Prostate Cancer

Prostate cancer detected using a prostate-specific antigen (PSA) blood test and digital examination is almost always treatable. In fact, PSA screening may lead to over-detection and over-treatment. For this reason, most medical societies now agree prostate cancer screenings should not occur without an informed decision-making process. 

There are commonly no associated symptoms for prostate cancer, but occasionally men present with difficulty urinating or pain in their bones.

Prostate Basics (Click to Expand)
Prostate Cancer 101 (Click to Expand)
Gleason Score (Click to Expand)
Prostate Cancer Surgical Treatment (Click to Expand)
Prostate Cancer Radiation Treatment (Click to Expand)


Treatments for Prostate Cancer

Treatment depends on the age and overall health of the patient and stage of the cancer. There are three general approaches:

  • For tumors limited to the prostate, surgical removal of the prostate or radiation
  • For low-risk cancer, active surveillance
  • For more advanced cancer, hormonal or chemotherapy along with surgery or radiation. Inclusion in a clinical trial may be an option.

No one treatment is best for all patients. Consulting with doctors specializing in this area can help obtain an optimal outcome for the patient’s condition.

Active Surveillance
Keeping a close eye on prostate cancer, rather than treating it immediately, is increasingly being offered to patients with slow-growing cancers. With observation, which can be more involved (active surveillance) or less involved (also called "watchful waiting"), you can potentially forego the side effects of treatment. Careful monitoring of the cancer includes periodic PSA testing, physical exams and more advanced testing.

Minimally-Invasive (or Laparoscopic) Surgery
Spectrum Health surgeons perform robotic and advanced minimally invasive surgeries that use very small incisions to perform surgery inside the body. By expanding the abdomen with gas, the surgeon has greater ability to see and operate, leading to less bleeding and less pain. Minimally invasive surgeries, either with or without robotic assistance, allow faster recovery times in many cases.

Perineal Prostatectomy
Perineal surgery is an ‘open’ surgical procedure that allows removal of the entire prostate gland, but does not allow nerve-sparing or removal of lymph nodes.

Prostate Brachytherapy
Brachytherapy is a term for radiation delivered inside the body. When used to treat prostate cancer, the surgeon implants a "seed" containing either low dose or high dose radiation into the prostate. It allows more healthy cells to be spared than external radiation.

Prostate Cryosurgery
This less-invasive technique uses ultrasound and very cold gasses to "freeze" the prostate. Nearby nerves may be damaged during the procedure. Not all patients are eligible for cryosurgery.

Prostate MRI Diagnostics
MRI (or magnetic resonance imaging), uses magnets to produce images of organs inside your body. MRI can also be used to identify specific, suspicious areas within the prostate gland. This is a great diagnostic service if you have risk factors or your doctor has recommended further checking for prostate cancer. MRI results let urologists and radiologists target precise areas for biopsy (see UroNav Fusion Biopsy).

Retropubic Prostatectomy
This "open" surgery technique involves a four-inch incision made below the belly button. It can be a beneficial technique for nerve-sparing and early stage cancer treatment, but has become less commonly performed than robotic prostatectomy.

Robotic Prostatectomy
The most common treatment for localized prostate cancer. When performed by an experienced physician or one specializing in cancer surgery, the advantages of nerve-sparing robot-assisted surgery include better preservation of urinary and erectile function, as well as shorter hospital stays and recovery period.

Robotic Surgery
A Spectrum Health urological oncologist was the first in West Michigan to use the daVinci® Surgical System to perform prostate cancer surgery.  In the more than 10 years since, Spectrum Health surgeons have performed more than 4,800 procedures using daVinci® Surgical Systems at Butterworth and Blodgett hospitals.  Robotic, or robot-assisted, surgery allows for more precise surgery and faster recovery times.

UroNav Fusion Biopsy
UroNav fusion biopsy targets the suspicious areas and can better identify and more accurately characterize prostate cancer when present.

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What Is Prostate Cancer?

Prostate cancer is an abnormal growth in the prostate gland. This walnut-shaped gland in the male reproductive tract makes seminal fluid, which mixes with sperm. The prostate is around the urethra, near its connection to the bladder. The urethra is the tube that takes urine from the bladder to outside the body. Cancer develops when cells divide out of control. Early detection and treatment have led to better survival for all stages of prostate cancer in the past 20 years.

What Are the Symptoms of Prostate Cancer?

Early prostate cancer generally does not cause symptoms. Depending on its location within the prostate and how far it has spread, it may cause pain, problems urinating, erectile dysfunction, and other symptoms.

A weak or interrupted flow of urine, having to urinate often (especially at night), trouble holding back urine, being unable to urinate, pain or burning when urinating, blood in urine or semen, and nagging pain in the back, hips, or pelvis may occur as the cancer spreads.

These symptoms are not always due to prostate cancer and may have other less serious causes, including benign prostatic hypertrophy (BPH) and infections. Always see your health care provider for a diagnosis.

How Is Prostate Cancer Diagnosed?

The health care provider may suspect prostate cancer from a complete medical history and physical examination. The health care provider will do a digital rectal examination (DRE) and a blood test known as prostate-specific antigen test (PSA test).

The health care provider may recommend that men older than 50 have yearly DREs and PSA tests. These tests may be helpful in making the diagnosis. Men in high-risk groups, such as African Americans, or those with a family history of prostate cancer may need testing at a younger age.

The diagnosis can be proved only by a biopsy, in which the urologist (doctor who specializes in diseases of the urinary tract) takes a sample of prostate tissue for study.

What Are the Complications of Prostate Cancer?

Many prostate cancers don’t lead to death, but some can spread (metastasize) through blood and lymph nodes (glands) to bones and major organs. This is called extracapsular spread.

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How Is Prostate Cancer Treated?

The choice of treatment depends on a man’s age and health, how far the cancer spread (stage of disease), what the cancer looks like under the microscope, and response to first treatment. Standard treatments include watchful waiting, surgery, radiation therapy, and hormone therapy. Radiation therapy can be external beam radiation (x-rays to kill cancer cells) or proton beam therapy (special high-dose treatment). Also, tiny radioactive implant (seeds) can be put directly into the prostate. Hormone therapy affects testosterone production, so cancer cells shrink or grow more slowly.

Surgery is called radical prostatectomy. It’s used for localized cancer (one that hasn’t spread). Sometimes, chemotherapy (drugs), cryosurgery (freezing), or some treatment combination may be tried.

Prostate cancer usually occurs in older men, who often die of other causes before slowly growing prostate cancer spreads or causes symptoms. When occurring in younger men, it tends to much more aggressive. Also, treatments generally have side effects, such as incontinence and erectile dysfunction, that may decrease quality of life. Choosing a treatment is therefore hard. The decision whether to try to cure localized prostate cancer is a trade-off between survival and quality of life.

DOs and DON’Ts in Managing Prostate Cancer:
  • DO have yearly DRE and PSA tests as your health care provider suggests.
  • DON’T eat too much saturated fat.
  • DON’T smoke.
FOR MORE INFORMATION

Contact the following sources:

  • American Cancer Society
    Tel: (800) 227-2345
    Website: http://www.cancer.org
  • National Cancer Institute
    Tel: (800) 422-6237
    Website: http://www.cancer.gov
  • American Urological Association
    Tel: (866) RING-AUA (746-4282)
    Website: http://www.auanet.org

Copyright © 2016 by Saunders, an imprint of Elsevier, Inc.

Ferri’s Netter Patient Advisor