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Prostate Cancer: Let's Start the Conversation

September is National Prostate Cancer Awareness month and it’s a good time to start the conversation about prostate cancer. The physicians at TUCC understand this is a sensitive topic, but it is very important that men understand their risks and discuss screening with their physicians. About 1 in 9 men will be diagnosed with prostate cancer, according to the American Cancer Society. It is the second leading cause of cancer death in American men, behind lung cancer. But, if it is caught early, prostate cancer has potential for being cured. TUCC is known across the country and around the Rocky Mountain region as a prostate cancer treatment center of excellence. From diagnosis, to treatment, to survivorship resources, we are committed to providing patients with technologically advanced, compassionate care. We are here as a resource for all your questions and we offer a free monthly support group with a TUCC urologist. We are here for you.

Dr. Juan Montoya – Prostate Cancer Screening Updates

RISK factors for Prostate Cancer

According to the American Cancer Society, one in seven American men will be diagnosed with prostate cancer during his lifetime. Because of early detection and advanced treatment options, cure rates for prostate cancer are very high when the cancer is diagnosed at an early stage. There are often no symptoms of early stage prostate cancer, so early detection and screening are critical. The following considerations put individuals at higher risk for prostate cancer:


Men ages 55 to 69


The mortality rate of African-American men diagnosed with prostate cancer is twice that of other men.


Men who have family members diagnosed with prostate cancer have a greater risk of developing the disease.

Why is Prostate Cancer Screening So Important?

The American Cancer Society estimates that more than 25,000 Coloradans will be diagnosed with cancer in 2018, and 3,190 of those will be men with prostate cancer. While these statistics can be scary, the survival rates for prostate cancer found in the local and regional stages can be nearly 100% (American Cancer Society). There are often no early signs or symptoms of prostate cancer. By the time symptoms are present, the cancer has often metastasized and treatment options, as well as positive outcomes, are more limited. Not all prostate cancer diagnoses are life threatening and not all prostate cancer diagnosis require treatment. The Prostate-Specific Antigen (PSA) test has served as an important tool to help men assess their risk for prostate cancer and then determine the appropriate next steps with their physician. The physicians at The Urology Center of Colorado support the recommendations of the American Urological Association (AUA) and the final recommendations by the U.S. Preventative Services Task Force that are in alignment with the AUA. These recommendations generally include consideration for screening:

  • men ages 55 to 69
  • African American men
  • men with a family history of prostate cancer who are at increased risk
CDC Prostate Cancer Deaths - Chart

Additional consideration for PSA testing may include the use of PSA for men who have voiding difficulties or symptoms that may be associated with prostate cancer. The largest study on prostate cancer screening, the European Randomized Study for the Screening of Prostate Cancer, published its updated findings in the March 2012 issue of the New England Journal of Medicine. This study demonstrated a 21 percent survival advantage to PSA screening for all patients and for those with the longest follow-up (over 10 years) this increased to 38 percent. This is consistent with experience in the U.S., where death rates from prostate cancer per 100,000 men have declined by nearly 40 percent over the last two decades. This graph outlines the decline in U.S. prostate cancer-related deaths from 1999 to 2015; since the onset of regular PSA screening. ( Moving forward, the PSA test will remain a tool for the diagnosis of prostate cancer. TUCC encourages all men to have an informed decision-making discussion with their primary care physician or urologist about the risks and benefits of prostate cancer screening. Click here for an infographic from the AUA>> Dr. Montoya, President of The Urology Center of Colorado, recommends this article for some quick and easy to understand facts about prostate cancer: 10 Prostate Cancer Truths That May Surprise You>>  ( If you have any questions about whether or not you should be screened for prostate cancer, a TUCC urologist would be happy to speak with you.

Diagnosing Prostate Cancer

There are often no symptoms of early-stage prostate cancer, so early detection and screening are critical.

Digital Rectal Exam (DRE)

This exam involves a physician assessing a patient’s prostate gland through the rectal wall to determine its size, shape and consistency. Cancerous tissue may be firm, hard, asymmetrical or stony.

PSA Blood Test

PSA (prostate-specific antigen) is a protein produced by prostate cells, which can be detected in the blood. A simple blood test can indicate if further evaluation for prostate cancer is necessary depending on the patient’s PSA level.

