Prostate Cancer

Cancer of the prostate is the most common type of cancer among American men. It is estimated that one out of every 10 American men will develop prostate cancer before the age of 85. The risk of developing prostate cancer greatly increases with age. It rarely occurs in men younger than 40.

The prostate is a male gland normally the size of a walnut. It secretes a milky fluid that is part of the semen needed for ejaculation. The prostate gland lies at the base of the penis, just below the urinary bladder and in front of the rectum. It surrounds the first inch of the urethra, the tube that carries urine from the bladder.

The cause of prostate cancer remains unknown. Several factors associated with a higher rate of prostate cancer, however, have been identified. The risk of developing prostate cancer increases with age. A family history of prostate cancer and a brother or a father also doubles once chances of getting prostate cancer there may be evidence that a high-fat diet or cigarette smoking is associated with developing prostate cancer.

Signs and Symptoms

In the very early stages of prostate cancer, there usually are no symptoms. When symptoms do develop, they vary according to the size and location of the tumor, and are often the same as those for benign prostate conditions. It is much more likely that any symptoms indicate benign prostate enlargement, known as benign prostatic hypertrophy (BPH), infection, or other conditions rather than cancer. Still, any symptoms should be checked by a healthcare provider, because only a healthcare provider conducting the proper tests can determine for sure whether the condition is cancerous or benign. Symptoms of prostate problems include:

• Weak or interrupted urine flow.
• Inability to urinate.
• Difficulty in starting or stopping urination.
• Need to urinate frequently, especially at night.
• Blood in the urine.
• Painful or burning urination.
• Continuing pain in lower back, pelvis, or upper thighs.

Early Detection

Every man over the age of 40 should have a digital rectal examination (DRE) as part of his regular annual physical checkup.  In addition to the DRE, it is recommended that men 50 and over who have at least a 10-year life expectancy have an annual prostate specific antigen blood test (PSA).  If there is a family history of prostate cancer in a first-degree relative (father or brother) then PSA screenings should begin at age 40.

If the individual has a more distant family history of prostate cancer or if the individual is African-American, screenings should begin at age 45.  If either digital rectal examination or prostate specific antigen blood testing is abnormal, further evaluation including a biopsy should be considered as 1 out of 5 men in the US will be diagnosed with prostate cancer.  Annual screenings can lead to early detection, and early detection can diagnose prostate cancer when it is most treatable.

For Screening information, click here.

Newly Diagnosed Prostate Cancer Patients

Most prostate cancers are found after routine screenings and are often caught at an early stage before symptoms begin to appear. If your physician suspects you may have prostate cancer based on your screening results, they may run a series of tests to confirm your diagnosis. This may include a digital rectal exam or a blood test to detect prostate-specific antigens(PSA).   A prostate biopsy would be performed to confirm the diagnosis.

Receiving a prostate cancer diagnosis can be overwhelming. You may be feeling stress and anxiety over what comes next. Our team at Missouri Cancer Associates and Urology Associates of Central Missouri are here to support you and provide you with the information you need to find the right path for your treatment.

Who Will Treat My Prostate Cancer?

You will usually see a urologist first when a suspicion that prostate cancer might exist.  The urologist will perform a prostate ultrasound and biopsy to confirm the diagnosis.  You may have received a diagnosis of prostate cancer from your primary care, for which you should be referred first to a urologist to discuss your diagnosis and options for treatment.  Ultimately, you may see a team of cancer experts that include a urologist, a medical oncologist, and a radiation oncologist.

A urologist is an oncologist who specializes in treating cancers of the urinary organs, including the prostate, and is the only member of the team who is a surgeon as well.  Your urologist can recommend surgical therapy, if indicated, but also can use medications such as hormone therapy in the treatment of prostate cancer.

A medical oncologist treats cancers with medications, and will usually treat prostate cancers that have become more advanced.  These treatments may include hormone therapy, chemotherapy, or immunotherapy as needed in some, but not all, prostate cancer patients.

