Prostate cancer is one of the most common cancers found in men. It is second only to skin cancer. The American Cancer Society estimates that about one in seven men will be diagnosed with prostate cancer in their lifetime. More than 164,690 cases are found each year.
Cancers of the prostate vary widely, ranging from slow growing to more aggressive and higher risk malignancies. Determining the type of prostate cancer an individual has is critical to personalizing care. At present, the standard of care to establish the diagnosis of prostate cancer is an ultrasound guided prostate needle biopsy. In the last few years, the accuracy of biopsy has greatly improved by incorporating MRI into the biopsy algorithm in a technique called MRI Fusion Biopsy or Fusion Biopsy. Fusion Biopsy combines the MRI and ultrasound images to get an even clearer target to biopsy, which leads to more accurate diagnosis and less repeat biopsies.
Prostate cancer begins in the prostate, which is a gland that makes some of the fluid that is part of semen. The prostate is about the size of a walnut, but can change with age. It is located below the bladder and in front of the rectum.
Prostate cancer is often treated with surgery, chemotherapy or radiation. Your doctor will work closely with you to develop a plan that is right for you. Your plan may include more than one type of treatment. You may have surgery, radiation and chemotherapy based on your prostate cancer.
Surgery can often treat prostate cancer by removing the cancerous cells. At Penn State Cancer Institute, our urologic team includes three fellowship-trained surgeons. They have extensive surgical experience in all urological cancers, including prostate cancer. Our highly skilled team delivers the latest advances in care:
- Minimally invasive surgical procedures (robotic surgery)
- Standard, open surgery
- Salvage surgeries following radiation
- Surgery to address locally-advanced cancer
Radiation Therapy for Prostate Cancer
Radiation is a common treatment for many cases of prostate cancer. It uses high-energy radiation, such as X-rays or gamma rays, to shrink tumors and kill cancer cells. A radiation oncologist manages your care and treatment plan during radiation. Radiation can occur at different times in your treatment plan:
- Before or after surgery
- During or after chemotherapy
- If cancer cells return after initial treatment
Your radiation oncologist will recommend when radiation therapy should occur in your treatment plan.
There are two main types of radiation:
- External-beam radiation therapy
- Internal radiation therapy (or brachytherapy)
External-beam radiation is delivered from a machine outside the body. A powerful radiation wave is directed at the precise location of cancer in your body to kill the tumor or cancer inside your body.
Internal radiation is also called brachytherapy. Low-dose radioactive materials are placed in your prostate, near cancerous cells. These implants, often called seeds, deliver a low dose of radiation over time - often a few months. This procedure only happens once. Most patients are asleep during the internal radiation therapy procedure.
Androgen Blocking Agents
These are a class of drugs that block the testosterone action on prostate cancer cells with different mechanisms. They are given orally and your doctor will talk to you about it during your visit. These are generally given in patients with more advanced stage of cancer.
Chemotherapy is usually recommended if prostate cancer has spread outside the prostate gland. Your doctor will work closely with you to determine if chemotherapy is an effective way to fight your prostate cancer.
Additional Treatment Options for Prostate Cancer
Research continues to advance the treatment options available to men with prostate cancer. Your doctor will talk to you if any of the following treatment options are right for you:
- Hormone therapy
- Vaccine treatment
- Bone-directed treatment
Prevention and Screening
Like most cancers, you can’t prevent prostate cancer from developing. Most risk factors are outside of your control. Risk factors for prostate cancer include:
- Age. Being older than 50 increases your risk.
- Race. African American men and Caribbean men of African ancestry are at higher risk.
- Family history. Prostate cancer seems to run in families.
Fortunately, there are tests that can identify prostate cancer before you have any symptoms. Talk to your doctor at your annual physical about your risk factors and if you need a prostate cancer screening. There are two different tests that can identify prostate cancer:
- A digital rectal exam, which is a painless and quick exam where a doctor checks for abnormalities around your scrotum
- A prostate-specific antigen (PSA) test that can detect higher than normal amounts of a substance call prostate-specific antigen in your blood, which may indicate early stages of prostate cancer
The American Cancer Society recommends that men should be screened for prostate cancer at:
- Age 50 or older if you have a normal risk of developing prostate cancer
- Age 45 if you have a high risk of developing prostate cancer
- Age 40 if you have an even higher risk of developing prostate cancer, including race and family history of an immediate relative with prostate cancer.
Symptoms and Diagnosis
Prostate cancer is one of the most common cancers found in men. It is second only to skin cancer. The American Cancer Society estimates that about one in seven men will be diagnosed with prostate cancer in their lifetime. More than 160,000 cases are found each year.
Symptoms of prostate cancer can vary between individuals. Some common symptoms include:
- Difficulty urinating, including a week urine stream or a hard time emptying your bladder completely
- Frequent urination
- Pain or burning during urination
- Blood in the back, hips or pelvis
- Painful ejaculation
If you experience any of these symptoms or have any concerns about prostate cancer, you should contact your doctor right away.
Your provider will perform a complete evaluation and may run prostate cancer screenings, like a digital rectal exam or PSA test. If your doctor finds anything unusual through your prostate cancer screening, then you may need more tests, including a:
- Transrectal ultrasound to get a clearer picture of the prostate and any abnormalities
- Biopsy (Fusion biopsy) to collect small samples of the prostate and check for cancerous cells
By combining MRI and ultrasound images, Fusion Biopsy gives urologic surgeons a clearer picture of which areas of the prostate to biopsy.
Ultrasound-Guided Needle Biopsy vs. Fusion Biopsy
Until recently, the standard of prostate cancer diagnosis was an ultrasound-guided prostate needle biopsy. This random approach can potentially miss cancerous areas in the prostate. Fusion Biopsy, or MRI Fusion Biopsy, improves the accuracy of prostate cancer diagnosis, reduces the need for repeat biopsies and increases the safety of this diagnostic procedure.
Providing a Clearer Picture
A specially-trained urologist at Penn State Cancer Institute performs a 3D ultrasound to build a live image of your prostate. The urologist overlays or merges your previous MRI onto the live 3D ultrasound image. This enhanced 3D map of your prostate enables the urologist to determine more precisely the exact location to target for biopsy.
The procedure requires the same preparation as standard prostate biopsies. It is completed in one day and usually does not require a hospital stay.
Fusion Biopsy is covered by most medical insurance plans.
- More accurate diagnosis
- Fewer unnecessary biopsies
- Safer procedure
- Better overall outcomes
You may be a candidate if you:
- Have an elevated Prostate-Specific Antigen (PSA) level
- Have a negative prior prostate biopsy with continued elevated PSA
- Are on active surveillance for prostate cancer and require repeat biopsy
After testing is complete, your doctor will give you a Gleason score, from 2-10, to describe how likely it is your cancer will grow and spread. Grades 2-4 are usually considered less aggressive. The higher your score, the more aggressive your cancer may be.
It is important to keep in mind that your doctor will discuss your score with you and what it means for your treatment. Together, you can create a plan that is right for you and will effectively treat your cancer.
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