Diagnosing & Treating Prostate Cancer
- In recent years, there have been incredible advances when it comes to treating prostate cancer, especially for patients diagnosed at an advanced stage.
- Because of these advances, the treatment approach can vary a great deal from patient to patient — and will depend on several factors such as their cancer’s stage, Gleason score, PSA level, and their overall health and personal preferences.
- To diagnose and categorize prostate cancer, doctors will perform a series of tests, which may include a PSA blood test, a digital rectal exam, a prostate biopsy, and imaging tests like MRI, CT, or bone scans.
“The big news for us has really been the treatment of advanced prostate cancer over the last 10 to 15 years,” Dr. Leonard Gomella, Chair of the Urology Department at Thomas Jefferson University’s Sydney Kimmel Medical College, tells SurvivorNet. “There’s been a tremendous number of advances. Today we literally have a dozen different options for men with advanced prostate cancer that are really being shown to be very effective to extend the quality and quantity of life.”
Read MoreHow Is Prostate Cancer Diagnosed?
The prostate is a small gland, about the size of a walnut, located below the bladder in men. It helps produce seminal fluid, which nourishes and transports sperm. Prostate cancer develops when cells in the prostate grow uncontrollably. Most prostate cancers are adenocarcinomas, arising from the glandular tissue. Some prostate cancers grow very slowly and may never cause symptoms or require treatment, while others are more aggressive and can spread to other parts of the body.Prostate cancer is diagnosed through a series of tests, and may be detected during routine screening such as a PSA (Prostate-Specific Antigen) blood test or a digital rectal exam. Elevated levels of the PSA protein may suggest cancer. During a digital exam, a doctor feels the prostate through the rectum to check for abnormalities.
If prostate cancer is suspected, your doctor may order the following tests to confirm a diagnosis:
- Prostate biopsy (where tissue samples are examined under a microscope to confirm cancer)
- Imaging tests (MRI, CT, or bone scans), which help determine whether the cancer has spread
After a diagnosis is confirmed, the Gleason score, which ranges from 6 to 10, helps assess how aggressive the cancer is.
The cancer stage (1 through 4) describes how far the cancer has spread. Your doctor will use these factors, along with PSA levels and imaging, to assign a risk group (low, intermediate, or high), which helps guide treatment.
Treatment Options For Prostate Cancer
The treatment approach for prostate cancer will depend on several factors — like the stage, Gleason score, PSA level, overall health, and personal preferences — and may include several different types of therapy.
“One of the challenges we have today with prostate cancer are, there are many different options available for all stages of disease,” Dr. Gomella says. “It’s not a one size fits all anymore.”
This is great for patients as it expands the toolkit doctors can use to treat their disease — but it can also be overwhelming and complicated when trying to pick the best approach, Dr. Gomella adds.
Below is a breakdown of common approaches based on stage.
Active Surveillance
This is closely monitoring the cancer without immediate treatment. It’s a common approach for low-risk or very low-risk prostate cancer. It includes regular PSA tests, imaging, and sometimes repeat biopsies. If signs suggest the cancer is growing, treatment can then be started.
Your medical team might recommend this approach to avoid the potential side effects of treatment while still keeping cancer under close watch.
Surgery (Radical Prostatectomy)
This involves removing the entire prostate gland. It can be done using open surgery or a robotic-assisted laparoscopic approach.
In many cases, surgery can remove the cancer completely. However, surgery does include risks like urinary incontinence and erectile dysfunction.
Improved surgical techniques can reduce the recovery time for patients, but side effects are still an important factor to consider.
Radiation Therapy
There are two main types of radiation used for prostate cancer: external beam radiation therapy (EBRT), where a machine delivers radiation to the prostate, and brachytherapy, where radioactive seeds are implanted in the prostate.
Radiation therapy can be used in many cancer stages, but side effects affecting urinary, bowel, and sexual function are possible and should be discussed with your medical team.
Hormone Therapy (Androgen Deprivation Therapy)
This lowers or blocks testosterone, which fuels prostate cancer growth. It’s often used with radiation in higher-risk cases or when cancer has spread.
Hormone therapy can be incredibly effective at shrinking or slowing down cancer. Potential side effects include hot flashes, weight gain, fatigue, and reduced libido.
Chemotherapy & Newer Treatments
For advanced or resistant cases, chemotherapy, immunotherapy, or targeted therapies may be used. These are typically considered when hormone therapy is no longer effective.
Choosing The Right Treatment
As Dr. Gomella explained, there’s no one-size-fits-all answer to treating prostate cancer.
The following factors should go into the treatment decisions:
- Your age and overall health: Younger, healthier men might lean toward surgery; older patients may prefer surveillance or radiation.
- Cancer risk level: Low-risk cancers may not need immediate treatment.
- Your values and lifestyle: Think about how treatment might affect your quality of life, work, and relationships.
- Second opinions: Don’t hesitate to get another opinion from a urologist, radiation oncologist, or medical oncologist.
Coping With Side Effects
Prostate cancer treatment can cause a range of side effects — but effects on urinary, bowel, and sexual function are often a top concern for patients.
Here’s a general overview of side effects and how they are managed:
- Urinary incontinence: This is common after surgery, usually improves over time, but does sometimes require pelvic floor therapy or surgical solutions.
- Erectile dysfunction: This may occur after surgery or radiation. Medications, injections, or implants may be used to address it.
- Bowel changes: Radiation may cause temporary diarrhea or rectal discomfort.
- Hormonal side effects: Hormone therapy can affect energy, mood, muscle mass, and libido.
It is recommended that patients speak openly with their doctors about these issues — they’re common and often manageable.
Follow-Up & Monitoring
After treatment or if you’re on active surveillance, regular follow-ups are essential.
This may include:
- PSA tests every 3-12 months
- Imaging or physical exams as needed
- Monitoring for recurrence or new symptoms
Even if your cancer is considered cured, long-term monitoring ensures that any changes are caught early.
Questions To Ask Your Doctor
- What is the stage and Gleason score of my cancer?
- What are my treatment options?
- What are the potential side effects?
- How will this affect my daily life and long-term health?
- Should I see a specialist, such as a radiation or medical oncologist?
- Is a clinical trial an option for me?
Content independently created by SurvivorNet with support from Novartis Pharmaceuticals Corp.
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