directed at the cancerous tissue through an ultrasound probe inserted into the rectum. The high intensity sound waves heat up and ablate the targeted tissue, causing cell death.

Ochsner Health is using Focal One Robotic HIFU, the world’s most advanced HIFU system, and the only system available to treat prostate cancer patients throughout the Gulf Coast region. With Focal One, high resolution images are fused with biopsy data and real-time ultrasound imaging which allows the urologist to view cancerous tissue images in 3D. With this clear view, the doctor can draw precise contours around the diseased tissue, ablate only that portion of the prostate and minimize damage to surrounding structures, which include nerves, blood vessels and muscle tissue. For the patient, this reduces the risk of urinary incontinence and erectile dysfunction.

Focal One Robotic HIFU gives urologists the ability to use focal therapy to ablate only the diseased portion of the prostate. This is similar to performing a lumpectomy to remove only the diseased tissue from the breast of a woman with breast cancer, and focal therapy still leaves the options of radical surgery or radiation therapy, should the cancer return. Read more about the Focal One HIFU treatment here.

For men diagnosed with localized prostate cancer, HIFU provides another alternative between active surveillance, and radical surgery and radiation. HIFU is a minimally invasive, outpatient procedure. No incisions are made during treatment. Think of holding a magnifying glass above a leaf on a sunny day. The sun’s rays shine through the lens and cause the leaf to burn.

Ideal candidates for HIFU are those who have early stage (Gleason 6 or 7), low-grade cancer that is confined to the prostate and that is visible on an MRI or ultrasound. A PSA level below 20ng/mL is also preferred. HIFU is used to treat a single tumor or part of a large tumor and is not meant for those whose cancer has spread beyond the prostate. If you are interested in HIFU, please contact our team at 504-842-4043.