Prostate Cancer

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What You Should Know About Prostate Cancer

Prostate cancer occurs in one out of nine men in the U.S. during his lifetime. Early detection means more options for treatment and an increased chance of survival.


What is 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. Prostate cancer is common and the second leading cause of cancer death in men. The function of the prostate is to produce fluid to facilitate sperm survival. Prostate cancer is often detected using a blood screening test called prostate-specific antigen (PSA). If the test returns elevated or if the prostate exam is abnormal, your doctor may recommend a biopsy of the prostate.

Watch this webinar for an in-depth discussion about prostate cancer causes and treatments.


What are the symptoms of Prostate Cancer?

Most prostate cancers are asymptomatic. However, some advanced cancers may cause the following symptoms:

  • Trouble with urination or bowel movements
  • Blood in urine or semen
  • Back or bone pain
  • Weight loss


What causes Prostate Cancer?

Like most cancers, the cause of prostate cancer is not known. However, the following factors that increase the risk of developing prostate cancer:

  • Age. Men who are 50 or older have a higher risk for prostate cancer.
  • Race. African-American men have the highest risk for prostate cancer—the disease tends to start at younger ages and grows faster than in men of other races.
  • Family History. Men whose fathers or brothers have had prostate cancer have a higher risk than men who do not have a family history of the disease. Prostate cancer risk also appears to be slightly higher for men from families with a history of breast cancer.
  • Diet. Risk may be higher for men who eat high-fat diets.
  • Smoking
  • Obesity

The Genetics of Hereditary Cancer

Did you know that many cancers are hereditary, and your genetic code is the key to unlocking your risk? If you are a prostate cancer patient, you may be eligible for this testing. Read more about genetic testing for prostate cancer here.


How is Prostate Cancer diagnosed?

What to know before your visit to MidLantic Urology in Philadelphia and surrounding counties

  • During your visit, your doctor will ask you questions regarding your medical, surgical, and family history, and perform an exam.

Other tests that may be performed during or after your visit: 

  • Lab tests will often be performed including PSA, testosterone, and urine studies
  • Imaging studies are often performed after the diagnosis of prostate cancer: CT, MRI, bone scan
  • 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.
  • Prostate biopsy
  • Prostate needle biopsy:
    • Transperineal prostate biopsy: This involves placement of an ultrasound probe in the rectum. However, instead of taking biopsies through the rectum, biopsies are taken through the skin located between the scrotum and the rectum (typically 12 biopsies are taken, but occasionally more). The procedure lasts approximately 10-15 minutes. This has been associated with lower infection rates and higher cancer detection rates.
    • Transrectal prostate biopsy: This involves placement of an ultrasound probe into the rectum. We then measure the size of the prostate, provide local anesthetic, and perform biopsies of the prostate (typically 12 biopsies, but occasionally more). The procedure lasts approximately five minutes.


How is Prostate Cancer treated?

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. When treatment includes radiation therapy, you may be offered the option of SpaceOAR, a gel-like spacer which protects the rectum during therapy and minimizes  side effects.

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 2 (least aggressive) to 10 (most aggressive) and is based on prostate cancer cells’ microscopic appearance.

The tumor stage, however, 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.
  • Stage II: The tumor is more advanced but has not spread outside 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 situation.

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

  • Surgical removal of the prostate through:
    • Robotic surgery: Minimally invasive 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 a two-week period
    • External or image-guided radiation: Uses two- and three-dimensional imaging to direct radiation, often referred to as IMRT or IGRT.
    • Brachytherapy: Inserts seeds containing radioactive material directly into the prostate.
    • SpaceOAR: When treating prostate cancer with radiation, the goal is to destroy the cancer cells while avoiding damage to surrounding healthy tissue. SpaceOAR Hydrogel may be used to help reduce the radiation dose delivered to the rectum during treatment, thus reducing chances of injury to the rectum.
  • 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 thereafter depending on the patient’s individual risk factors.

Treatments for metastatic growth (stages III and IV):

  • Hormone therapy: Blocks the patient’s production of testosterone to slow the cancer’s growth or cause it to shrink.
  • Immunotherapy: Stimulates the patient’s immune system to fight the cancer cells. This includes chemotherapy, radiation, surgical removal of the tumor, and more recently developed immunotherapies that use your body’s own immune system to attack cancer cells.
  • Chemotherapy: Medication or a combination of medications given to patients whose cancer has spread and no longer responds to hormone therapy.

Schedule an appointment with a MidLantic Urology Physician near you today!

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