A radiation oncologist specializes in treating cancers with radiation therapy.  This treatment uses high energy x-rays to eliminate cancer cells or radiotheranostics to treat advanced prostate cancer.

While the treatment of prostate cancer usually begins with the urologist, these clinicians all work together to develop the treatment path that is right for you.

Urologists, who are urologic oncologists with regard to prostate cancer, medical oncologists, and radiation oncologist, all represent medical specialties focused on the treatment of cancer with various modalities (surgery, medications, and radiation).  These specialists are certified by the American Board of Urology, the American Board of Internal Medicine, and the American Board of Radiology, and they possess a wealth of specialty training and experience with expert knowledge of innovative treatment methods.  They collaborate to discuss individual patient cases and review treatment options to ensure that each patient is given the best possible chance of a successful outcome.

Treatment of Prostate Cancer

The treatment that is right for you depends mainly on your age, the stage of the cancer, the grade of the tumor (Gleason score), the number of biopsy tissue samples that contain cancer cells, your symptoms, and your general health.

Your urologist can explain the details of your prostate cancer, and cannot describe your treatment choices, the expected results of each, and the possible side effects, as well as the appropriate inclusion of a medical oncologist or radiation oncologist, is needed. You and your doctors will work together to determine which treatments are needed and the timing of those treatments so you can have the best possible outcome.

Not Every Patient Starts Treatment Right Away Surveillance

You may choose active surveillance if the risks and possible side effects of treatment outweigh the possible benefits. Your doctor may suggest active surveillance if you’re diagnosed with early-stage prostate cancer that is slow growing. Your doctor may also offer this option if you are older or have other serious health problems.

Choosing active surveillance doesn’t mean you’re giving up. It means you’re putting off the side effects of surgery and/or radiation therapy. Having surgery or radiation therapy is no guarantee that a man will live longer than a man who chooses to put off treatment.

If you and your doctor agree that active surveillance is a good idea, your doctor will check you regularly (every 3 to 6 months). After about one year, your doctor may order another biopsy to check the Gleason score. You may begin treatment if your Gleason score rises, your PSA level starts to rise, or you develop symptoms. You could receive surgery, radiation therapy, or another approach.

Active surveillance avoids or delays the side effects of surgery and radiation therapy, but this choice has risks. For some men, it may reduce the chance to control cancer before it spreads. Also, it may be harder to cope with surgery or radiation therapy when you’re older.

If you choose active surveillance but grow concerned later, you should discuss your feelings  and options with your doctor.

Prostate Surgery

Surgery is an option for men with early (Stage I or II) prostate cancer. It is sometimes an option for men with Stage III or IV prostate cancer. The surgeon may remove the whole prostate or only part of it.Surgery can be performed to remove the prostate if the cancer is found in its early stages.

Surgery may help prevent further spread of the cancer to other parts of the body. da Vinci Prostatectomy is the #1 choice for treatment of localized prostate cancer in the United States, and is rapidly being chosen by more men, as well as their doctors, worldwide. da Vinci Prostatectomy is a minimally invasive, robotic-assisted surgical procedure that removes the cancerous prostate gland and related structures.

If the surgeon removes the prostate (prostatectomy), they may remove some or all of the lymph nodes in the pelvic area to check for cancer cells. This is called a pelvic lymph node dissection.If prostate cancer cells are found in the lymph nodes, the disease may have spread to other parts of the body.

If cancer has spread to the lymph nodes, the surgeon does not always remove the prostate and may recommend other types of treatment.

There are several types of surgery for prostate cancer. Each type has benefits and risks. You and your doctor can talk about the types of surgery, and which may be right for you.

Radiation Therapy

When the time comes for treatment the cancer care team at Missouri Cancer Associates will develop a plan that’s right for you.Missouri Cancer Associates uses a team approach for the consultation, simulation, treatment planning, treatment delivery, quality assurance and follow-up care that you will receive.

