When patients experiencing common prostate cancer symptoms visit their doctor, they will most likely require further testing to determine whether or not those symptoms are indicative of cancer or other disease. There are a number of methods used to test for prostate cancer. Most require a physical examination and PSA testing.
Prostate-specific antigen test—The prostate-specific antigen (PSA) test, measures the presence of the chemical PSA in the blood. Typically, men with prostate cancer register higher levels of PSA, but high levels are not necessarily indicative of cancer. They may also be related to infection, enlargement, or inflammation of the prostate. Since the PSA test is only a screening test, a biopsy is often required to diagnose prostate cancer. Biopsy is indicated for an elevated PSA or abnormal prostate exam. The Jackson Clinic also currently offers prostate cancer biomarker testing with the 4 K Score ®. If you are interested in having this test performed, please contact one of the Jackson Clinic Urologists for an appointment.
Transrectal ultrasound—During this exam, a thin probe is inserted into the rectum to check the prostate for abnormalities. By bouncing high-frequency sound waves off of the wall of internal tissues in order detect anomalies. This technique is often used during biopsy procedures.
Biopsy—This procedure uses a thin needle to extract tissue from the prostate, which is then viewed under a microscope to look for cancer cells. This is the most definitive method for identifying cancer and can also indicate how likely that cancer is to spread using the Gleason score. Traditional biopsy is called transrectal biopsy and is usually performed in conjunction with the transrectal ultrasound.
During this procedure, both instruments are inserted into the rectum to retrieve the prostate cells.
A newer technique is called MRI (Magnetic Resonance Imaging) fusion biopsy. This involves an MRI performed prior to the biopsy. MRI is more accurate than ultrasound at detecting prostate lesions. The MRI is then overlayed on the ultrasound at the time of biopsy to accurately biopsy prostate lesions.
Treating Prostate Cancer
Several factors affect the likelihood of a patient to be cured from prostate cancer. Perhaps the most important is how advanced the cancer has become when treatment begins. When cancer is reserved to a small part of the prostate, it is almost always easier to treat than when it has begun to take over the entire prostate or has spread to other parts of the body. The aggressiveness of the cancer also plays a major role in the patient’s ability to be cured. The Gleason score defines a cancer’s tendency to spread and the lower the number, the slower the cancer should spread. As with most diseases, age and previous levels of health factor into a patient’s likelihood of cure. Current treatments depend on the exact prostate cancer diagnosis and include active surveillance, radiation, prostate removal (prostatectomy), and hormone therapy. If the prostate cancer has spread to other organs, hormones are typically offered and chemotherapy may be offered as well (Link to Advanced Prostate Cancer). Each patient receives a specialized treatment recommendation based on the pros and cons of each treatment and the health and age of the patient.
AUA Urology Care: Localized Prostate Cancer
Active Surveillance is a term used to describe closely watching the prostate cancer with scheduled repeat prostate biopsies and monitoring the PSA. This is reserved for patients with low Gleason scores and PSA values. Any increase in the prostate cancer severity may trigger a recommendation of other treatments.
AUA Urology Care: Active Surveillance
Radiation therapy is a very common treatment for cancer of all types. This method involves the use of high levels of energy to kill cancer cells. To treat prostate cancer, two types of radiation treatment are typically used. The first delivers radiation through a powerful beam, into the affected area. These treatments are called external beam radiation and are usually done five days a week for several weeks. This is usually administered with hormone treatments if the Gleason score is higher or the PSA is higher at the time of diagnosis.
An alternate type or radiation therapy involves the placement of tiny radioactive seeds into the affected tissues. This treatment is called brachytherapy and delivers a relatively low dose of radiation over a longer period of time. The seeds will eventually cease giving off radiation and do not have to be removed.
Although radiation therapy is often an effective treatment for many types of cancer, on some patients, it carries side effects. Many patients experience skin changes, fatigue, swelling, diarrhea, constipation, blood in urine or stool, urge to urinate, and nausea to name a few.
Surgery to remove the prostate gland is also used to treat cancer. The full, surgical removal of the prostate is referred to as radical prostatectomy. A radical prostatectomy may be performed traditionally, through a full incision in the abdomen or robotically. Robotic prostatectomy offers doctors the ability to perform surgeries with increased precision and accuracy, as well as decreased blood loss (Link to Robotic Prostatectomy).
Hormone therapy is another treatment used to stave off cancer. Because prostate cancer relies on the male hormone testosterone, cutting that supply off can often lead to cancer cells growing more slowly or even dying off. Methods for reducing or depleting the supply of testosterone vary from medication regimens to full removal of the testicles, the organ that produces testosterone.
A newer technique termed High Intensity Focused Ultrasound (HIFU, Link to HIFU of Prostate) has been used to treat localized prostate cancer by killing tumor cells with heat. This was approved through the FDA in late 2015. With the addition of MRI fusion biopsy of the prostate, specific locations of prostate which contain cancer can be specifically targeted by HIFU. Targeted cancer treatment typically carries less risk of complications or side effects of surgery or radiation.
AUA Urology Care: Staying Healthy Through Prostate Cancer Treatment