Transrectal Ultrasound and Prostate Biopsy

If a patient’s PSA is abnormal or if a firm area is noted on a DRE, an ultrasound and biopsy are performed to determine if cancer is present. A transrectal ultrasound is performed by inserting a probe into the rectum. The probe emits sound waves which allow the prostate to be visualized. Then, a biopsy needle is inserted along the ultrasound probe and small pieces of prostate tissue are removed for diagnosis. This procedure is done under local anesthesia in the office and takes approximately 15 minutes.

Treatment Options

The most advanced treatments for prostate cancer are at The Urology Center of Colorado. TUCC doctors provide the full spectrum of treatment options for prostate cancer patients and have access to the newest and most advanced treatments available today.


Brachytherapy is a form of radiation therapy administered over a short distance. In select prostate cancer patients, radioactive seeds may be implanted into the prostate. As they decay, radiation is released. The radiation dose is determined by the seed characteristics, the number of seeds implanted and the distribution of the seeds. The seeds remain in the prostate after the radiation dose is released. A combination of brachytherapy and external beam radiation therapy may be used in select patients.

External Beam Radiation Therapy

External beam radiation therapy utilizes a linear accelerator to generate a radiation beam toward the desired treatment area.Treatment planning and delivery techniques such as 3-D conformal planning and intensity modulated radiation therapy (IMRT), can be utilized to conform the dose of radiation to the planned treatment area. This allows higher doses to be administered to desired treatment areas and reduces the risk of exposure to surrounding normal tissues. Both techniques allow for better control of the radiation beam to the tumor with reduced side effects. TUCC also offers patients a more advanced form of IMRT, volumetric arc therapy (VMAT), on the Versa HD With conventional IMRT, the linear accelerator must rotate around the patient a few times to treat the cancerous tumor from several different angles. In contrast, VMAT delivers the radiation dose to the entire tumor in a 360-degree rotation within minutes. With image guided radiation therapy (IGRT), metallic markers are inserted into the prostate so that their position can be visualized on a daily basis. Daily assessment of the markers and subsequent adjustments enable therapists to deliver more accurate radiation treatments. This reduces the risk of radiation exposure to normal tissues and side effects.

Stereotactic Body Radiotherapy

SBRT is an ultra-high dose and precise form of radiation therapy used to eliminate prostate and kidney tumors. This type of treatment is known as hypofractionated radiation therapy, which delivers higher doses of radiation in a more targeted fashion over fewer treatments. Shortened treatment times can improve patient comfort, particularly for older patients who may find it difficult to remain in one position over extended periods of time. The risk of movement by patients who are receiving treatment near important structures is minimized, as well. TUCC is pioneering the use of SBRT in Colorado on the Versa HD. TUCC’s radiation oncologist, Thomas Pugh, M.D., is board certified in radiation oncology by the American Board of Radiology. He is the only radiation oncologist in Colorado to devote his entire practice to the treatment of urologic cancers and TUCC is one of the few centers in the U.S. to offer on-site, comprehensive radiation therapy for urologic cancers.

Radical Prostatectomy

Radical prostatectomy is a surgical procedure where the entire prostate gland is removed. The procedure is usually performed in the early stages of the disease to prevent the cancer from spreading throughout the body. Patients undergoing this procedure will be admitted to the hospital and typically have a one to three day hospital stay. A radical prostatectomy may be performed as an open procedure. However, the majority of radical prostatectomies are now performed robotically. There are many benefits to a robotic prostatectomy including shorter hospital stays, quicker recovery times, faster return to normal activity and work, less pain and decreased blood loss. Numerous medical studies have shown that a patient’s surgical outcomes with a robotic surgery are equal or superior to traditional open surgical procedures for the same urologic conditions. TUCC surgeons are leaders in the urologic field in performing robotic prostatectomies, having performed thousands since 2006.

Immunotherapy – Provenge

Provenge is a treatment therapy for men with advanced stage prostate cancer (cancer that has progressed or metastasized following surgery or hormone therapy). It is the first FDA-approved immunotherapy to mix cells from a patient’s own immune system with a protein that produces an immune response to prostate cancer. The Provenge treatment schedule includes three doses given two weeks apart. TUCC is one of the few urologic centers in the Rocky Mountain region to offer Provenge as a treatment option for men diagnosed with advanced stage prostate cancer.

