Welcome to Prostate Cancer Answers. Welcome to The Cancer Team.
If you’ve been diagnosed with prostate cancer you, with the help of your physician, will make decisions about treatment.
Bellin Health and The Cancer Team have surgeons and radiation oncologists who are experienced in treating prostate cancer. Before you decide, spend time with your physician to understand the specifics of your cancer and make the decision that is best for you.
There are several factors that will be considered when formulating your treatment plan, including age of the patient and the specifics of the cancer. And there are several types of treatment options available.
What Is PROSTATE CANCER?
The prostate is a gland located between a male’s bladder and urethra. Its function is to produce a fluid that transports sperm.
Prostate Cancer develops when the cells of the gland begin to change, becoming malignant. These malignant cells may grow at a rapid rate and spread throughout the gland. If left untreated the cancer can spread beyond the prostate to other areas of the body.
Prostate Cancer is one of the most common male cancers, with approximately 200,000 new diagnoses occurring every year.
The disease usually occurs among older men. There is wide variation in how aggressively prostate cancers may behave, ranging from slow growing prostate cancers, which may not require immediate treatment, to highly aggressive cancers that may require multiple treatment types.
Symptoms
Oftentimes, early on, when prostate cancer is at its most treatable stage, there are no symptoms. This is why it is important for a man 50 years of age and older to have his PSA levels checked regularly. A PSA (protein-specific antigen) test can be performed during a routine blood test.
Advanced prostate cancer can cause pressure on the urinary tract and create discomfort or impair urination.
- If you have difficulties with urination, see your doctor. These symptoms are not always caused by prostate cancer but screening for prostate cancer is advisable.
- The American Cancer Society and American Urologic Association recommend that regular prostate cancer screenings be discussed with the patient starting at age 50. If there is a family history or the patient is African-American, consider starting at an earlier age.
PSA
The PSA (prostate-specific antigen) is a blood test that is commonly used to screen for prostate cancer. It is a chemical, made by both normal prostate cells and prostate cancer cells, that is detectable in the blood. A PSA level above the normal level, or an increase in the PSA level over time, is often the first sign of a possible prostate cancer. This often leads to a biopsy, which establishes the diagnosis of prostate cancer, and gives additional information on how aggressive a prostate cancer may behave. The PSA is also a valuable tool that your physician will use to determine the most appropriate treatment and to measure the response of a prostate cancer after treatment with surgery or radiation therapy.
Gleason Score
The most common way of grading prostate cancer is called the Gleason Scoring System. Your Gleason score offers insight into the prostate cancer’s behavior. A tumor with a low Gleason score is likely to be slow growing, while one with a high score is more likely to be aggressive.
How It Works
A sample of cancerous tissue is obtained through a biopsy and then analyzed. The two largest areas of cancer are assigned numbers from one to five, with one being the least aggressive and five being the most aggressive.
The two grades are then added together to produce a Gleason score. A score of two to four is considered low grade. Five through seven is considered slightly more aggressive, and eight through 10 is high grade.
Ask your physician to provide you with the details of your Gleason score. Not all scores are equal. For instance a score of 3 + 4 = 7 is likely to be slightly less aggressive than a score of 4 + 3 = 7, because the first number indicates the grade of the largest amount of cancer. The second number indicates the grade of the lesser amount.
Your Gleason score is a primary tool in determining your treatment plan.
Stage and Prognosis
Because of PSA screenings, most prostate cancer is currently diagnosed at an early stage, with the cancer still confined to the prostate. In this situation, the chances for successful treatment of the disease with surgery or radiation therapy are very good. At more advanced stages, more aggressive cancers may eventually spread beyond the prostate. Although there are still treatments which may effectively treat these more aggressive cancers, and delay its progression, it is more likely that the cancer may become life-threatening. This is why early diagnosis and treatment are felt to be beneficial.
Treatment
The decision for treatment of prostate cancer depends on the age and health of the patient, the aggressiveness of the cancer and the extent of the cancer at the time of diagnosis.
All treatments for prostate cancer can have an effect on quality of life, including urinary continence, erectile function and bowel effects. So, it is important to have a thorough discussion with your urologist and radiation oncologist about the side effects of each of the treatment options.
Watchful Waiting
For selected patients with non-aggressive forms of prostate cancer, active surveillance with deferral of treatment to a later date may be an option.
Curative Treatments
For many patients, therapies designed to cure the cancer are the best choice and there are basically three options:
- Surgery to remove the prostate (Radical Prostatectomy)
Radiation therapy is given either using external beam radiation therapy (EBRT), which uses a non-invasive, painless radiation beam delivered from outside the body inwards to the prostate area, or brachytherapy (“seed implant”) where the radiation is delivered internally from radioactive seeds that are placed inside the prostate during a minor outpatient surgical procedure.
At Bellin Health's Cancer Team, the preferred method of external beam radiation is IMRT, or intensity modulated radiation therapy, which allows the radiation to be delivered with more precision focusing on the prostate only, while minimizing radiation dose to the surrounding normal organs such as the bladder and bowel. This is done in combination with daily image guided radiation therapy (IGRT) techniques, which further enhance the precision of treatment.
In patients with more aggressive forms of prostate cancer (larger tumors, high Gleason score or PSA levels), radiation therapy may be combined with hormonal therapy. This involves stopping your body from producing the male sex hormone testosterone which stimulates the growth of prostate cancer cells. The combination of hormonal therapy and external beam radiation therapy has been shown to enhance cure rates and survival for men with more aggressive forms of prostate cancer. Hormonal therapy is therefore very beneficial for some patients, but does have some side effects that you should discuss with your doctor.
Cryosurgery is another option and involves freezing of the prostate. Your physician will help determine if this is an option for you to consider.
The Treatment Right for You
Prostate cancer patients typically have more than one option to choose from when deciding how to be treated for their prostate cancer. Men should base their treatment decision on a good understanding of how effective each of the treatment options will be for curing their cancer, and on understanding how each treatment will impact their long term quality of life. Ideally, prostate cancer patients should talk to both their urologist and to a radiation oncologist to discuss all of their options. For some men, a combination of treatments — such as surgery followed by radiation or radiation paired with hormone therapy — works best.
The treatment you choose may depend on several factors:
- How fast your cancer is growing
- How much it has spread
- Your age
- Your overall health
- The benefits and potential side effects of the treatments
In deciding on the treatment that's right for you, consider not only the potential physical outcomes of treatment but also the psychological and social aspects. The Cancer Team, including your physician, cancer coach, and entire team of cancer specialists will be available from the beginning to help you make these decisions.
