Prostate Cancer

Prostate cancer is one of the more-common cancers in men, developing when some cells in the prostate gland grow abnormally and rapidly. This cancer is usually found in the rear portion of the gland, closest to the rectum, but it may also arise elsewhere within the gland.
If detected early while confined to the prostate gland, this cancer often has no or minimal symptoms, or it may present like common prostate infections. By identifying a rising PSA level, however, an abnormal growth of prostate-cancer cells may be detected at an early stage, when the disease is still limited to the prostate gland. When not detected early, however, the disease can invade nearby tissues or spread to other parts of the body (especially, bone) and cause death.
In early stages, proper treatment will often result in a complete cure. Early stage prostate cancers can be treated with brachytherapy alone (see elsewhere in this website). More advanced prostate cancers may require a type of external beam radiation called intensity modulated radiation therapy (IMRT), which is used to deliver a very precise radiation field that markedly lessens dose to adjacent structures.
Our Tomotherapy equipment is an advanced form of IMRT technology, which can be used successfully to treat both early stage and more-advanced prostate cancers, by  aggressively irradiating the prostate gland, the adjacent seminal vesicle structures, and the nearby pelvic lymph nodes.

Symptoms of Prostate Cancer

Cancers of the prostate gland tend to grow slowly, compared with most other cancers. Early stage prostate cancer often does not cause symptoms. However, some of these problems may be caused by prostate cancer:

  • A frequent need to urinate, especially at night
  • Inability to urinate
  • Weak or interrupted flow of urine
  • Difficulty in starting to urinate or holding back urine
  • Pain or burning sensation during urination
  • Blood in urine or semen
  • Difficulty in having an erection
  • Painful ejaculation

Any of these symptoms can be caused by cancer or by other, less serious health problems, such as an infection. If you are experiencing any of these symptoms, you should consult with a doctor.

To diagnose prostate cancer, your physician will ask you questions about your personal and family health history, as well as perform a physical examination, a digital rectal exam, a urine test to check for blood or infection, and a PSA blood test. A transrectal ultrasound and cystoscopy could also be ordered to assist your physician in determining the cause of your symptoms.

Stages of Prostate Cancer

Once your physician has diagnosed prostate cancer, the next step is to determine the stage or extent of the disease. This staging process determines if the cancer has spread, and if so, the extent, as well as the areas of the body that are affected.

Staging the disease is a complex process. Your physician may use a Roman number (I-IV) or a capital letter (A-D) to describe the stage of your prostate cancer.

  • Stage I or A: Your physician does not feel your cancer when he is doing a rectal exam, and there is no evidence that the cancer has spread outside the prostate.
  • Stage II or B: Your physician can feel the tumor during a rectal exam, but there is no evidence that the cancer has spread outside the prostate gland.
  • Stage III or C: The cancer has spread to nearby tissues around the prostate gland, such as penetrating through the prostate capsule or invading into the adjacent seminal vesicles.
  • Stage IV or D: The cancer has spread to lymph nodes, to the bladder, or to other parts of the body.

Treatment Options

It can be very challenging to select your treatment choice after having received a diagnosis of prostate cancer. In reaching a decision for treatment, we suggest that you involve your wife/partner in this process. Discuss each treatment option, including benefits and side effects. There are also prostate support groups. Our office would be happy to assist you in contacting one in your area.

Treatment options for prostate cancer include watchful waiting, surgery, radiation therapy or hormonal therapy. Some patients receive a combination of therapies. Watchful waiting can be suggested if the cancer is found at an early stage and appears to be slow growing. This also applies to men who are older and have certain medical conditions that would outweigh the possible benefits of treatment.

Patients with a diagnosis of prostate cancer should be evaluated and counseled regarding the several treatment options available. A careful physical examination and review of the patient’s diagnostic tests and pathology slides are performed to ensure a cancer diagnosis and to confirm that the prostate cancer is likely confined to the gland. Depending on the patient’s stage and/or medical condition, he may be a candidate for prostate brachytherapy (either alone or in combination with external beam irradiation therapy).

Please learn more about prostate brachytherapy by clicking HERE.

The surgeon may remove part of the prostate or the entire gland and the lymph nodes. During this procedure, the surgeon will attempt to spare the muscles and nerves that control urination and sexual function.

Radiation therapy uses high-energy X-rays to kill cancer cells. External beam radiation is directed at the body by a machine. Prostate brachytherapy delivers radiation by placement of tiny radioactive seeds inside and near the tumor. The seeds deliver a higher dose of radiation than the external beam. Some men with prostate cancer receive both types of radiation therapy. For external beam radiation, patients come to the clinic 5 days a week during the course of the treatment. Because external beam requires no surgery, it is an advantageous method for men who are older or with medical conditions which make surgery no longer an option.

Hormonal therapy works against the prostate cancer by cutting off the supply of male hormones or androgens, such as testosterone, that assist the prostate cancer growth. Hormonal therapy targets the cancer that has spread beyond the prostate gland, rendering it beyond the reach of local treatments such as radiation therapy or surgery. Although hormonal therapy cannot cure the prostate cancer, it can assist in shrinking or halting advancement of the disease, often for many years.

See More Details About Prostate Cancer Treatment Click HERE

1 Di Muzio NG, Fodor A, Noris Chiorda B, et al. “Moderate Hypofractionation with Simultaneous Integrated Boost in Prostate Cancer: Long-term Results of a Phase I-II Study.” Clin Oncol (R Coll Radiol). 2016 Aug;28(8):490-500. doi: 10.1016/j.clon.2016.02.005.
2 Tomita N, Soga N, Ogura Y, et al. “High-dose radiotherapy with helical tomotherapy and long-term androgen deprivation therapy for prostate cancer: 5-year outcomes.” J Cancer Res Clin Oncol. 2016 Jul;142(7):1609-19. doi: 10.1007/s00432-016-2173-9.
3 Yamazaki H, Masui K, Suzuki G, et al. “High-Dose-Rate Brachytherapy Monotherapy versus Image-Guided Intensity-Modulated Radiotherapy with Helical Tomotherapy for Patients with Localized Prostate Cancer.” Cancers (Basel). 2018 Sep 10;10(9). pii: E322. doi: 1.
4 Macias VA, Barrera-Mellado I. “Ultra-hypofractionated radiation therapy for unfavourable intermediate-risk and high-risk prostate cancer is safe and effective: 5-year outcomes of a phase II trial.” BJU Int. 2019 Oct 15. doi: 10.1111/bju.14925.
5 Saldi S, Bellavita R, Lancellotta V, et al. “Acute Toxicity Profiles of Hypofractionated Adjuvant and Salvage Radiation Therapy After Radical Prostatectomy: Results of a Prospective Study.” Int J Radiat Oncol Biol Phys. 2019 Jan 1;103(1):105-111. doi: 10.10.
6 Fodor A, Berardi G, Fiorino C, et al. “Toxicity and efficacy of salvage carbon 11-choline positron emission tomography/computed tomography-guided radiation therapy in patients with lymph node recurrence of prostate cancer.” BJU Int. 2017 Mar;119(3):406-413.

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