Androgen Deprivation Therapy

Androgen Deprivation Therapy (ADT), a treatment therapy for prostate cancer that causes a man’s body to stop producing testosterone, is a very effective treatment for advanced or metastatic prostate cancer or to improve outcomes for men undergoing radiation therapy. There are multiple risks of this therapy that TUCC tries to minimize by adopting a teamwork approach to treatment. Under the leadership of a TUCC physician, a nurse practitioner, physical therapist, nutritionist and nurse specializing in male sexual medicine lead prostate cancer patients through this treatment.

Advanced Therapeutic Prostate Cancer Clinic

When prostate cancer has metastasized and is no longer responding to androgen deprivation therapy, it is considered castration resistant prostate cancer. TUCC’s on-site Therapeutic Prostate Cancer Clinic offers patients a dedicated team of nurses, urologists and medical oncologists to treat their advancing disease.

ATC - Advanced Therapeutics Clinic for Prostate Cancer

The Urology Center of Colorado is committed to caring for prostate cancer patients at all stages and we created the Advanced Therapeutics Clinic to provide specialized support for our advanced prostate cancer patients. Through state-of-the-art, individualized care the ATC provides our patients with a wealth of services including:

  • Urologists who specialize in treating advanced prostate cancer. These physicians have in-depth knowledge of the disease and new treatment options.
  • Prostate cancer nurses, including an advanced prostate cancer nurse navigator, to help patients understand treatments, coordinate care and access resources.
  • The opportunity to have a panel of health care providers review patient cases in order to provide personalized and advanced care.
  • Comprehensive care focusing on individualized patient needs and wishes.
  • The latest clinical research studies.

Dr. Ragan, Co-Director of ATC shares the benefits for patients of the specialized clinic.

What is advanced prostate cancer?

Prostate cancer is defined as “advanced” when it spreads outside the prostate gland. It is considered metastatic if it has spread to: bones, brain, lungs, liver or other organs. The primary treatment option for advanced prostate cancer is androgen deprivation therapy (ADT). Historically known as hormone therapy, ADT works to reduce the level of male hormones – androgens – in the body, as these hormones stimulate the growth of prostate cancer cells. However, at some point prostate cancer can become resistant to androgen deprivation. This is signaled by a rise in prostate specific antigen (PSA) levels with very low serum testosterone. This rise in PSA levels indicates that the cancer is now advanced prostate cancer (APC). There are several treatment options available to manage advanced prostate cancer. Some of the current treatment methods include Provenge (Sipulecuel-T); Xtandi (Enzalutamide); Zytiga (Abiraterone + prednisone); Taxotere (Docetaxel); Jevtana (Cabazitaxel); and Xofigo (Radium 223). More drugs will become available over the next few years.

Patient Stories

Dale Fitzsimmons Shares His Journey Through Prostate Cancer and Robotic Surgery

Dale Fitzsimmons has been a patient of Dr. Montoya’s at TUCC for a few years. He decided after a few years of watchful waiting that it was time to remove his prostate. Dr. Montoya was able to operate using the da Vinci robot at Swedish hospital and Dale says he didn’t even feel like he had surgery.

Kelsey’s Story

Kelsey Canady was diagnosed with prostate cancer in 2009. Kelsey tells his story, he describes his road to survivorship and the assistance he received from the physicians and staff at TUCC. Dr Mark Jones talks about the increased risk for prostate cancer in the African American population and reiterates the importance of seeking medical care early. Kelsey had a robotic radical prostatectomy with the DaVinci, a procedure that TUCC has performed more of than anyone else in the Rocky Mountain region. Kelsey was back to walking on the treadmill a mere 40 hours after his surgery.

Richard’s Story

Richard Forman, a hockey player and prostate cancer survivor, talks about his diagnosis and his treatment for prostate cancer at TUCC. He was diagnosed with prostate cancer in 2009 and he shares his experience as a radiation therapy patient at The Urology Center of Colorado and his road to survivorship. He talks about his realization that Prostate Cancer, while sounding scary, was not a death sentence. Richard highlights that he was able to go through the treatment on his lunch hour and did not even need to miss work.

Jim’s Story

In this edition of TUCC Patient Storytellers, TUCC radiation oncology patient and prostate cancer survivor Jim Hasemeyer describes his experience at TUCC and the impact it had on his treatment. He starts his story when he learned about his diagnosis of  prostate cancer, he talks about his decision to have radiation oncology, and talks about the people at TUCC who helped him through this experience and had him leave with tears of joy on the last day of treatment at TUCC.

We’re here to help.

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