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School of Medicine
Johns Hopkins prostate cancer experts lead the world in surgical, medical, radiation and experimental treatments for prostate cancer. Prostate cancer experts from the James Buchanan Brady Urological Institute and Kimmel Cancer Center collaborate to provide world-class care and conduct innovative research, pushing the boundaries of current care to develop new and better ways to fight prostate cancer.
Consultations with a multidisciplinary group of experts are available through a single-day clinic at the Brady Urological Institute.
Prostate Cancer Information and Statistics
Prostate cancer is the second most common diagnosed cancer in American men, and one in six men will be diagnosed with the cancer in his lifetime. Nearly 85 percent of prostate cancers diagnosed at a localized stage (meaning they only affect the prostate tissue) can be cured. More than half of prostate cancer deaths are in men who have been diagnosed with the disease after age 75. The National Cancer Institute estimates that about 5 percent of men diagnosed with prostate cancer each year will have advanced disease, meaning the cancer has spread beyond the prostate gland.
- Family history: In 1992, Johns Hopkins researchers confirmed a link between a man’s family history of prostate cancer and his own risk of developing the cancer. For example, a patient with a father or brother with prostate cancer has two times the usual risk of developing prostate cancer. A man with both his father and brother affected with prostate cancer has almost a 50 percent chance of developing the disease.
- African-American men: African-American men are 70 percent more likely to get prostate cancer, and twice as likely to die from the cancer, than white men. The exact reasons for this difference are still being studied.
Up to 85 percent of prostate cancers are detected with either a PSA test or a physical exam, usually before a man notices any symptoms. Symptoms, when they do happen, might include:
- Difficulty starting urination, holding back urine, or a weak or interrupted urine flow
- Blood in urine
- Difficulty in having an erection
- Painful ejaculation
- Frequent pain or stiffness in the lower back, hips, or upper thighs
There are two tests to screen for prostate cancer: the PSA test and the digital rectal exam. The digital rectal exam is performed by inserting a gloved finger into the rectum to feel for abnormal areas on the prostate. The PSA test is a blood test that measures levels of the PSA protein, produced by the prostate gland. The higher the PSA level, the more likely a man is to have prostate cancer. At the moment, the effectiveness of PSA prostate cancer screening is uncertain.
Johns Hopkins physicians, following the American Urology Association guidelines, recommend prostate cancer screening every two years for men, beginning at age 55, and continuing until age 70. African-American men and men with a family history of prostate cancer should discuss earlier or more frequent screenings with their doctor.
Diagnosis and Staging
Prostate cancer is diagnosed with a prostate biopsy, which removes tissue from the prostate to examine it for cancer cells. This removal is guided by transrectal ultrasound, which uses a rectal probe to deliver ultrasound waves to the prostate and surrounding tissues. Christian Pavlovich, M.D. and colleagues are testing a type of high resolution transrectal ultrasound in prostate cancer patients, to confirm whether the technique can better detect prostate cancer.
The Partin Tables are tools developed by Johns Hopkins researcher and Chair of the Urology Department Alan Partin, M.D. to help patients and their doctors understand the extent of a patient’s prostate cancer and guide his treatment options. Factors that go into the Partin Tables include the patient’s PSA levels; their Gleason score, which looks at microscopic differences in cancer cells retrieved during biopsy; and information from physical exams. (Read more about the Partin Tables.)
Active Surveillance of Prostate Cancer
Patients with low-grade, slow-growing tumors confined to the prostate gland (Grades 1 or 2) may consider active surveillance as treatment. This involves monitoring prostate cancer in its localized stage by continual monitoring of PSA and biopsies of the tumor until your doctor feels that further treatment is needed to halt the disease at a curable stage.
- Since 1994, H. Ballentine Carter, M.D. and Jonathan Epstein, M.D. of Johns Hopkins’ James Buchanan Brady Urological Institute have run the world’s largest study of active surveillance for prostate cancer.
- A 15-year study conducted by Dr. Carter and others found that in a group of 1,298 low-grade prostate cancer patients under active surveillance, only two men died of prostate cancer and only three men had metastatic prostate cancer.
Patients who may be too old or too sick from other causes to benefit from therapy to early-stage prostate cancer may choose watchful waiting. Doctors continually monitor PSA levels and image any prostate tumors until they cause symptoms or spread to distant sites in the body.