Prostate Cancer

Prostate cancer is second only to skin cancer as the most common male cancer in the United States. Each year more than 200,000 men are affected by this disease. Men aged 50 and older, African American men and men with a family history of prostate cancer are at higher risk. Fortunately, most prostate cancers are slow growing and can be detected at an early stage, when most can be cured.

Risk Factors

Factors that may increase your risk of prostate cancer include:

  • Family history – having a brother, father, grandfather, son or cousin with prostate cancer
  • Age – 90% of prostate cancers are diagnosed in men 50 and older

Please note that an enlarged prostate (benign prostatic hyperplasia or BPH) does not increase your risk of prostate cancer.

Symptoms and Screening

Early stage prostate cancer often has no warning signs, making regular screening tests such as PSA and digital rectal exams critically important.

Men are more likely to detect prostate cancer early when they have two simple screening tests – a digital rectal exam (DRE) and a prostate-specific antigen (PSA) blood test. During the DRE, your physician will insert a gloved finger into your rectum to feel the size, shape and texture of your prostate. The PSA test determines the level of PSA in a blood sample; high levels may indicate prostate cancer, an enlarged prostate or prostate infection. Men with normal levels of PSA may also have prostate cancer.

These tests are recommended yearly starting at age 50 or sooner, depending on your risk factors. Many urologists recommend that even men without risk factors get a baseline PSA at age 40 to 45.

Diagnosis and Staging

If further evaluation is needed after the screening tests, either a prostate biopsy or a prostate MRI may be recommended. During a prostate biopsy, an ultrasound probe two fingers wide is placed in your rectum. A local anesthetic is given, and your urologist will insert a tiny needle into the prostate and withdraw small amounts of tissue to be examined in a laboratory.

A prostate MRI is a high-resolution, detailed road map of your prostate. It helps to understand if there are any suspcious areas to target for biopsy. It may also help avoid a biospsy if PSA is elevated from an enlarged prostate, which is a benign condition.  If prostate cancer is found during the biopsy, additional testing such as a bone sance, CT, or PET scan.

In its early stages (T1 and T2), prostate cancer is usually confined to the prostate itself. As the cancer advances, it may move outside the prostate to surrounding tissues, lymph nodes, bones or other parts of the body (Stage T3 or T4). Your tissues will also receive a Grade Group or “Gleason Score” that helps your doctor predict how the cancer may progress.

Treatment

Your urologist may recommend active surveillance. This is for men with slow-growing, early-stage cancers. Watchful waiting is for men with serious health problems or advanced age. Be advised to monitor the cancer rather than actively treating it. Many men will “outlive” their prostate cancer.

  • Surgery – a surgical procedure called a radical prostatectomy removes the cancerous prostate gland. The highly skilled surgeons of Carolina Urology Partners use the latest techniques to remove cancerous tissue while minimizing side effects. These techniques include the da Vinci robotic prostatectomy, a state-of-the-art robotic-assisted laparoscopic removal of the prostate.
  • HIFU – High-intensity focused ultrasound is a minimally invasive treatment option for localized prostate cancer. Ultrasound waves generate heat to destroy cancer cells.
  • Radiation therapy – This therapy offers highly targeted radiation to maximize tumor shrinkage while minimizing damage to surrounding tissues. This is given by a radiation oncologist.
    • SpaceOAR Hydrogel helps protect the rectum during prostate cancer radiation by creating space between the prostate and rectum, which can reduce side effects.
  • Brachytherapy – tiny radioactive “seeds” are placed into the prostate to release radiation over the course of several months, providing targeted treatment to the cancer.
  • Hormone therapy – in some cases, your physician will recommend a medicine to block the release of testosterone, the male hormone that fuels the growth of prostate cancer. This can be given through a pill or a shot.
  • Cryotherapy – in an outpatient procedure, a very thin needle is inserted into the prostate to freeze and destroy the cancer cells it contains. It can be used as primary therapy or as an alternative if other treatment is not successful.
  • Chemotherapy – chemotherapy is sometimes recommended for men who have progressive prostate cancer or cancer that is not responding to other therapy.