Prostate Cancer Treatment in Lubbock, TX

Symptoms of Prostate Cancer

With the early stages of prostate cancer there are often no symptoms. When symptoms do occur, they can be like those of an enlarged prostate or BPH. Prostate cancer can also cause symptoms unrelated to BPH. If you have urinary problems, talk with your doctors at Covenant Urology Group.

Although rare, symptoms of prostate cancer may include:

• Dull pain in the lower pelvic area
• Frequent urinating
• Trouble urinating, pain, burning, or weak urine flow
• Blood in the urine (Hematuria)
• Painful ejaculation
• Pain in the lower back, hips or upper thighs
• Loss of appetite
• Loss of weight
• Bone pain

Causes of Prostate Cancer

Although the exact cause is largely unknown, autopsy studies show 1 in 3 men over the age of 50 have some cancer cells in the prostate. Eight out of ten “autopsy cancers” found are small, with tumors that are not harmful.

Even though there is no known reason for prostate cancer, below are risks associated with the disease.

Age

As men age, their risk of getting prostate cancer goes up. It is rarely found in men younger than age 40. Damage to the DNA of prostate cells is more likely for men over the age of 55. Damaged or abnormal prostate cells can begin to grow out of control and form tumors.

Age is a well-known risk factor for prostate cancer. But, smoking and being overweight are more closely linked with dying from prostate cancer.

Ethnicity

African American men have, by far, the highest incidence of the disease. One in six African American men will get prostate cancer. African American men are more likely to get prostate cancer at an earlier age. They are also more like to have aggressive tumors that grow quickly, spread and cause death. The reason why prostate cancer is more prevalent in African American men is unclear.

Family History

Men with a family history of prostate cancer also face a higher risk of also developing the disease. A man is 2 to 3 times more likely to get prostate cancer if his father, brother or son had it. This risk increases with the number of relatives diagnosed with prostate cancer. The age when a close relative was diagnosed is also an important factor.

Smoking

Studies show prostate cancer risk may double for heavy smokers. Smoking is also linked to a higher risk of dying from prostate cancer. However, within 10 years of quitting, your risk for prostate cancer goes down to that of a non-smoker the same age.

Diet

Diet and lifestyle may affect the risk of prostate cancer. It isn’t clear exactly how. Your risk may be higher if you eat more calories, animal fats, refined sugar and not enough fruits and vegetables. A lack of exercise is also linked to poor outcomes. Obesity is known to increase a man’s risk of dying from prostate cancer. One way to decrease your risk is to lose weight and keep it off. In general, good eating habits, along with proper sleep, exercise and weight control may prevent disease occurring in the first place.

Diagnosing Prostate Cancer

Screening

“Screening” means testing for a disease even if you have no symptoms. The prostate specific antigen (PSA) blood test and digital rectal examination (DRE) are two tests that are used to screen for prostate cancer. Both are used to detect cancer early. However, these tests are not perfect. Abnormal results with either test may be due to benign prostatic enlargement (BPH) or infection, rather than cancer.

The American Urological Association (AUA) recommends talking with your healthcare provider about whether or not you should be screened.

PSA Blood Test

The prostate-specific antigen (PSA) blood test is one way to screen for prostate cancer. This blood test measures the level of PSA in the blood. PSA is a protein made only by the prostate and prostate cancers. Our providers will order a PSA to be completed and will schedule a lab draw at a nearby lab. Although there are other reasons for PSA elevation in a man (enlarged prostate, prostate infection, recent manipulation, intercourse prior to lab draw), if you experience a steady rise in sequential PSA evaluations, your doctor may recommend a prostate biopsy.

Prostate Biopsy

For a prostate biopsy, tiny pieces of tissue are removed from the prostate and looked at under a microscope. The pathologist is the doctor who will look carefully at the tissue samples to look for cancer cells. This is the only way to know for sure if you have prostate cancer.

The decision to have a biopsy is based on PSA and exam results. Your doctor will also consider your family history of prostate cancer, ethnicity, biopsy history and other health factors.

Prostate biopsy is done using an ultrasound probe to look at the prostate and guide the biopsy. You will be instructed to take an antibiotic starting the night before your procedure. You should continue this antibiotic for the recommended duration. Then, on the day of the biopsy, you will receive an injection of a second antibiotic to prevent infection after the biopsy. For the test, you will lie on your side as the probe goes into the rectum. First, your provider takes a picture of the prostate using ultrasound. Your healthcare provider will note the prostate gland’s size, shape and any abnormalities. The prostate gland is then numbed (anesthetized) with a needle passed through the probe. Then, the provider removes very small pieces of your prostate using a biopsy device. The amount of tissue removed depends on the size of the gland, PSA results and past biopsies. It takes anywhere from 3 days to 2 weeks to receive results from the pathologist. If cancer cells are found, the pathologist will assign a “Gleason Score” which helps to determine the severity/risk of the disease. You will then have a detailed discussion regarding your options for how to proceed if cancer is present.

