Prostate Cancer

What is prostate cancer?

Prostate cancer is a disease in which cells in the prostate start growing abnormally and uncontrollably.

The prostate is a walnut-shaped organ that contributes fluid to semen and helps expel semen during ejaculation.

Almost all prostate cancers are adenocarcinomas (which originates from the glandular cells of the prostate) and most are slow growing. However, they may cause symptoms that require timely interventions, such as restricting urine flow or sexual function.

What increases your risk of prostate cancer?

Factors that can elevate risk prostate cancer include:

• A family history of prostate cancer
• Inherited genetic mutations, such as BRCA1/BRCA2 genes and Lynch syndrome (also known as hereditary nonpolyposis colorectal cancer or HNPCC)
• Conditions such as prostatitis, inflammation of the prostate, and benign prostatic hyperplasia or BPH, a noncancerous enlargement of the prostate gland
• A diet high in red meats and high-fat dairy and low in fruits and vegetables
• Obesity
• Age: approximately 60 percent of cases are diagnosed in men older than 65
• Race and ethnicity: African-American men and Caribbean men of African ancestry are more likely to be diagnosed with prostate cancer

Research has also shown that a healthy lifestyle, including a well-balanced diet and maintaining a healthy weight, may reduce prostate cancer risk.

LEARN MORE

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• Breast cancer risk appears linked to family history of prostate cancer
• The real link between prostate cancer and hair loss
• Urologist Bertram Yuh on prostate cancer risk

What are the signs and symptoms of prostate cancer?

Because the prostate lies below the bladder and surrounds the urethra, most prostate cancer signs are tied to urinary symptoms, including:

• Weak or interrupted flow of urine
• Frequent and sudden urge to urinate, especially at night
• Difficulty starting urination
• Trouble emptying the bladder completely
• Painful or burning sensations while urinating
• Blood in urine or semen

Prostate cancer may also cause more generalized symptoms, such as:

• Pain in the lower back or pelvic area
• Weakness or numbness in the legs or feet
• Dizziness
• Fatigue

Although these symptoms can be caused by other conditions, you should check with a doctor – preferably a urologist – so they can make a definitive diagnosis.

Sources: National Cancer Institute and American Cancer Society

Diagnosing prostate cancer

Precise prostate cancer tests are crucial for treatment planning, and City of Hope is equipped with state-of-the-art technologies and specialized staff to ensure an accurate, comprehensive diagnosis of prostate cancer.

Highlights of our screening and diagnosis services include:

• Advanced imaging technologies to detect and locate prostate tumors
• MRI-guided biopsies to increase precision and accuracy
• An experienced pathology staff specializing in prostate cancer diagnosis
• Genomic testing of cancer cells to find the most effective treatments available

How is prostate cancer detected?

Once you notice symptoms, or as part of a routine examination, your doctor may use the following tests to look for prostate cancer:

• Physical exam
• Prostate specific antigen (PSA) test: This test measures PSA levels in your blood. Levels higher than normal range (4 nanograms per milliliter of blood) may indicate prostate cancer or other conditions, such as prostate inflammation or BPH, an enlarged, noncancerous prostate.
• Digital rectal exam: A doctor or nurse inserts a lubricated, gloved finger into the rectum to feel for prostate abnormalities.
• Biopsy: Surgical removal of suspicious tissues for further examination
• Transrectal ultrasound: A small probe is inserted into the rectum to take images of the prostate using high energy sound waves. A biopsy may be taken if the images show any abnormalities. This procedure typically takes less than 10 minutes and the area may be numbed to reduce discomfort.
• Transrectal magnetic resonance imaging (MRI): This procedure images the prostate using a powerful magnet, radio waves and a computer; a radio wave-emitting probe is inserted into the rectum and the MRI machine takes a series of detailed images of the prostate and its surrounding regions. A biopsy may be taken at the same time if the images show any abnormalities.

If cancer is found, additional tests are performed to determine the type and stage of disease. These diagnostic tests include:

• Lymph node biopsy: Removal and examination of lymph nodes in the pelvic region to see if the cancer has spread
• Seminal vesicle biopsy: Removal of fluid from seminal vesicles (glands that produce semen) to detect prostate cancer spread
• ProstaScint scan: A test that uses a small amount of radioactive material, which binds selectively to prostate cancer cells. After the material is injected into the bloodstream, a scanner is used to detect prostate cancer spread, which shows up as bright spots due to concentration of the material.
• Computed tomography (CT or CAT) scan: This test involves taking a series of X-ray images at different angles to form a computer-generated image, which determines tumor size, location and number. Special dyes may be used to enhance this scan.
• Bone scan: A procedure using a small amount of radioactive material to determine if prostate cancer cells have spread to the bones.
• Genomic testing: The cancerous tissue is tested to see if it exhibits certain genetic mutations, which can be used to determine better treatments.

