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Prostate Cancer

Prostate cancer is a sensitive topic, but the physicians at The Urology Center of Colorado believe it’s a conversation worth starting. It is crucial for men to understand the risk factors connected to prostate cancer, as well as what options are available should they receive a prostate cancer diagnosis.

Prostate Cancer: Let's Start the Conversation

According to the American Cancer Society, prostate cancer is the most common cancer in American men, other than skin cancer. In fact, about one in eight men will be diagnosed with prostate cancer during his lifetime.

While prostate cancer is the second leading cause of cancer death in American men—behind only lung cancer—it can be cured if it is caught early. That’s why starting the conversation is the most important course of action for any man. 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.

Prostate Cancer Screening

What Is Prostate Cancer?

Most cancers are named for the organ in which the tumor originates. Almost all prostate cancers (99 percent) are of a type called adenocarcinoma—cancers that originate in glandular tissue.

At the time of diagnosis, it is important to know the extent of the tumor. The tumor is considered to be local when it is contained within the prostate gland itself. If it has spread to other organs or tissues, it is metastatic prostate cancer. When cancer cells break away from the original tumor, they can travel through lymph fluid, or blood, and metastasize to other places in the body, where another tumor may form. If prostate cancer cells spread to bones, the cancer is called metastatic prostate cancer in the bone.

Prostate Cancer medical illustration

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 the brain, bones, lungs, liver, or other organs. The primary treatment option for advanced prostate cancer is androgen deprivation therapy (ADT). 

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, 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 (Sipuleucel-T)
  • Xtandi (Enzalutamide)
  • Zytiga (Abiraterone + prednisone)
  • Taxotere (Docetaxel)
  • Jevtana (Cabazitaxel)
  • Xofigo (Radium 223)
  • More drugs will become available over the next few years

What Causes Prostate Cancer?

No one knows how or why prostate cancer starts, but there are several risks associated with the disease.

Risk Factors

Because of early detection and advanced treatment options, cure rates for prostate cancer are very high when the cancer is diagnosed at its beginning stage. There are often no symptoms of early stage prostate cancer, so screening and early detection are critical. The following considerations put men at higher risk for prostate cancer:

Age

As men age, their risk of getting prostate cancer increases. About six cases in 10 are diagnosed in men who are 65 or older, with the average age for diagnosis being about 66. It is rare for men under the age of 40 to be diagnosed with prostate cancer. By the time a man reaches the age of 80, he has an 80 percent chance of being diagnosed with prostate cancer, but this is unlikely to affect his life span.

Race/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 likely 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, but it may be due to socioeconomic, environmental, dietary, or other factors. Other ethnicities, such as Hispanic and Asian men, are less likely to get prostate cancer.

Genetics

Men with a family history of prostate cancer face a higher risk of 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.

Symptoms

In its early stages, prostate cancer often has no symptoms. When symptoms do occur, they can be like those of benign prostatic hyperplasia (BPH)—also called prostate gland enlargement. If you have any urinary problems, talk to your TUCC physician.

Symptoms of prostate cancer can include: 

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

Diagnosing Prostate Cancer

Why a Prostate Cancer Screening Is So Important

While these prostate cancer statistics can be scary, the survival rates for prostate cancer found in the local and regional stages can be nearly 100 percent. Early detection is the key to survival. 

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.

Prostate-Specific Antigen (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. A 2018 study demonstrates that a yearly PSA screening has the potential to be highly effective in reducing prostate cancer in men aged 55-75, when combined with vigilant surveillance and a healthy lifestyle.

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 to remove small pieces of prostate tissue for diagnosis. This procedure is done under local anesthesia in the office and takes approximately 15 minutes.

Prostate Cancer Grading

Should signs of prostate cancer be detected in the biopsy, your physician will send tissue samples to a pathologist. If prostate cancer is found, it will be scored using a method known as the Gleason grading system. 

Cancer cells are mutated healthy cells. As such, they appear different from typical cells. And the more different they appear, the more aggressive the cancer tends to be. The Gleason grading system uses the numbers 1 to 5 to score the most common (primary) and second most common (secondary) patterns of cells found in a tissue sample.

Grade 1

The cell tissue appears normal and healthy.

Grades 2-4

Cells scoring closer to 2 look closest to normal, representing a less aggressive cancer. Cells scoring higher are likely more aggressive.

Grade 5

Cells appear extremely different from healthy cells. 

Your total Gleason score includes both your primary and secondary numbers added together. The lowest possible Gleason score for cancer is 6, or a low-grade cancer. Gleason scores at 7 are medium-grade cancers. And scores between 8 and 10 are considered high-grade cancers.

Stages of Prostate Cancer

Stage refers to the extent or spread of the cancer. If doctors suspect the cancer has spread outside the prostate to other tissues or organs, they may order a CT scan (computed tomography scan), an MRI (magnetic resonance imaging scan), or a bone scan.

Stage 1

The cancer cannot be felt by digital rectal exam but is suggested by high PSA scores.

Stage 2

The cancer can be felt by digital rectal exam (DRE) and is confined within the prostate gland.

Stage 3

The cancer extends through the prostate capsule and into the seminal vesicles.

Stage 4

The cancer has invaded adjacent organ structures such as the bladder neck, rectum, or pelvic floor muscles.

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

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 modulated 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

Stereotactic body radiotherapy (SBRT) is a precise form of radiation therapy that uses an ultra-high dose 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. A robotic prostatectomy has many benefits, 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 urological conditions. TUCC surgeons are leaders in the urologic field, having performed thousands of robotic prostatectomies 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 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 guide prostate cancer patients through this treatment.

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. 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.

After Prostate Cancer Treatment

Once you have finished prostate cancer treatment, it is time to manage your side effects, create a long-term schedule with your doctor for future tests, and most importantly, move forward with your life. 

Follow-Up Care

The care you receive following your cancer treatment is as important as the treatment itself. While follow-up care depends on the risk group, as well as the type of treatment you received, there is a general track of care followed by physicians.

Patients who had surgery, radiation therapy, hormone therapy, or a combination of treatments will be scheduled for follow-up visits: 

  • Every 3 to 6 months for the first 5 years
  • Once a year after 5 years
  • For those participating in active surveillance, follow-up visits are usually scheduled every 3 to 6 months.

Follow-up visits will usually include a discussion regarding any side effects, as well as how you are coping both physically and emotionally. Physicians will ask about any problems with your bladder, bowel movements, or sex life. Physical examinations will occur, including a digital rectal exam (DRE).

Second Opinions

If you so choose, it is absolutely your right to seek a second opinion following a prostate cancer diagnosis. Should you seek a second opinion, it should be with different prostate cancer experts, such as another urologist, oncologist, or radiation oncologist.

Patient Stories

Dale’s Story

Dale Fitzsimmons has been a patient of Dr. