It's usually a combination of factors -these might be environmental or hormonal or relate to lifestyle or family history. There may be genetic factors at play as well.

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Yes. Prostatitis, inflammation or infection of the prostate, mainly affects men under 40 and can develop from a urinary tract infection. Symptoms can include pain when urinating and ejaculating and pelvic pain. The cause can be anything from bacteria to sexually transmitted infections (STIs) such as gonorrhoea or chlamydia. It can be treated with antibiotics.

Yes. Good genital hygiene and condoms can help prevent urinary tract infections and prostatitis. There is also increasing evidence that vitamin D promotes resistance to infections.

Yes. At least 60 per cent of men over 60 have benign prostatic hyperplasia (BPH), or an enlarged prostate. Symptoms include difficulty urinating and needing the toilet often. If symptoms are mild, no treatment is needed, but in severe cases, medication to shrink the gland or surgery can improve quality of life.

Yes. One in nine men develops prostate cancer, about 20,000 are diagnosed annually in Australia and 3300 die from it. Almost two-thirds of those diagnosed are older than 65. Men of Afro-Caribbean descent have an increased risk, as do those who have a close relative with the disease. Having an STI at a young age can also be a risk factor. According to the American Cancer Society, about 238,590 new cases of prostate cancer will be diagnosed in 2013, and about 29,720 will die from it.

Yes. Up to 10 percent of prostate cancer cases have an inherited component. For example, the BRCA2 gene, which can cause breast cancer in women, is also associated with prostate cancer.

Although some men have lower back or hip pain, prostate cancer may have few or no signs in the early stages. A PSA blood test checks whether levels of prostate-specific antigen, a chemical made by the gland, are raised, which may indicate cancer. In advanced prostate cancer the sufferer may experience bone, pelvic or back pain, weight loss and blood in the urine or semen.

Yes! A new test, PCA3, measures a protein only produced by cancer cells and is about 80 per cent accurate. A definite diagnosis can be made with a biopsy.

Actually, prostate cancer is usually slow-growing, but the challenge is to find out whether the cancer is aggressive or slow-growing as treatment can cause serious side effects, including incontinence and impotence. Most cancers are slow-growing. Post mortems show that 80 per cent of men aged 80 have cancer cells in the prostate that may have been present for 20 to 25 years and they have died of other causes.

In general, no. Most men diagnosed with prostate cancer will die of something else, even if their cancer has spread beyond the prostate. That said, there are aggressive forms of prostate cancer. When that's the case, we can often manage the disease for many years before it leads to the complications we expect to see with advanced cancers.

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Yes. The workup for screening usually involves two important components -a finger exam (called a "digital exam") of the prostate and a PSA blood test. PSA stands for prostate-specific antigen, a protein that only the prostate makes. A rising or elevated PSA is an indicator of potential prostate cancer.

The PSA test isn't perfect, but urologists look at the results and put them in context with other indicators of risk, such as family history, the presence or absence of symptoms, how big or what the prostate feels like on exam, and whether the PSA level has changed over time. This "big picture" helps us decide whether a man may benefit from having a biopsy, which is the only way to diagnose prostate cancer definitively. A biopsy involves simply getting a tissue sample.

The screening process typically happens in the primary care office, and if there is a concern, the doctor will refer the patient to a urologist.

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The current recommendation is that men talk to their primary care doctor or urologist about getting screened when they are 55 years old. If a man has African American heritage or has a brother or father with a history of prostate cancer, their screenings should begin in their 40s.

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When prostate cancer is diagnosed early, the cancer is contained within the prostate -it hasn't spread to the bones or lymph nodes. This is the scenario for most men and their chances for survival are very good.

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No. Doctors decide on treatment based on a man's age, how aggressive the cancer appears, PSA test results and the man's attitude. Out of every 100 men diagnosed, about two-thirds have aggressive treatment. The other third opt for monitoring through regular blood tests, biopsies and digital rectal examinations.

