Prostate Cancer

What is prostate cancer?

Prostate cancer starts in the cells of the prostate, a small, walnut-shaped gland in men that makes the fluid that carries sperm. The prostate is located below the bladder, around the urethra, and in front of the rectum.

When prostate cancer is found early, it’s often treatable. Many prostate cancers grow very slowly and don’t need immediate treatment. However, some types can grow quickly and spread. It's important to know your risk and keep up with regular screenings.

Prostate cancer is the second most common cancer in men behind skin cancer. The primary care providers, urologists, and oncologists at Reid Cancer Center are dedicated to helping men in East Central Indiana and West Central Ohio reduce their risk for prostate cancer risk factors, get the screenings they need, and find the right treatment if it’s necessary. 

Prostate cancer symptoms

In its early stages, prostate cancer typically doesn’t cause symptoms, which is why prostate cancer screenings can be so valuable.  

Prostate cancer can have similar symptoms to a noncancerous condition called benign prostatic hyperplasia (BPH). BPH happens when the prostate becomes enlarged, blocking the flow of urine and affecting sexual function. Prostate cancer symptoms can also resemble those of other common prostate issues. Because of this, it's crucial to discuss any symptoms you experience with your healthcare provider, especially if you’re at higher risk.

When prostate cancer symptoms appear, they might include:

• A dull, persistent, aching pain in your lower pelvis, lower back, or hips
• Blood in your semen
• Blood in your urine
• Difficulty getting or maintaining an erection or pain while ejaculating
• Difficulty urinating, including a slower or weaker urine stream  
• Increased need to urinate, especially at night
• Legs or feet feeling weak or going numb
• Losing control of your bladder or bowel
• Loss of appetite
• Pain or burning when you urinate
• Unexplained weight loss 

Diagnosing prostate cancer 

High PSA levels from a prostate cancer screening might prompt your provider to order additional tests. You can have high PSA levels for many reasons, though, so the first thing to know is high PSA levels don’t necessarily mean you have cancer. 

If your prostate-specific antigen (PSA) levels are higher than normal, or if abnormalities are detected during a digital rectal exam (DRE), your provider might recommend a prostate biopsy as the next step. Most likely, you’ll have a core needle biopsy, performed by a urologist.

You’ll lie on an exam table and your provider will use imaging — either a transrectal ultrasound, an MRI, or a combination of the two — to look at the prostate and guide their needle as they insert it, either through the skin between the scrotum and anus or the wall of the rectum. You might experience brief discomfort each time a tissue sample is removed, but a prostate biopsy is not overly painful. The procedure usually takes between 10 to 20 minutes.

Your prostate tissue will be tested for cancer. If the tests come back negative, you might not need any more tests, but your primary care provider might recommend more frequent screenings.  

If your test results are inconclusive, your healthcare provider might recommend additional lab tests. If your test results are positive, your provider will speak with specialists at Reid Cancer Center to decide on the most appropriate course of action. This could involve beginning active treatment or opting for "expectant management," where your cancer is closely monitored without immediate action. For slow-growing cancers, doctors often prefer the approach known as watchful waiting.

Prostrate cancer staging

If diagnostic tests such as a PSA test, DRE, prostate biopsy, and imaging studies indicate you have prostate cancer, the next step is to determine the stage of the cancer. Staging helps to assess the size of the tumor and whether the cancer has spread beyond the prostate.

Prostate cancer is typically staged from 1 to 4, with some stages having different levels:

• Stage 1: At stage 1, cancer is confined to the prostate. In some cases, stage 1 cancer can only be detected by a biopsy and cannot be felt during a DRE or seen on imaging.  
• Stage 2: At stage 2, cancer is still confined to the prostate but may be larger or more detectable.
• Stage 3: By stage 3, cancer can be larger, or it has spread outside the prostate to nearby tissues, such as the seminal vesicles, but has not spread to the lymph nodes or to distant organs.
• Stage 4: At stage 4, cancer has spread beyond the prostate to nearby lymph nodes, surrounding tissues, or distant areas, such as the bones or other organs. 

Prostate cancer treatments

Not all prostate cancers require treatment, or at least not right away. There are two types of expectant management for managing these types of cancers:

• Watchful waiting: This approach, typically recommended for those with a continued life expectancy of 10 years or more, doesn’t involve performing tests. Symptoms are treated as they arise.
• Active surveillance:  Active surveillance involves regular testing of PSA levels and regular prostate biopsies. If either of these things change in a way that indicates the cancer is growing, or if symptoms arise, your provider will recommend treatment.

If providers opt for active treatment options, you’ll need one or more procedures or treatments.  

Radical prostatectomy  

For men whose cancer hasn’t yet spread, providers might recommend a radical prostatectomy, or removal of the entire prostate gland. Although this procedure can be done as a traditional open surgery, laparoscopic (minimally invasive) surgery to remove the prostate is also an option. Physical therapy after the procedure can help strengthen the pelvic floor.

Pelvic lymph node dissection (PLND)

Performed along with a radical prostatectomy in more aggressive cases of prostate cancer, a PLND can tell your provider whether prostate cancer cells have begun to spread elsewhere in the body.

Hormone therapy

If, after your PLND, your provider finds cancer in your lymph nodes, they might recommend hormone therapy. This particular prostate cancer treatment keeps cancerous cells from receiving hormones necessary for their growth and spread.

External beam radiation therapy

Reid Cancer Center’s sophisticated radiation therapy includes external beam radiation, which targets cancerous cells with a high degree of accuracy while sparing as much healthy tissue as possible. Your provider will use imaging to map out the precise location of the cancerous cells and focus radiation on those locations.

Brachytherapy  

This form of radiation therapy involves planting radioactive seeds or pellets into or close to the prostate gland to kill cancer cells. Brachytherapy takes between one to four sessions, and although the seeds are placed permanently, they’re no longer radioactive after a certain amount of time.

In cases when prostate cancer has spread to organs, bones, or tissues, treatment is focused on improving quality of life while keeping the cancer under control. These treatments may include chemotherapy, hormone therapy, and another form of radiation.