Urology Services

Prostate Cancer

What is Prostate Cancer?

Prostate cancer is the most common cancer diagnosed in men, with about 200,000 new prostate cancer cases each year. It is typically seen in men over the age of 50, and the incidence increases with age. Men experience about a one-in-seven chance of a prostate cancer diagnosis in their lifetime. Risk factors for prostate cancer include age, family history, race, obesity, and a diet high in saturated fats.

There are many types of prostate cancer. The most common form is adenocarcinoma which is found in the granular part of the prostate. Rare types of prostate cancer include ductal carcinoma, signet-ring cell carcinoma, mucinous carcinoma, clear cell adenocarcinoma, small cell carcinoma, and giant cell carcinoma. It is imperative to know which kind of prostate cancer you have as the rare types are often more aggressive and require different therapies as opposed to adenocarcinoma.

Today, most prostate cancers are diagnosed early using prostate-specific antigen (PSA) and therefore, more curable. The American Urologic Association’s recommendations for prostate cancer screening are:

• Prostate cancer screening should be a shared decision between urologist and patient.
• A serum prostate-specific antigen and a digital prostate exam should both be performed during a prostate cancer screening.
• Men between the ages of 55-69 should be screened regularly.
• Men 70+ should be screened based on medical history and life expectancy.
• Men with a family history of prostate cancer and African Americans should begin prostate cancer screening at 40.
• Screenings should be performed every 1-2 years depending on the patient.

What is Local Prostate Cancer?

Local prostate cancer accounts for about 90% of all prostate cancers. This type of prostate cancer is confined to the prostate and has not spread yet. Localized prostate cancer is typically detected through an elevated PSA. Some local prostate cancers are asymptomatic and will not cause issues while others will require treatment. Your cancer urologist will determine the best course of treatment based on several factors like the cancer itself, age, candidacy for treatment, risk, and patient preference. Some local prostate cancers do well with a single therapy while others may require a combination of therapies. It is important to know that 15-25% of men with early-state local prostate cancer will encounter a relapse and may need additional treatment; however, early detection is key. Men diagnosed early with local prostate cancer have close to a 100% 5-year survival rate.

What is Advanced Prostate Cancer?

Advanced prostate cancer makes up about 10% of prostate cancer diagnoses. Advanced prostate cancer is cancer that has spread beyond the prostate to surrounding organs, structures, lymph nodes, or metastasis to more distant areas. Symptoms like blood in the urine (hematuria) or urinary obstruction are more likely to be present in advanced prostate cancer. Treatment options will depend upon how far the cancer has spread and will likely include more than one therapy. Androgen Deprivation Therapy (ADT) will also be used to control the spread and slow the growth of advanced prostate cancer. Chemotherapy may also be an option depending on where the cancer has spread. Advanced prostate cancer commonly spreads to the lungs, bones, and liver. The 5-year survival rate for advanced prostate cancer is about 32%, further emphasizing that early detection and regular screenings are important.

What are the Signs and Symptoms of Prostate Cancer?

Most men do not experience symptoms of prostate cancer because of early detection through regular cancer screenings and elevated PSA. However, there are many common symptoms to look out for including:

• Blood in the urine
• Frequent need to urinate
• Urgent need to urinate
• Pain or discomfort when urinating
• Urinary retention
• Pelvic pain
• Back pain
• Bone pain
• Weight loss

Many of the symptoms above are also indicators of BPH, a benign prostate condition. If you are experiencing any of these symptoms, you should schedule an appointment with Dr. Kenworthy to determine the cause.

How is Prostate Cancer Diagnosed?

A urologist will review your medical history and perform a physical exam first. This physical exam will include a digital rectal examination. A PSA test will also be performed. If your PSA levels are elevated, then the urologist will recommend a prostate biopsy. A prostate biopsy is performed as an outpatient procedure under local anesthesia. Pending the results of the biopsy, your urologist may recommend a CT scan to obtain detailed imaging for clinical staging and to determine if the cancer has spread to any other parts of the body.

What are the Stages of Prostate Cancer?

The stage of prostate cancer is determined by a physical exam and CT scan. If the cancer has already spread, additional testing, like a bone scan, may be needed. The stage of the cancer determines how far it has grown. Therefore, the prognosis is directly linked to the stage. Treatment options are based on the stage of prostate cancer.

Only a board-certified urologist can determine the stage of prostate cancer. The earlier it is detected, the better the prognosis is. If you are over the age of 55 or have a family history of prostate cancer, it is imperative to have regular prostate cancer screenings.

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How is Prostate Cancer Treated?

The good news is most prostate cancers are found early and can be treated with surgery, external radiation therapy, or interstitial brachytherapy. In some cases, observation may be the best option. Many treatment options are available for localized prostate cancer and include:

Observation
Sometimes active surveillance is the best approach as some cases of prostate cancer never become life-threatening. This method is best for low-risk cases and older patients who are not eligible for surgery or radiation. Patients undergoing this method will have regular prostate cancer screenings and PSA checks with their urologist. Repeat biopsies may be necessary.Interstitial prostate brachytherapy may also be an option for a low-risk patient. This active observation approach involves placing small radioactive pellets into the prostate. This treatment option can help control the cancer and is often used in conjunction with hormone therapy.

‍3D Conformal and Intensity-Modulated Radiation Therapy
Radiation therapy can be used in both low and high-risk prostate cancer patients and is very effective. There are two types of radiation therapy. 3D Conformal Radiation Therapy uses guided imaging to deliver the radiation directly to the prostate. This limits the radiation exposure to other parts of the body and surrounding tissue. Intensity-Modulated Radiation Therapy sends a boosted dose of radiation to the prostate while reducing the radiation around the bladder, rectum, and bowel. A course of radiation typically lasts 10 weeks. How high of a dosage a patient receives depends on the stage of their cancer.

‍Focal Therapy
Focal therapies like cryoablation, radiofrequency ablation, and high-frequency ultrasonic ablation may be options for patients with low-risk prostate cancer. Ablative therapies focus solely on the cancer rather than the entire prostate and can be associated with fewer side effects. However, focal therapies may be less effective in accurately targeting the tumor and identifying other areas of concern in the prostate.

‍Radical Retropubic Prostatectomy (RRP)
Radical retropubic prostatectomy is the most common surgical treatment for prostate cancer. RRP involves the removal of the prostate and surrounding lymph nodes. RRP is an available treatment for all levels of prostate cancer. This surgery is an in-patient procedure that will require a 1-2 night stay in a hospital. Depending on the stage of the cancer, RRP may be performed with nerve-sparing which can help preserve erectile function. Side effects from RRP may include erectile dysfunction, urinary issues, and others.

‍Robotic-Assisted Laparoscopic Prostatectomy (RALP)
Robotic-Assisted Laparoscopic Prostatectomy is like RRP in many ways. RALP is a surgical procedure requiring a 1–2-night hospital stay, and the prostate and surrounding lymph nodes are removed. RALP is best for patients with localized prostate cancer. A laparoscopic prostatectomy also has fewer risks and side effects than RRP.

Dr. Paul Kenworthy and Prostate Cancer

Dr. Kenworthy is a well-versed prostate cancer urologist. He will help guide his patients through their cancer journey and offer the best treatment options available that fit their goals. Stop waiting if you think you are experiencing the symptoms of prostate cancer or are due for a prostate cancer screening. Early detection can save your life.

Are you experiencing unpleasant urological symptoms?

Contact us to schedule an evaluation for Dr. Kenworthy to identify the problems behind your symptoms and provide the correct treatment to restore your comfort and well-being.