PROSTATE CANCER

The prostate is a gland in the male reproductive system. About the size of a walnut, it sits below the bladder, in front of the rectum, and surrounds the urethra. It releases prostatic fluid, which contributes to the formation of semen. Prostate cancer forms in prostate tissues.

Prostate cancer is often detected using a blood screening test called prostate-specific antigen (PSA). If the test returns elevated or is the prostate exam is abnormal, your doctor may recommend a biopsy of the prostate.

Men who are at normal risk should have an annual prostate exam starting at age 50. Men with higher risk (family history or African American) should start around age 40.

The exact causes of prostate cancer are unknown, though genetics, inflammation, and environmental factors such as diet and smoking likely play a role. Men older than 65 and/or with an immediate family history of prostate cancer are at greater risk, as are African American men. Obesity also increases the risk of prostate cancer.

Prostate cancer usually causes no symptoms unless it has spread outside the prostate, but some patients may experience:

• Difficulty starting or stopping urine flow
• Increased urinary frequency, particularly at night
• Weak urine flow
• Blood in the urine or semen
• Pain in the lower back, hips or upper thighs

Men older than 65 and/or with an immediate family history of prostate cancer are at greater risk, as are African American men. Obesity also increases the risk of prostate cancer.

Diagnosis

A urologist performs a detailed history and physical exam, including a variety of tests:

• Digital rectal exam: To get a general idea of the size and condition of the gland, the doctor inserts a lubricated, gloved finger into the patient’s rectum and feels the prostate through the rectal wall.
• PSA Blood test: Blood sample reveals the level of prostate-specific antigens (PSA) in the blood.
• MRI: A magnetic resonance imaging (MRI) scan is a common procedure that uses a strong magnetic field and radio waves to create detailed images of the organs and tissues within the body.

If test results are abnormal, the urologist may advise:

• Transrectal ultrasound: A rectal probe identifies abnormal areas of the prostate.
• Transrectal biopsy: A biopsy needle passed through the rectum gathers a tissue sample to detect cancer cells.
• MRI fusion biopsy: MRI/ultrasound fusion technology uses MRI images and targets abnormal areas identified on those images. While performing the biopsy, the urologist will then have the annotated images of the MRI with the suspicious areas marked on these images available on his/her monitor. These images will then be fused with the real-time transrectal ultrasound image of the prostate. This subsequently allows an MRI-targeted sampling of suspicious areas under ultrasound guidance.

Treatment

A variety of treatment options exist for prostate cancer, and an individual approach is developed depending on the grade and stage of the cancer, as well as the age and overall health status of the patient.

Treatment options include active surveillance, robotic surgery, radiation, hormonal therapy, and chemotherapy. Occasionally, a combination of treatments is recommended.

The Gleason score and tumor stage are used together to predict prognosis of prostate cancer and help guide therapy.

The Gleason score is a description of the aggressiveness of the cancer cells and is assigned based on the microscopic appearance of the cancer cells. The Gleason score ranges from 6 (least aggressive) to 10 (most aggressive) and is based on prostate cancer cells’ microscopic appearance.

The tumor stage describes how the cancer was detected and the extent of the cancer in the body. The tumor stage will not be indicated on a prostate biopsy report, but will be described by your doctor.

• Stage I: Cancer is limited to the prostate and detected based on an abnormal PSA test.
• Stage II: The tumor is localized to the prostate.
• Stage III: The tumor has been detected in organs next to the prostate, extending into the seminal vesicles (a gland behind it that helps produce semen), sphincter (muscles that control urine flow), bladder, rectum or wall of the pelvis.
• Stage IV: The tumor has spread beyond the prostate into the lymph nodes or other organs, including bones.

We base our prostate cancer treatment approach on each patient’s unique situation and consider each person’s preferences while balancing risks and benefits of treatment options. Learn more about our Advanced Prostate Cancer Treatments here.

Treatments for local growth (stages I and II) include:

• Surgical removal of the prostate through:
  • Robotic surgery: Minimally invasive laparoscopic surgery is the most common surgical treatment for prostate cancer.
  • Open surgery: Prostate removal through a cut in the abdomen or an incision between the prostate and the anus.
• Radiation:
  • Stereotactic body radiation therapy: Delivers high doses of radiation in a small number of treatment sessions – five outpatient sessions on consecutive days or over two weeks.
  • External or image-guided radiation: Uses two- and three-dimensional imaging to direct radiation, often called IMRT or IGRT.
  • Brachytherapy: Inserts seeds containing radioactive material directly into the prostate.
• Active surveillance: Urological exams, including regular PSA tests and digital rectal exams with repeat biopsy within the first one to two years and as needed after that, depending on the patient’s risk factors and clinical condition