The prostate is a small walnut-shaped gland that produces seminal fluid in men. It is one of the most common types of cancer and, with early detection, has a significant chance of successful treatment. Often slow-growing and confined to the gland, prostate cancer may need only minimal treatment or just observation. Other more aggressive types may spread quickly and require treatment.
Every patient’s prostate cancer is different. We use advanced risk assessment techniques before and after diagnosis to tailor the most appropriate surveillance and treatment of a patient's condition.
Digital rectal exam: This is done to check the prostate gland as part of a man’s complete physical examination. During the exam, the doctor gently inserts a lubricated, gloved finger into the rectum to check for enlargement or growths in the prostate gland.
PSA testing: This test involves drawing blood (usually from the arm) to check the level of prostate-specific antigen present in the bloodstream. Routine PSA screening is not recommended in men 70 and older or any man with less than a 10- to 15-year life expectancy.
For men ages 55 through 69, the American Urological Association strongly recommends shared decision-making between physicians and patients who are considering PSA screening, and then proceeding based on men’s values and preferences.
For men younger than 55 at higher risk (such as men with prostate cancer in their family history or who are African American), decisions regarding prostate cancer screening should be individualized. There is no specific normal or abnormal PSA score. Rather, the physician will weigh factors such as age and previous PSA test scores.
PCA3 testing: This test involves obtaining a urine sample after a digital rectal exam. A high score would indicate an increased likelihood of having prostate cancer; where as a low score would indicate less likelihood of having prostate cancer. The PCA3 test may help to avoid an unnecessary prostate biopsy procedure.
4K score test: This test involves drawing a blood sample and calculating the individual’s percentage risk for aggressive prostate cancer. The test has a potential to increase the accuracy of prostate cancer detection, particularly in its most aggressive forms. It also can help to avoid an unnecessary biopsy.
Select MDX: This test involves obtaining a urine sample after a digital rectal exam and provides the likelihood of detecting prostate cancer upon biopsy and the probability of high-grade versus low-grade disease. It can help the patient and his urologist decide whether a prostate biopsy is needed.
Prostate biopsy: If symptoms and/or test results indicate the possible presence of prostate cancer, the physician may order a prostate biopsy. A core needle biopsy is the typical method used to remove a sample of prostate tissue for further examination. The biopsy itself takes a short amount of time to conduct and can be done in a doctor’s office or surgical center. The tissue that is removed is then sent to a lab for evaluation by a pathologist.
MRI/Ultrasound fusion biopsy: This type of biopsy represents the most sophisticated approach to finding aggressive prostate cancer. Initially, a prostate MRI scan is done, which is then read by a radiologist to identify any areas of suspicion for cancer. The MRI scan is often done on a separate day from the biopsy. A trans-rectal, ultrasound-guided biopsy will be performed by a urologist. While the biopsy procedure is being performed, the MRI images can be fused over the real-time ultrasound images for accurate targeting of any suspicious lesions.
Imaging tests: If prostate cancer is diagnosed, other imaging tests such as a transrectal ultrasound, computed tomography (CT), magnetic resonance imaging (MRI) or bone scan may be used to evaluate any possible progression or spreading of the disease.
Risk stratification: The urologist may utilize the latest techniques to obtain a genetic fingerprint of a patient’s unique prostate cancer and guide him in choosing options accordingly. These include Oncotype DX, Prolaris, Decipher, among others, to get the most personal, accurate information on the patient’s cancer, and provide guidance on treatment choice.
Active surveillance: This approach often is used to monitor the existing cancer closely. It usually includes a doctor visit, PSA blood test and digital rectal exam every 3 to 6 months. Prostate biopsies may be done on an annual basis as well. If test results change, the physician and patients would talk about treatment options.
Prostatectomy surgery: The prostate gland and any cancerous tumors or tissue can be removed using standard surgical or laparoscopic procedures. The DaVinci surgical system (robotic prostatectomy) is a minimally invasive surgical procedure that provides superior visualization and instrumentation for the surgeon when compared with traditional surgical prostatectomies.
Besides cancer control, the goal of robotic-assisted surgery is to preserve the nerves running alongside the prostate, which are responsible for erectile function and continence. Additional benefits include less blood loss, shorter hospital stays and quicker return to normal activities, versus standard surgical techniques.
DaVinci surgical system for robotic prostatectomy: This minimally invasive surgical procedure provides superior visualization and instrumentation for the surgeon when compared with traditional open surgical or laparoscopic prostatectomies. Besides cancer control, the goal of robotic-assisted surgery is to preserve the nerves running alongside the prostate, which are responsible for erectile function and continence. Additional benefits include less blood loss, shorter hospital stays and quicker return to normal activities.
Three types of radiation treatment options:
- External beam therapy includes intensity modulated radiation therapy (IMRT), which uses a computer to aim radioactive rays at the prostate from outside of the body, killing cancer cells over time. Image-guided radiation therapy techniques are used with IMRT to deliver treatments that tightly conform to the shape of the prostate while minimizing the radiation received by other nearby organs. Radiation is administered based on tumor size, shape and location. The intensity of the beams can be adjusted as needed to match the exact geometric shape of the tumor, minimizing damage to surrounding tissue. The high degree of accuracy makes IMRT a treatment option for some men who have reached the maximum allowable dose of radiation therapy and have a tumor (or tumors) that recur. Generally, five treatments are required per week for a period of several weeks. The treatments cause no pain and only last a few minutes each. Hormonal therapy may be used in combination with this technique.
- CyberKnife® is a very precise form of radiation treatment that uses a computer-controlled robotic arm to aim highly concentrated beams of radiation at tumors with pinpoint accuracy. This precisely directed radiation attacks tumor cells while minimizing injury to healthy tissue surrounding the tumor. This treatment does not require an incision and does not require a hospital stay. The CyberKnife treatment for prostate cancer is completed in just five sessions. Patients generally experience minimal side effects and are typically able to continue normal activities throughout treatment.
- Brachytherapy, also known as prostate seed implant, involves implanting tiny radioactive seeds into the prostate. This highly targeted application of radiation reduces both the potential for damage to surrounding healthy tissue and side effects. This procedure is performed in a hospital setting; patients are generally discharged the same day the procedure is performed.
Additional treatment options:
Hormone therapy: Hormone therapy can inhibit the growth of cancer cells by cutting off the supply of male hormones. This therapy uses drugs that can either cause medical castration or prevent the brain from signaling the testicles to produce testosterone.
Chemotherapy: Chemotherapy uses anti-cancer drugs that are injected or given as pills. These drugs enter the bloodstream and spread throughout the body, making treatment effective for cancer that may have metastasized or spread to other parts of the body. Chemotherapy may be added to initial therapy, which helps improve survival in patients with advanced prostate cancer.