Usually not. Treatment can include removing the prostate, radiotherapy, freezing or heat treatment to destroy the gland. There is little difference in survival rates between treatments, although freezing and heating are quite new. Due to better techniques, serious side effects from treatment are less common.

Yes! Several studies show that men who eat foods containing lycopene, found in tomatoes and tomato-based foods, have a lower risk of developing prostate cancer. Getting enough exercise also appears to reduce the risk. Eat a variety of fruits and vegetables, maintain a healthy weight and don't smoke.

STPB is performed by taking an average of 40 samples of the prostate through the Perineum while the patient is under general anesthesia. It allows more comprehensive sampling compared to the transrectal method, which takes fewer samples through the rectum. In addition, by taking more samples during STPB, the exact location of the cancer can be pinpointed.

The standard office biopsy is done under local anesthesia and uses a rectal approach, taking from 10-14 samples. The stereotactic biopsy is done under general anesthesia through the Perineum (just above the rectum and below the scrotum), and takes an average of 40 samples depending on the size of the patient’s prostate. It is performed as an outpatient procedure, so patients go home that same day.

You will usually get results in 3-5 working days.

This is an ultrasound study of the prostate to determine the exact size and shape of the gland. Pictures or images of the prostate are taken and used to design each patient’s individualized treatment plan. At the conclusion of the volume study, the radiation oncologist will decide if a patient is a candidate for seed implantation.

Yes. The volume study is used to measure the size and shape of the prostate gland which is essential to planning the placement and number of seeds. Unlike the biopsy, there is no needle used and no specimen is obtained.

If a patient and his radiation oncologist decide that the he is a good candidate for a seed implant, the procedure typically is scheduled in two to four weeks following the volume study; sooner for patients traveling from out of town.

Seed implant may still be a treatment option for the patient in combination with other treatment modalities. The patient will need to consult with his radiation oncologist.

During a volume study, there is no anesthesia used so a patient may drive himself home afterward.

No. Because the patient is given general anesthesia in conjunction with the seed implant. Therefore, the patient will need to have a responsible adult drive him home.

Although the actual seed implant takes approximately one hour, the patient will be at the surgery center for three to four hours total. It is a one-time, outpatient procedure.

Although the seeds remain in a patient’s prostate forever, they only remain active for a certain period of time, depending on the type of seed used.

The main difference between these sources is the time in which the radiation is delivered. All 3 isotopes are short-lived or decay rapidly, meaning they deliver the required dose in a short amount of time. So far, the cure rates within all 3 isotopes appear to be equal.

The radiation oncologist will choose the optimal plan for each patient, taking into consideration many factors including the size and shape of the prostate gland, Gleason score, age, other health conditions, etc.

This depends on the type of seed implant that a patient is getting. The way Dr. Moran does it, only he (a radiation oncologist and an anesthesiologist) actually do the implant. A urologist may sometimes be involved as well. A radiation physicist and certified medical dosimetrist are involved in the treatment planning.

After a seed implant, it is common to experience some urinary symptoms. Common urinary symptoms are: frequency (a need to urinate more often), urgency (a strong desire to urinate), a decreased force of the urinary stream and difficulty starting the urinary stream. A small percentage of patients (less than 7%) may require a temporary catheter or short-term intermittent self catheterization.

A patient may resume intercourse when ready, with the recommendation that a condom is used for the first two weeks following the implant.

After a prostatectomy, a man can still have an orgasm but won't ejaculate. That's because the gland that produces semen is gone. This side effect can also occur after radiation therapy.

The other side effect men worry about is whether they will be able to have an erection after surgery. This depends on what happens during surgery. The two nerves that stimulate an erection sit on the surface of the prostate. If the surgeon can spare those nerves during surgery, there's a pretty good chance the patient will be able to have an erection. However, the surgeon sometimes has to remove one or both of these nerves to get rid of the cancer cells. This will impact whether an erection is possible after surgery.

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The prostate is like a speed bump holding urine back. When a man doesn't have a prostate anymore, we strongly recommend doing Kegel exercises to strengthen his pelvic floor. With Kegels, about 90% of men are continent one year after surgery, meaning they don't have

to wear a pad or anything like that to keep dry.