Based on the results of these tests, the prostate cancer is then staged according to its size, number of lymph nodes affected and whether it has spread to nearby or distant organs.

What are the current screening guidelines for prostate cancer?

The American Cancer Society currently recommends men discuss with their health care provider the routine screening options available for prostate cancer. The discussion should take place at:

• Age 50 for men of average risk
• Age 45 for men at high risk, including African-American men and those with a first-degree relative (father or brother) who was diagnosed with prostate cancer before the age of 65
• Age 40 for men at highest risk, including those with two or more first-degree relatives who had prostate cancer at an early age

Based on your discussion, your provider may screen you with a prostate specific antigen (PSA) test and possibly a digital rectal examination. Depending on the initial screening results and other risk factors, the screening may be repeated annually or once every two years.

LEARN MORE

• Prostate cancer 2016: New surgical options, better screening
• Black men need prostate cancer consultation at age 40, expert says

Prostate cancer treatment options

Patients ... can rest assured that we have more experience than anyone else in the region for robotic surgery for straightforward and complex cases.”  Clayton Lau, M.D., director, Prostate Cancer Program

Your prostate cancer is every bit as unique as you are, and that is why prostate cancer treatment at City of Hope is focused around you and your loved ones.

This means our physicians will personally consult with you about your disease, treatment options and desired outcomes. Afterward, our multidisciplinary team of specialists will work together to discuss, design and deliver an individual treatment plan to best meet those goals.

The innovative treatments we use to treat prostate cancer include:

Surgery

Surgery is a common treatment option for most prostate cancer patients, particularly early-stage prostate cancer that has not spread beyond the glands.

The most common prostate cancer surgery is a radical prostatectomy, an operation that removes the prostate gland, seminal vesicles and surrounding tissues. When possible, nearby nerves and blood vessels will be spared to preserve urinary and sexual function.

Nearby lymph nodes may also be removed and examined to determine if the cancer has spread.

City of Hope is a leader in minimally invasive, robotically-assisted prostatectomies, with over a decade of experience and 7,000 surgeries performed — the most in Western United States. This procedure uses a surgical robot and smaller incisions to remove the prostate and surrounding tissue.

Compared to an open surgical approach, robotic prostatectomies offer several benefits:

• Less pain and discomfort
• Reduced blood loss
• Shorter recovery time
• Faster return to normal activities or follow-up treatments

City of Hope also has an extensive recovery and follow-up program after the procedure to help patients monitor for complications, manage side effects, restore urinary/sexual function and resume normal activities as soon as possible.

LEARN MORE

• Robotic Prostatectomies
• Meet our doctors: Surgeon Clayton Lau on prostate cancer treatment
• The benefits of surgery for aggressive prostate cancer

 

Radiation Therapy

Radiation therapy uses high-energy X-rays or other forms of radiation to kill cancer cells. It may delivered externally using focused beams of energy, or internally with a radiation-emitting substance placed in or near the tumor site.

Depending on the cancer, the patient’s health and desired outcomes – radiation therapy may be offered on its own, or in conjunction with surgery and drug therapy. Radiation may also be used to relieve symptoms associated with prostate cancer.

City of Hope offers a wide variety of leading-edge radiation therapy options to treat prostate cancer. These methods include:

• Image-guided external radiation systems, including TomoTherapy and TrueBeam: These systems combine detailed imaging and radiation delivery technologies, allowing our care team to “sculpt” radiation beams to the tumor site while avoiding nearby healthy tissue. This maximizes radiation’s prostate cancer fighting ability while minimizing exposure to the bladder, rectum and other nearby organs.
• MRI-guided focused ultrasound: This nonradiation technology uses magnetic resonance imaging (MRI) to detail images of the prostate area, followed by highly focused ultrasound to heat up and destroy cancerous tissue.
• Brachytherapy: This therapy involves the placement of radioactive material next to or within the tumor site. Depending on the disease, patient health and treatment goals, the radioactive material may be low-dose and permanently placed (low dose rate / LDR brachytherapy) or high-dose and placed for only a few minutes (high dose rate / HDR brachytherapy).

Patients also have access to our recovery program to address and treat symptoms and issues that may arise from radiation therapy – such as urinary and sexual dysfunction.

