Prostate Cancer

The prostate is a gland in the male reproductive system. About the size of a walnut, it sits below the bladder, in front of the rectum, and surrounds the urethra. It releases prostatic fluid, which contributes to the formation of semen. Prostate cancer forms in tissues of the prostate.

Men who are at normal risk should have an annual prostate exam starting at age 50. Men with higher risk (family history or African American) should start around age 40.

A 2022 study concluded that PSA screenings prevented one death in every 11 to 14 men who were diagnosed with the disease – exceeding previous research results by twofold. Among Black Americans, who are at higher risk of dying from the disease, the survival rate is higher.

Exact causes of prostate cancer are unknown, though genetics, inflammation, and environmental factors such as diet and smoking likely play a role. Men older than 65 and/or with an immediate family history of prostate cancer are at greater risk, as are African American men. Obesity also increases the risk of prostate cancer.

Prostate cancer usually causes no symptoms unless it has spread outside the prostate, but some patients may experience:

• Difficulty starting or stopping urine flow
• Increased urinary frequency, particularly at night
• Weak urine flow
• Blood in the urine or semen
• Pain in the lower back, hips or upper thighs

A urologist performs a detailed history and physical exam, including a variety of tests:

• Digital rectal exam: To get a general idea of the size and condition of the gland, the doctor inserts a lubricated, gloved finger into the patient’s rectum and feels the prostate through the rectal wall.
• Blood test: Blood sample reveals the level of prostate-specific antigens (PSA) in the blood.
• MRI: A magnetic resonance imaging (MRI) scan is a common procedure that uses a strong magnetic field and radio waves to create detailed images of the organs and tissues within the body.

If test results are abnormal, the urologist may advise:

• Transrectal ultrasound: A rectal probe identifies abnormal areas of the prostate.
• Transrectal biopsy: A biopsy needle passed through the rectum gathers a tissue sample to detect cancer cells.
• MRI fusion biopsy: MRI/ultrasound fusion technology uses MRI images and targets abnormal areas that have been identified on those images. While performing the biopsy, the urologist will then have the annotated images of the MRI with the suspicious areas marked on these images available on his/her monitor. These images will then be fused with the real-time transrectal ultrasound image of the prostate. This subsequently allows an MRI-targeted sampling of suspicious areas, under ultrasound guidance.

The Gleason score and tumor stage are used together to predict prognosis and help guide therapy.

The Gleason score is a description of the aggressiveness of the cancer cells and is assigned based on the microscopic appearance of the cancer cells. The Gleason score ranges from 2 (least aggressive) to 10 (most aggressive) and is based on prostate cancer cells’ microscopic appearance.

The tumor stage, however, describes how the cancer was detected and the extent of the cancer in the body. The tumor stage will not be indicated on a prostate biopsy report, but will be described by your doctor.

• Stage I: Cancer is limited to the prostate.
• Stage II: The tumor is more advanced but has not spread outside the prostate.
• Stage III: The tumor has been detected in organs next to the prostate, extending into the seminal vesicles (a gland behind it that helps produce semen), sphincter (muscles that control urine flow), bladder, rectum, or wall of the pelvis.
• Stage IV: The tumor has spread beyond the prostate into the lymph nodes or other organs including bones.

We base our prostate cancer treatment approach on each patient’s situation.

Treatments for local growth (stages I and II) include:

• Surgical removal of the prostate through:

• • Robotic surgery: Minimally invasive surgery using the da Vinci® Surgery System which is the most common surgical treatment for prostate cancer.

• • Open surgery: Prostate removal through a cut in the abdomen or an incision between the prostate and the anus.

• Radiation:​

• • CyberKnife® SBRT: Delivered at our Cincinnati, Ohio location, stereotactic body radiation therapy (SBRT) delivers high doses of radiation in a small number of treatment sessions – five outpatient sessions on consecutive days or over a two-week period.

• • External or image-guided radiation: Uses two- and three-dimensional imaging to direct radiation, often referred to as IMRT or IGRT.

• • Brachytherapy: Inserts seeds containing radioactive material directly into the prostate.

• Active surveillance: Urological exams, including regular PSA (prostate-specific antigen) tests and digital rectal exams with repeat biopsy within the first one to two years, and as needed thereafter depending on the patient’s individual risk factors.

Treatments for metastatic growth (stages III and IV):

• Hormone therapy: Blocks the patient’s production of testosterone to slow the cancer’s growth or cause it to shrink.
• Immunotherapy: Stimulates the patient’s immune system to fight the cancer cells. This includes chemotherapy, radiation, surgical removal of the tumor, and more recently developed immunotherapies that use your body’s own immune system to attack cancer cells.
• Chemotherapy: Medication or a combination of medications given to patients whose cancer has spread and no longer responds to hormone therapy.