Prostate Cancer

What is prostate cancer?

Prostate cancer occurs in the prostate gland, which is a small walnut-shaped gland located below the bladder in the men, and is responsible for producing the majority of the fluid involved in semen. Prostate cancer is one of the most common cancers diagnosed in men.

What are the risk factors for prostate cancer?

Some of the common risk factors for prostate cancer include advanced age, family history of prostate cancer, African-American race, and certain genetic mutations such as BRCA 2. Lifestyle factors such as a high-fat diet and obesity may also increase the risk.

How is prostate cancer diagnosed?

Prostate cancer is typically diagnosed through a combination of medical history, physical examination, a PSA blood test, and imaging tests (such as ultrasound or MRI). A biopsy of the prostate gland is usually required for a definitive diagnosis.

What are the symptoms of prostate cancer?

In its early stages, prostate cancer often does not cause noticeable symptoms. As the disease progresses, symptoms may include difficulty urinating, blood in the urine or semen, pain or discomfort in the pelvic area, and bone pain.

What are the treatment options for prostate cancer?

The treatment options for prostate cancer depend on various factors including the stage and aggressiveness of the cancer, the patient’s age and overall health, and personal preferences.

Active surveillance

Active surveillance is a strategy where men with low-risk prostate cancer are closely monitored through regular check-ups, PSA tests, MRI imaging, and occasional biopsies. Treatment is deferred unless there are signs of cancer progression or patient preference. It is an option for men who may not require immediate treatment and wish to avoid potential side effects.

Robotic radical prostatectomy

Surgical removal of the prostate gland is done most commonly with the Da Vinci robot. During the procedure, the prostate gland is removed along with the nearby lymph nodes. Patients typically remain in the hospital for one night and are discharged with a catheter for about one week. Risks of the procedure include bleeding, infection, and damage to nearby structures. Side effects of the surgery include urinary incontinence (involuntary leakage of urine), and erectile dysfunction.

Radiation therapy

Radiation therapy uses high-energy beams to kill cancer cells. It can be delivered externally or internally. Common options include external beam radiation therapy, where radiation is directed at the prostate gland from outside the body using a machine— the treatment is typically administered over several weeks with daily sessions. Brachytherapy involves the placement of small radioactive seeds directly into the prostate gland— these seeds emit radiation and gradually deliver the treatment over time.
Risks of radiation include scatter to nearby organs such as the bladder and bowels. Toxicity to the bowel can be prevented by a procedure called SpaceOar. Long term effects to the bladder include urinary frequency and urgency, and blood in the urine, which can sometimes be challenging to manage. Radiation also poses a small risk of developing bladder cancer in the future. Radiation also can cause erectile dysfunction.

Focal Therapy

Focal therapy is a newer treatment for prostate cancer, and includes the procedures HIFU and TULSA. During focal therapy, high intensity ultrasound waves ablate the area of the prostate gland where the cancer is located. While targeting the location of the cancer, this minimizes the risks associated with surgery including erectile dysfunction and urinary incontinence. Focal therapy is typically reserved for low risk to intermediate prostate cancer, and disease that has not spread outside of the prostate capsule. It is performed in the operating room under anesthesia, and occasionally patients may need more than one session to adequately treat the prostate. Following the treatments, close follow up is required to ensure adequate cancer control. This typically includes PSA levels, MRI imaging, and biopsies.