Urology Expert Answers Your Prostate Cancer Questions
Urology expert David Silver, MD, who specializes in treating prostate cancer, recently joined the urology team at miVIP Surgery Centers in New York. Dr. Silver sat down with us at miVIP to answer some of the many questions we receive about prostate cancer treatment options and how men can optimize their prostate health. Dr. Silver specializes in treating cancers of the urinary tract and male reproductive system, and performs robotic prostatectomies and related procedures at miVIP on an outpatient basis. Calling on his more than 20 years of experience in caring for patients with prostate cancer, Dr. Silver shared his recommendations for managing your prostate health.
Doctor Q&A: Dr. David Silver answers your frequently asked questions about prostate cancer & prostate health
Q: How common is prostate cancer and who is most likely to get prostate cancer?
A: By age 70, almost half of men have prostate cancer. By age 90, the majority of men have it. However, most men will die from other causes. This is due to the relatively slow growth of prostate cancer – by the time the tumor grows and spreads, most older men will have died from a non-cancer cause. African-American and Caribbean-American men have the highest incidence of prostate cancer at younger ages.
Q: More men are becoming aware that early detection of prostate cancer provides the best chance for effective treatment and, possibly, a cure. What are the early warning signs of prostate cancer?
A: Unfortunately, most prostate cancers have no early warning signs. This is very similar to breast cancer in women – by the time symptoms are present, the tumor is quite advanced.
Q: What are the recommended or most reliable prostate cancer screenings and when should a man undergo testing or screening?
A: Prostate-specific antigen (PSA) is a blood test that can indicate a prostate problem. Digital rectal examination (DRE) is the “finger test” done by a doctor to examine the prostate, which can help to detect prostate health problems. Multiparametric Prostate MRI is a non-invasive imaging test that can point towards abnormalities in the prostate. However, only a biopsy – removal of bits of tissue from the prostate – can definitively diagnose prostate cancer. The average man should begin testing at age 55 and continue until he is no longer likely to live 10 years. At-risk men (African- or Caribbean-American), and men with a first-degree relative with prostate cancer diagnosed before age 65, should begin testing earlier.
Q: Recent news articles are warning men of certain risks associated with prostate biopsy and urging them not to undergo unnecessary transrectal biopsies. What are your thoughts on that?
A: The major risk associated with prostate cancer screening is OVERTREATMENT of small non-aggressive tumors, NOT overdiagnosis. The infection risk of up to 3% traditionally associated with prostate biopsy may be minimized by appropriate application of a variety of strategies, including a transperineal approach, and core number reduction with lesional biopsy.
Q: Once a man receives a prostate cancer diagnosis, what treatments do you recommend?
A: Radiation, surgery, or deferred treatment (so-called “watchful waiting”) approaches may each be reasonable treatment options depending upon the tumor stage, grade, volume, predictive biomarker assessment, and patient expectations.
Q: You have expertise in robotic prostatectomy, among other prostate health treatments. Can you explain the benefits of a robotic prostatectomy compared to a traditional open prostatectomy or other method?
A: The da Vinci® Robotic Surgical System enhances the precision of the laparoscopic approach for both the ablative (tumor removal) and reconstructive aspects of the procedure. While all approaches can remove the prostate and the cancer safely and effectively, the robotic approach greatly reduces the need for blood transfusion, and can be accomplished with much less pain and disability than other approaches. When used in combination with modern anesthetic and pain-management techniques, most patients having robotic prostatectomy can be discharged the day of surgery and avoid even an overnight hospitalization.
Q: As with any type of surgery, surgeon experience counts! How many robotic prostatectomies do you think a surgeon should have completed before a patient can be reassured that he/she has achieved a high level of expertise with robotic technology?
A: This topic has been quite well studied: A minimum of 50 “learning curve” procedures is necessary for the surgeon to become fully familiar with the approach, and improvement continues up through 500 cases.
Q: What are the possible side effects or complications of prostate surgery and can these be prevented?
A: Although a surgeon’s experience and minimally invasive techniques can reduce some risks, no surgeon or approach can fully guarantee the prevention of all side effects. If any short-term side effects occur, including infection or deep venous thrombosis, these will resolve with specific treatment. If any less frequent, longer-term side effects occur, including stress urinary leakage or erectile dysfunction, these may be improved with more interventional and sustained efforts.
Q: What lifestyle changes or measures can a man take to prevent prostate cancer?
A: This is an active area of research. While a healthy lifestyle (including proper diet and exercise) can generally increase longevity (by decreasing the risk of death from cardiovascular disease), to date the only medication specifically associated with a decreased risk of developing prostate cancer is lifetime use of a 5-alpha reductase inhibitor (5-ARI), as shown by the Prostate Cancer Prevention Trial (PCPT).
Q: Are there other conditions of the prostate or related conditions that men should look out for and learn how to manage?
A: Yes. Benign prostatic enlargement, not due to prostate cancer, can cause damage to both the bladder and kidneys if left untreated. In general, most men with this condition will have symptoms (slowed urinary stream, arising at night to urinate, sensation of incomplete emptying) that typically will call attention to the problem with sufficient time for treatment to prevent permanent damage.
David Silver, MD, was interviewed to help raise awareness about prostate health during September, National Prostate Health Month.
About Dr. David Silver
David Silver, MD, is board-certified in urology and urologic oncology. He received a Doctor of Medicine degree from Albert Einstein College of Medicine. Following medical school, he completed an internship and two residencies at Maimonides Medical Center in surgery and urology, and a fellowship in urologic oncology at Memorial Sloan-Kettering Cancer Center. Since 1997, Dr. Silver has served as the Section Chief of Urologic Oncology at Maimonides Medical Center in Brooklyn, NY. Since 2015, Dr. Silver has chaired the Division of Urology at Maimonides Medical Center. Dr. Silver is a Fellow of the American College of Surgeons, and a member of the American Urologic Association and the American Medical Association, among other professional organizations. He has been a presenter at national and international conferences, and has authored or co-authored numerous abstracts and articles for peer-reviewed journals.
Learn more about Dr. Silver in the miVIP Physician Directory.
Call miVIP Surgery Centers at (855) 337-0691 for a Free Evaluation with Dr. Silver!
miVIP Locations in New York:
551 5th Ave Suite #525, New York, NY 10176
1575 E 19th Street, Brooklyn, NY 11230