Prostate Cancer

  • Overview
    • The prostate is a gland in the male human body that produces prostatic fluid, which makes up a significant portion of the male ejaculate. It sits below the bladder and the first part of the urethra runs through the prostate. About the size of a walnut, your doctor can feel the prostate with his/her finger in the rectum. 
  • Causes
    • Risk factors for prostate cancer include age (with older age being a higher risk), family history, and some environmental factors. 
  • Signs/symptoms
    • Prostate cancer that is contained within the prostate rarely causes symptoms. It is nearly always diagnosed with screening, which involves a rectal exam and a simple blood test. 
    • Men should begin screening for prostate cancer at the age of 55 or sooner if he has risk factors (African-American, family history, certain environmental exposures). 
  • Diagnosis
    • Screening for prostate cancer included a digital rectal exam and a blood test. This gives the doctor an estimate of the likelihood of a patient having undiagnosed prostate cancer
    • If the above tests are abnormal, a prostate biopsy is performed. Sometimes, your doctor may order an MRI to be performed prior to a prostate biopsy to help guide the biopsy samples. 
    • A prostate biopsy is a largely painless procedure performed in clinic which includes:
      • Transrectal ultrasound – an ultrasound probe is inserted into the rectum to visualize the prostate gland and adjacent structures
      • Prostate biopsy – Multiple sample of the prostate are obtained with a needle biopsy device. These biopsies are taken through the rectum or through the perineum (skin between the anus and the scrotum).
  • Staging
    • If your biopsy shows prostate cancer, your doctor may order tests to evaluate if the cancer has spread outside the prostate. 
      • CT scan – evaluates the abdomen and pelvis organs for evidence of spread of the cancer to other organs or lymph nodes
      • MRI – detects for lymph node involvement as well as local advancement of prostate cancer
      • Nuclear medicine bone scan – detects prostate cancer spread to bones
  • Treatment
    • Treatment recommendations depend on tumor and patient characteristics. 
    • Treatment options for prostate cancer confined to the prostate include:
      • Radical prostatectomy – minimally invasive surgery using the da Vinci Surgery System to remove the prostate and adjacent lymph nodes.
      • Radiation – either external beam radiation therapy or brachytherapy. This treatment is performed by a radiation oncologist. This often requires 6 months to 2 years of hormone therapy in addition to the radiation treatments.
      • Active surveillance – close monitoring to ensure the cancer doesn’t progress/spread. This includes serial exams and blood tests, as well as repeat prostate biopsy in the first 12 months and as indicated thereafter. 
    • Treatment options for cancer that has spread outside the prostate is performed by a medical oncologist and include:
      • Hormone therapy, immunotherapy, chemotherapy
      • Sometimes surgery and/or radiation is indicated as well