New York Health
Urology Centers

Urologic Cancer – Prostate Cancer

What is prostate cancer?

The prostate is part of the male reproductive system located below the bladder in front of the rectum and surrounds the urethra, a tube-like structure that carries urine from the bladder to the penis.  Normally, the prostate is about the size and shape of a walnut and primarily produces fluid for the semen.

Prostate cancer is a common form of cancer affecting men. It typically grows slowly, though certain other types of prostate cancer might grow rapidly. Usually confined to the prostate gland, it typically develops in the cells that create and release mucus, among other bodily fluids. This type of cancer is called adenocarcinoma.

Even though the cause of prostate cancer is unknown, certain risk factors increase the odds of developing prostate cancer, such as:

  • Age
  • Ethnicity (black males have a significantly higher risk of prostate cancer)
  • Family history of prostate cancer or breast cancer
  • Obesity

What are the symptoms of prostate cancer?

Early stage prostate cancer might not cause any symptoms but advanced stage prostate cancer may cause symptoms such as:

  • Blood in semen
  • Difficulty in urinating
  • Decreased size and strength of the urine stream
  • Pelvic area discomfort
  • Erectile dysfunction

How is prostate cancer diagnosed?

Prostate cancer screenings are used for an initial prostate cancer diagnosis. Screening tests include:

  • Digital Rectal Exam (DRE) is when a physician inserts a gloved, lubricated finger into the patient’s rectum to feel for irregularities such as changes in the size, shape or texture of the prostate.
  • Prostate-Specific Antigen (PSA) test is a blood sample used to analyze the PSA levels in the bloodstream. A high PSA level may indicate an inflamed, infected, enlarged or cancerous prostate.

If a DRE or PSA test detects an abnormality, additional testing is performed to confirm a diagnosis.  Tests to confirm a prostate cancer diagnosis include a taking a sample of prostate tissue, also known as a biopsy, or a transrectal ultrasound in which a probe is inserted into the rectum.

When a cancer diagnosis is confirmed, the cancer stage is confirmed and the physician begins discussing treatment options.

The stages of prostate cancer are:

  • Stage I is a very early type of cancer that is limited to a small area of the prostate
  • Stage II involves a tumor that might still be small but might also be aggressive when the cancer cells are viewed under the microscope, or it might involve a larger tumor that has grown to affect both sides of the prostate gland.
  • Stage III means that the cancer has spread [metastasized] to the seminal vesicles or other nearby tissues.
  • Stage IV cancer has spread to other tissues such as lymph nodes, bones or other organs.

How is prostate cancer treated?

If the prostate cancer is in the very early stages, treatment might not be immediately necessary. Instead, active surveillance involving follow-up bloodwork, rectal exams and biopsies to monitor the cancer progression may be recommended.

For more advanced cancer, several treatment options are available, such as:

Radiation Therapy

Radiation therapy involves high-energy beams used to target and kill cancer cells. It can be administered in two ways:

  • External beam radiation therapy uses a machine that moves around the body to direct the beams to the precise locations. External beam radiation therapy is frequently used after surgery to kill any remaining cancer cells.
  • Brachytherapy involves insert rice-sized radioactive pellets via X-ray-guided needle into the prostate gland. The pellets administer a low dose of radiation over time.

Hormone Therapy

Because prostate cancer cells feed on the male hormone testosterone, hormone therapy is used to stop the body from producing testosterone. That causes cancer cells to die or grow more slowly.

Hormone therapy options include:

  • Medications to stop the body from producing testosterone
  • Surgery to remove the testicles, also known as orchiectomy, to reduce testosterone levels
  • Medication to prohibit testosterone from reaching cancer cells

Surgery

For cases in which surgery is the best option, it generally involves removing the entire prostate gland and some of the surrounding tissues and the lymph nodes. This is known as a radical prostatectomy and involves three surgical approaches:

  • Retropubic surgery, which involves an Incision through the lower abdomen
  • An incision between the anus and the scrotum
  • Minimally invasive robotic surgery

Cryoablation

Using an X-ray-guided needle to inject special gases into the tumor to freeze and then heat the cancer cells to kill them. This cycle of freezing and heating can also kill a small portion of healthy tissue surrounding the cancer cells.

Chemotherapy

Chemotherapy is commonly used to kill remaining cancer cells after surgery or to shrink a tumor prior to surgery. Chemotherapy is administered in pill form or intravenously through a needle in the arm or a combination of both.

Chemotherapy is also used in combination with radiation therapy for inoperable cancers.

Immunotherapy

Immunotherapy, which is also known as biological therapy, helps a person’s immune system fight cancer.  Immune cells are removed and genetically modified to combat cancer before injecting into the body intravenously.