Prostate Cancer

The prostate is a small walnut shaped gland in the pelvis of men. It is located next to the bladder and can be examined by getting a digital rectal exam. Prostate cancer is a form of cancer that develops in the prostate gland. It is the second-leading cause of cancer deaths for men in the U.S. About 1 in 9 men will be diagnosed with prostate cancer in their lifetime.

Symptoms

In its early stages, prostate cancer often has no symptoms. When symptoms do occur, they can be like those of an enlarged prostate or BPH. Prostate cancer can also cause symptoms unrelated to BPH. If you have urinary problems, talk with your urologist.

Symptoms of prostate cancer can be:

    • Dull pain in the lower pelvic area
    • Frequent urinating
    • Trouble urinating, pain, burning, or weak urine flow
    • Blood in the urine (Hematuria)
    • Painful ejaculation
    • Pain in the lower back, hips or upper thighs
    • Loss of appetite
    • Loss of weight
    • Bone pain

Causes

No one knows why or how prostate cancer starts. Autopsy studies show 1 in 3 men over the age of 50 have some cancer cells in the prostate. Eight out of ten “autopsy cancers” found are small, with tumors that are not harmful. Risk factors can include family history, ethnicity, and age.

Diagnosis

Screening

“Screening” means testing for a disease even if you have no symptoms. The prostate specific antigen (PSA) blood test and digital rectal examination (DRE) are two tests that are used to screen for prostate cancer. Both are used to detect cancer early. However, these tests are not perfect. Abnormal results with either test may be due to benign prostatic enlargement (BPH) or infection, rather than cancer.

Who Should Get Screened?

Screening is recommended if you are a man:

    • Between 55–69 years old
    • African–American
    • Have a family history of prostate cancer
What are the benefits and risks of screening?

The PSA test and DRE are very important tools. They help to find prostate cancer early, before it spreads. When found early, it can be treated early which helps stop or slow the spread of cancer.

What is a Biopsy?

For a prostate biopsy, tiny pieces of tissue are removed from the prostate and looked at under a microscope. The pathologist is the doctor who will look carefully at the tissue samples to look for cancer cells. This is the only way to know for sure if you have prostate cancer.

The decision to have a biopsy is based on PSA and DRE results. We will also consider your family history of prostate cancer, ethnicity, biopsy history and other health factors.

Prostate biopsy is usually done using an ultrasound probe to look at the prostate and guide the biopsy. You may be given an enema and antibiotics to prevent infection. For the test, you will lie on your side as the probe goes into the rectum. First, we take a picture and measurement of the prostate using ultrasound. . The prostate gland is then numbed (anesthetized) with a needle passed through the probe. Then, we remove very small pieces of your prostate using a biopsy device.

If cancer cells are found, the pathologist will assign a “Gleason Score” which helps to determine the severity/risk of the disease.

After a biopsy, you may have blood in your ejaculate, urine and stool. This should go away fairly quickly.

Treatment

Some cancers grow so slowly that treatment may not be needed at all. Others grow fast and are life-threatening so treatment is usually necessary. Deciding what treatment you should get can be complex.

Treatment choices for prostate cancer include:

What is Active Surveillance?

Active surveillance means that you are not actively immediately treating your prostate cancer. We monitor the cancer growth with regular PSA tests, DREs and periodic biopsies. A schedule for tests will be set. We will know very quickly if the cancer grows. If that happens, we will suggest next steps for you. At that point, radiation and surgery may be the best treatment options.

What are the Benefits, Risks and Side Effects of Active Surveillance?

Active Surveillance is best if you have a small, slow growing (low-risk) cancer. It is good for men who do not have symptoms. If you want to avoid sexual, urinary or bowel side effects for as long as possible, this may be the treatment for you. Active surveillance allows men to maintain their quality of life longer without risking the success of treatment (if and when it’s needed). Action is taken only if the disease changes or grows. For many men, they never need more aggressive treatments.