After a biopsy, you may have blood in your urine and stool for 2-5 days. This should go away fairly quickly. You may have blood in the ejaculate for up to 3 months. If you have fever, chills or feel poor in general, please contact your doctor.

Uronav Fusion Biopsy

Due to advancing technology, we now have the power to sync high quality magnetic resonance imaging (MRI) with in-office ultrasound. This process is termed prostate fusion biopsy. The benefit of this technology is it combines multiparametric MRI of the prostate with needle guided biopsy to target regions of the prostate that appear more concerning. The procedure may be utilized with initial biopsy or as an additional option if the PSA continues to rise after initial biopsy in which the pathology is non-cancerous.

How to Interpret pathology results:

When prostate cancer cells are found in tissue from the core biopsies, the pathologist “grades” it. The grade is a measure of how quickly the cells are likely to grow and spread (how aggressive it is).

The most common grading system is called the Gleason grading system. With this system, each tissue piece is given a grade between three (3) and five (5). In the past, we assigned scores of one (1) and two (2). A grade of less than three (3) means the tissue is close to normal. A grade of three (3) suggests a slow growing tumor. A high grade of five (5) indicates a highly aggressive, high-risk form of prostate cancer.

The Gleason system then develops a “score” by combing the two most common grades found in biopsy samples. For example, a score of grades 3 + 3 = 6 suggests a slow growing cancer. The highest score of grades 5 + 5 = 10 means that cancer is present and extremely aggressive.

The Gleason score will help your doctor understand if the cancer is as a low-, intermediate- or high-risk disease. Generally, Gleason scores of 6 are treated as low risk cancers. Gleason scores of around 7 are treated as intermediate/mid-level cancers. Gleason scores of 8 and above are treated as high-risk cancers.

Prostate Cancer Treatment with Covenant Urology Group

Some cancers grow so slowly that treatment may not be needed at all. Others grow fast and are life-threatening, so treatment is usually necessary. Deciding what treatment you should get can be complex. Talk with your healthcare team about your options.

Results from other diagnostic tests will help your provider understand if the cancer can spread or recur (return) after treatment.

Before you decide what to do, you should consider how immediate and long-term side effects from treatment will affect your life, and what you’re willing to tolerate. Also, you should consider that you may try different things over time.

If you have time before you start treatment, consider your range of options. Get a second opinion from different prostate cancer experts. You may need to see another urologist, oncologist or radiation oncologist. Consider the expertise of your doctor before you begin. With more experienced surgeons, the risk of permanent side effects (like incontinence) is lower. Also, it helps to talk with other survivors and learn from their experiences.

In addition, try and get or stay healthy. Eating a well-balanced diet, maintaining a healthy weight, exercising and not smoking are all important factors when fighting prostate cancer..

Moreover, don’t ignore your emotions. Think about how you’re coping with this diagnosis. Many men who have prostate cancer feel worried, stressed and angry. You and those that care about you may need to consider professional counseling.

Treatment choices for localized prostate cancer (prostate cancer that has not spread to other parts of the body) include:

• Active Surveillance
• Surgical Removal
• Radiation Therapy

What is Active Surveillance?

Active surveillance does not actively treat prostate cancer. It monitors the cancer growth with regular PSA tests, DREs and periodic biopsies. A schedule for tests will be set with your provider. To help your provider do these biopsies, a multiparametric magnetic resonance imaging (pmMRI) exam might be done. With active surveillance, your doctor will know very quickly if the cancer grows. If that happens, then he will suggest next steps for you. At that point, radiation and surgery may be the best treatment options.

What are the Benefits, Risks and Side Effects of Active Surveillance?

Active Surveillance is best if you have a small, slow growing (low-risk) cancer. It is good for men who do not have symptoms. If you want to avoid sexual, urinary or bowel side effects for as long as possible, this may be the treatment for you. Active surveillance allows men to maintain their quality of life longer without risking the success of treatment (if and when it’s needed). Action is taken only if the disease changes or grows. For many men, they never need more aggressive treatments.

Active surveillance is mainly used to delay or avoid aggressive therapy. On the other hand, this method may require you to have several biopsies over time to track cancer growth.

Radical Prostatectomy (Surgery) for Prostate Cancer

There are two types of radical prostatectomy surgery:

Robotic Assisted Laparoscopic Radical Prostatectomy (RALP)

Robotic Assisted Laparoscopic Radical Prostatectomy (RALP) is the most common type of prostate cancer surgery done today. The surgeon is assisted with a robotic system that holds and guides the laparoscopic surgical tools and camera. It also allows the prostate to be removed through tiny ports placed in your belly. In experienced hands, RALP and retropubic prostatectomy (see below) have similar outcomes. There is also less blood loss with robotic surgery than other methods.

Retropubic Open Radical Prostatectomy

For this procedure, your surgeon will make a cut (incision) in your lower belly and remove the prostate through this opening. The entire prostate gland is removed. Your surgeon can assess the prostate gland and surrounding tissue at the same time, while reducing injury to nearby organs.