Depending on the stage of your prostate cancer Staging cancer and your overall health, your physician may recommend radiation therapy, which uses high-energy x-rays to eliminate cancer cells. Radiation therapy may be used as a primary treatment for cancer contained in the prostate gland. It can also be used:

• In combination with androgen deprivation therapy (ADT) that reduces or prevents the body from producing testosterone and other male hormones. ADT can help shrink tumors, slow their growth, and reduce symptoms.
• After surgery to treat any remaining cancer cells or any recurrence of cancer.
• To slow the growth of cancer cells and treat symptoms in more advanced stages of prostate cancer.

Immunotherapy

PROVENGE is the first and only FDA-approved, personalized (made from your own immune cells) immunotherapy for advanced prostate cancer (metastatic castrate-resistant prostate cancer [mCRPC]) in men who do not take prescription medicine for cancer-related pain.

• Your immune system is your body’s natural defense. PROVENGE is designed to work with your immune system to seek out and attack your prostate cancer cells. PROVENGE is made from your own cells. By activating immune cells already in your body, PROVENGE personalizes the fight against your prostate cancer.
• PROVENGE is clinically proven to help extend life in certain men with advanced prostate cancer.

Chemotherapy

Chemotherapy may be used for prostate cancer that has spread and no longer responds to hormone therapy.

What is Chemotherapy?

Chemotherapy is a treatment that uses powerful drugs to kill cancer cells or inhibit their growth. While it is not typically the first line of treatment for prostate cancer, it can be an effective option for advanced stages or when other treatments are not sufficient.

When is Chemotherapy Used?

Chemotherapy for prostate cancer is often used in the following situations:

• Advanced Prostate Cancer: When prostate cancer has spread beyond the prostate gland and is no longer responding to hormone therapy.
• Hormone-Resistant Prostate Cancer: In cases where the cancer no longer responds to hormone treatments.
• After Other Treatments: As an adjunct treatment following surgery or radiation therapy if the cancer persists or recurs.

Types of Chemotherapy Drugs

1. Docetaxel (Taxotere)

• One of the most commonly used chemotherapy drugs for prostate cancer, docetaxel helps to stop cancer cells from dividing and growing.

2. Cabazitaxel (Jevtana)

• This drug is often used if docetaxel has stopped being effective. It works similarly to docetaxel but is used for different stages or types of resistance.

3. Mitoxantrone (Novantrone)

• Less commonly used today, this drug can be an option for palliative care, helping to relieve symptoms and improve quality of life.

What to Expect During Chemotherapy

Treatment Schedule

• Chemotherapy is usually administered in cycles, which consist of a treatment period followed by a rest period to allow your body to recover. The exact schedule will depend on the specific drugs used and your overall health.

Administration

• Chemotherapy drugs can be given intravenously (IV) in a clinic or hospital setting, or orally in the form of pills. Your healthcare provider will guide you on the best method based on your treatment plan.

Side Effects

• While chemotherapy is effective in targeting cancer cells, it can also affect healthy cells, leading to side effects such as nausea, fatigue, hair loss, and a weakened immune system. Your healthcare team will work with you to manage these side effects and provide supportive care.

Monitoring and Support

• Regular monitoring during chemotherapy will include blood tests and check-ups to assess your response to treatment and manage any side effects. Supportive care services, including nutritional guidance, medications for symptom relief, and counseling, are available to help you through this process.

Before Your First Visit

When you are diagnosed with cancer, there are certain questions you should ask your doctor, so you will better understand your illness and what to expect during treatment. Review the following questions with your doctor at your first appointment.

Your Care Team

Our dedicated oncology team is here to support you through every stage of chemotherapy. From personalized treatment plans to compassionate care and support services, we are committed to helping you achieve the best possible outcomes.

If you have any questions about chemotherapy for prostate cancer or would like to schedule a consultation, please contact us.