LEARN MORE

• Radiation therapy and prostate cancer
• New prostate cancer treatment uses MRI to guide ultrasound ablation

 

Drug Therapy

Drug therapy may be given to patients to fight prostate cancer cells throughout the body by killing them or stopping their growth and spread. These drugs include:

• Hormone therapy, which blocks production or activity of hormones – particularly testosterone and dihydrotestosterone, or DHT – which fuels most prostate cancer growth
• Chemotherapy, which targets all rapidly-dividing cells, including prostate cancer cells
• Targeted therapy, which selectively attacks prostate cancer cells based on specific characteristics – such as a gene mutation
• Immunotherapy, which stimulates the patient’s immune system to attack cancer cells

Drugs may also be prescribed to treat conditions related to prostate cancer, such as weakened bones and sexual dysfunction – common side effects of hormone therapy – or bone loss from metastasized prostate cancer.

The drug or drug combination used depends on the type and stage of prostate cancer, previous treatments used, the patient’s health and overall treatment goals. This personalized medicine approach may be further enhanced by molecular or genetic testing of your cancer, which can help identify treatments that are more effective and with fewer side effects.

City of Hope has a wide portfolio of cancer-fighting drugs available in its on-site pharmacy, allowing our medical oncologists to plan and prescribe a drug regimen that can best fight prostate cancer while minimizing side effects.

Clinical Trials

In addition to standard drug treatments, patients may also be eligible for new, promising drugs through our clinical trials program.

LEARN MORE

• Prostate cancer drug therapy: “Don’t be afraid of it,” expert says

 

Active Surveillance

For men with early-stage, slow-growing prostate cancer, active surveillance may be considered an option, since the benefit of immediate treatment may not outweigh its risk. This approach includes regular monitoring of prostate-specific antigen, or PSA, levels and digital rectal examinations of the prostate. As soon as abnormalities arise or symptoms begin to display, the doctor and patient can opt for the treating the cancer.

When performed regularly and on-schedule, active surveillance typically catches prostate cancer in its earliest stages of progression, when it is still very treatable with surgery, radiation and/or drug therapy.

LEARN MORE

• For low-risk prostate cancer, he chose ‘active surveillance’
• Active surveillance is not avoiding the issue

Prostate cancer research and clinical trials

At City of Hope, prostate cancer clinicians and researchers collaborate extensively to develop and evaluate new therapies for better survival and quality-of-life outcomes. Our patients have access to a wide variety of clinical trials including new chemotherapy and targeted therapies, hormone therapies with fewer side effects, novel surgical techniques, innovative radiation approaches and new prevention strategies.

These trials give current patients access to promising, leading-edge therapies and improve overall care for future patients worldwide. Visit our clinical trials page to learn more about current studies and their eligibility criteria.

Some of our current research projects include:

• Using focused ultrasound to heat up and destroy prostate cancer
• Identifying and incorporating biomarkers for better detection of prostate cancer development, progression and recurrence, possibly bypassing the need for biopsies to make a diagnosis
• Using neural stem cells to target and deliver cancer-fighting drugs to prostate cancer cells throughout the body
• New imaging methods to detect microscopic disease outside the prostate
• Using re-engineered immune cells to target and attack prostate cancer throughout the body
• Examining the benefits of surgery for patients with metastatic prostate cancer
• Use of natural therapies, such as white mushroom powder, to help prevent prostate cancer recurrence
• Long-term follow-up with prostate cancer survivors to detect and manage long-term effects and improve their quality of life

LEARN MORE

• Trial offers new choice to some patients with metastatic prostate cancer
• Research, plus newest techniques, improves treatment of prostate cancer
• Brain cancer treatment helps men with advanced prostate cancer
• Mushroom powder linked to lower PSA levels in prostate cancer patients
• The potential of CAR T cells to fight prostate cancer

Living with prostate cancer

At City of Hope, the staff and the ability to talk to other patients make you feel like you’re not fighting this by yourself. You have a built-in support group.”  Barry Tyson, prostate cancer survivor

When you come to City of Hope, you automatically gain access to an unparalleled array of support services to help you and your loved ones take each step during and after your prostate cancer treatment.

We can help with all of the following concerns, and more:

• Managing symptoms and side effects, such as pain, bone loss, nausea and fatigue
• Regaining urinary and bowel continence
• Addressing intimacy concerns
• Handling emotional, social and spiritual issues
• Coping with stress
• Navigating the health care system
• Maintaining a healthy lifestyle with expert nutrition and physical activity guidance
• Building caregiver skills
• Improving communication with family, partners and loved ones
• Restoring normalcy in your family, job or school routine
• Healing arts workshops to restore the body and mind
• Returning to wellness after active treatment

Learn more about these resources at our Living with Cancer or Supportive Care Medicine sites.

For more information about the supportive care programs we offer, please contact the Sheri & Les Biller Patient and Family Resource Center at 626-218-2273 (CARE).