What to Expect After the Prostate is Removed

After the prostate has been removed, the urinary tract and the bladder are reconstructed. A catheter is passed through the urethra into the bladder to drain the urine while the new connections heal. One suction drains may be left in the pelvic cavity after surgery. They are brought through the lower belly to drain fluid from the wound. They help lower the risk of infection. The drains are usually removed before you are discharged from the hospital.

After surgery, your surgeon will review the final pathology report. Together you will make plans for next steps.

What Are the Benefits, Risks and Side Effects of Surgery?

The main benefit of a radical prostatectomy is the prostate with cancer is removed. This is true as long as the cancer hasn’t spread outside the prostate. Surgery also helps the healthcare provider know if you need more treatment.

The goal of surgery is to get a PSA value of less than 0.1 ng/mL for 10 years. Surgery is often a good choice if prostate cancer has not spread beyond the prostate.

Surgery always comes with risks. Some complications from surgery can happen early and some later. Bleeding or infection can happen with any major operation, so you will be monitored to prevent or manage these problems.

Not everyone has the same side effects for the same amount of time. With surgery (and with radiation therapy), there are two main side effects to consider: erectile dysfunction (ED) and urinary incontinence (a loss of urine control). For some men, surgery can relieve pre-existing urinary obstruction. Most men with these side effects find ways to manage them over time.

Erectile Dysfunction and Sexual Desire

All men have some form of erectile dysfunction after prostate surgery. Erectile dysfunction is the inability of a man to have an erection long enough for satisfying sexual activity. Nerves involved in the erection process surround the prostate gland, and they can be affected by surgery. They can also be affected by radiation treatment. These nerve bundles help control blood flow to the penis. The length of time ED lasts after treatment depends on many things, including how firm your erections are before treatment. Sometimes, it may take one year or longer to recover erectile function. In the meantime, your doctor may have ED treatment options for you.

It may surprise you to know that men are still able to have an orgasm (climax), even after a radical prostatectomy. An erection is not needed to climax. There will be very little, if any, fluid with an orgasm. In addition, you can no longer cause a pregnancy after surgery. This is because the prostate, seminal vesicles, and connections to the testicle were removed and the vas deferens was divided during surgery. Planning for fertility preservation in advance of surgery is an option for men who want to have children.

It is important to know that sexual desire is not lost with this surgery or radiation treatment. The exception to this is if hormones are also given as part of treatment, (usually given temporarily with radiation therapy).

Incontinence

Incontinence is the inability to control your urine. After prostate cancer surgery, you may experience one or more type of Incontinence.

Stress Incontinence – is urine leakage when coughing, laughing, sneezing or exercising. It is the most common type of urine control problem after radical prostatectomy.

Overactive Bladder (Urge Incontinence) – is the sudden need to go to the bathroom even when the bladder is not full because the bladder is overly sensitive. This type of incontinence is the most common form after radiation treatment.

Mixed Incontinence – is a combination of stress and urge incontinence with symptoms from both types.

Continuous Incontinence – is the inability to control urine at any time. It is not very common.

What is Radiation Therapy?

Radiation therapy uses high-energy rays to kill or slow the growth of cancer cells. Radiation can be used as the primary treatment for prostate cancer (in place of surgery). It can also be used after surgery if the cancer is not fully removed or if it returns.

Radiation therapy mostly involves photon beams or proton beams. Photon beams make up traditional x-rays. They carry a very low radiation charge and mass and can scatter to nearby health tissue. On the other hand, proton beams have more charge and heavy mass and can target deep tissue. A physician can direct proton radiation treatment to the specific site of cancer, minimizing damage to nearby healthy tissue.

Before you begin, it helps to ask your doctor(s) why they recommend one type of radiation therapy over another.

What are the Benefits, Risks and Side Effects of Radiation Therapy?

The benefit of radiation therapy is that it is less invasive than surgery. Whether the radiation is given externally or internally, this treatment is effective for early stage prostate cancer. Some need both types of radiation combined to treat their cancer.

The main side effects of radiotherapy are incontinence, erectile dysfunction and bowel problems. Urinary problems usually improve over time, but in some men they never go away. Erectile dysfunction, including impotence, is also possible. Many men feel tired for a few weeks to months after treatment.

If hormone therapy is used with radiation, sexual side effects are common. These can include loss of sex drive, hot flashes, weight gain, fatigue, decreased bone density and depression. Fortunately, these side effects can be managed and usually go away when hormone therapy is stopped.

It helps to work with your radiologist before you begin treatment to prepare for any known side effects in advance. Follow-up visits with your healthcare team will help you address any new problems.

Survivorship

Each year, more men are surviving prostate cancer and winning back their lives. Prostate cancer can be a manageable disease if caught early and treated appropriately.

Once you have finished treatment, it is time to manage your side effects. It is time to create a long-term schedule with your doctor for future tests. It’s also time to go on with your life.

Talk to your healthcare provider about the side effects or problems you have after treatment. You and your healthcare provider can decide your best next steps.

If you haven’t yet started treatment, consider the expertise of your doctor before you begin. With more experienced surgeons, the risk of permanent side effects, like incontinence, is lower.