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Most patients only take a day or two off work. We do not recommend lifting over 10-15 pounds for the first 2 weeks after the procedure. This is a minimally invasive, one-time, outpatient procedure with no incisions or stitches.

A patient may still be a candidate if only a small amount of tissue was removed. In fact, we have safely treated hundreds of patients who previously had a TURP in the past. A patient will need to consult with his radiation oncologist.

Pregnant women should maintain a distance of 3 feet (about an arm’s length)from the patient, for 2-6 months, depending on the isotope that the patient received. At this distance, there is no limit on the time a pregnant woman can spend with a patient who received prostate brachytherapy. There are no special precautions for a spouse, family member, pet or the general public. Detailed, written instructions are given to each patient after his implant. This information is based on recommendations from the American Association of Physics in Medicine.

A patient who received prostate brachytherapy should limit the amount of time that a child sits on his lap to 5 minutes per day for 2-6 months, depending on the isotope that the patient received. With this precaution, there is no limit on the time that a patient may spend with children. There are no special precautions for other family members, pets or the general public. Detailed, written instructions are given to each patient after his implant. This information is based on recommendations from the American Association of Physics in Medicine.

The seeds are implanted with accuracy and they pose minimal risk to surrounding organs or tissue.

No. Although the seeds are radioactive, patients are not. Since the radioactivity has low energy and the placement is so precise, virtually all the radioactivity is absorbed into the prostate. There is no radioactivity in a patient’s blood, sweat, urine and other bodily fluids. There are no issues with contamination.

No. The seeds are titanium, similar to other pins or clips used in medical procedures. There should be no problem with security systems or metal detectors.

Yes, the seeds are titanium, similar to other pins or clips used in medical procedures. There are no contraindications to MRI or other scans.

Yes, it is safe to have a colonoscopy, however, we recommend waiting 6 months after the seed implant before having a colonoscopy. A patient should always inform the physician performing the colonoscopy that the patient has had a prostate seed implant. If a patient needs a colonoscopy procedure urgently, the patient’s gastroenterologist should speak with the patient’s radiation oncologist.

Most private/commercial insurance companies allow benefits for this procedure and Medicare approves the seed implant as well. We contact each patient’s insurance carrier to verify benefits and coverage and we will pre-certify the procedure, if necessary. If we are out-of-network with a patient’s insurance plan, we discuss payment options with a patient in advance of treatment.

A post plan begins with the results from the patient’s CT scan and then is transferred to our treatment planning software. Our physics staff, with the use of this software, performs a replication of the seed implant using the CT images. These images are then compared to the pre-implant dosimetry plan. The post plan results provides the physician with the final radiation dose results, and confirms the prescribed dose was delivered to the prostate and surrounding organs. This is the final step in every seed implant. This will be a part of the patient’s permanent medical record and may be requested in the future for other medical planning. This charge will be billed the date that the physician approves this final analysis.

Intraoperative planning is when the prostate is measured and dose is calculated to deliver the proper amount of radiation in the operating room on the same day as the implant procedure. Pre-planning is very similar in that measurements of the prostate are taken 1-2 weeks prior to the day of implant. The radiation is calculated accordingly. We prefer pre-planning because the prostate really does not change its shape or size and therefore, accurate measurements can be taken to ensure the proper number of radioactive seeds are ordered, allowing for additional quality assurance prior to the actual implant. Furthermore, pre-planning is very efficient, requiring essentially no additional time for the patient who is under anesthesia during an implant.

Longer term, these men will need to have follow-up PSA tests for the rest of their lives. A rising PSA level would indicate that maybe cancer has come back.

Fortunately, the five-year survival rate for men with localized prostate cancer is nearly 700%. However, up to 40% of men will experience a recurrence, so it is essential to understand your risk and get tested periodically. And be sure to talk to your doctor about any changes, side effects from treatment, or other concerns you may have.

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