Active surveillance is mainly used to delay or avoid aggressive therapy. This may require you to have several biopsies over time to track cancer growth.

What is Radical Prostatectomy (Surgery) for Prostate Cancer?

Robotic Assisted Laparoscopic Radical Prostatectomy (RALP) is the most common type of prostate cancer surgery done today. The surgeon is assisted with a robotic system that holds and guides the laparoscopic surgical tools and camera. It also allows the prostate to be removed through tiny ports placed in your belly. There is also less blood loss with robotic surgery than other methods.

What to Expect After the Prostate is Removed

After the prostate has been removed, the urinary tract and the bladder are reconstructed. A catheter is passed through the urethra into the bladder to drain the urine while the new connections heal. One or two suction drains may be left in the pelvic cavity after surgery. They are brought through the lower belly to drain fluid from the wound. They help lower the risk of infection. The drains are usually removed before you are discharged from the hospital.
After surgery, we will review the final pathology report and make plans for next steps.
What Are The Benefits, Risks and Side Effects of Surgery?

The main benefit of a radical prostatectomy is the prostate with cancer is removed. This is true as long as the cancer hasn’t spread outside the prostate.

The goal of surgery is to get a PSA value of less than 0.1 ng/mL for 10 years. Surgery is often a good choice if prostate cancer has not spread beyond the prostate.

Surgery always comes with risks. Not everyone has the same side effects for the same amount of time. With surgery (and with radiation therapy), there are two main side effects to consider: erectile dysfunction (ED) urinary incontinence (a loss of urine control). For some men, surgery can relieve pre-existing urinary obstruction. Most men with these side effects find ways to manage them over time.

What is Radiation Therapy?

Radiation therapy uses high-energy rays to kill or slow the growth of cancer cells. Radiation can be used as the primary treatment for prostate cancer (in place of surgery). It can also be used after surgery if the cancer is not fully removed or if it returns.

There are two primary kinds of radiation therapy used for prostate cancer:

• External beam radiation therapy
• Brachytherapy (internal radiation)

What are the Benefits, Risks and Side Effects of Radiation Therapy?

The benefit of radiation therapy is that it is less invasive than surgery. Whether the radiation is given externally or internally, this treatment is effective for early stage prostate cancer. Some need both types of radiation combined to treat their cancer.

The main side effects of radiotherapy are incontinence and bowel problems. Urinary problems usually improve over time, but in some men they never go away. Erectile dysfunction, including impotence, is also possible. Many men feel tired for a few weeks to months after treatment.

What is Cryotherapy?

Cryotherapy, or cryoblation, for prostate cancer is the controlled freezing of the prostate gland. The freezing destroys cancer cells.
What is HIFU and Focal Therapy?

• High-intensity focused ultrasound (HIFU). HIFU uses the energy of sound waves to target and superheat the tumor to kill cells (with the help of MRI scans). It can be used for the whole gland.

What is Hormonal Therapy or Androgen Deprivation Therapy (ADT)?

Prostate cancer cells use the hormone testosterone to grow. Hormonal therapy is also known as androgen deprivation therapy (ADT). It uses drugs to block or lower testosterone and other male sex hormones that fuel cancer. ADT essentially starves prostate cancer cells of testosterone. 

Hormone therapy is done surgically or with medication:

Surgery: Removes the testicles and glands that produce testosterone with a procedure called an orchiectomy.

Medication: There are a variety of medications used for ADT. These therapies have been used for many years and are often offered as the first option for men who can’t have or don’t want other treatments. Hormone therapy usually works for a while (maybe for years) until the cancer “learns” how to bypass this treatment.

When they stop working, chemotherapy as well as immunotherapy may be an option.

What Are The Benefits, Risks and Side Effects of Hormone Therapy?

Hormone therapy has been linked to heart disease, diabetes and the loss of bone. Hot flashes and fatigue are also short-term side effects of hormone treatment. The same is true for the loss of sexual drive.

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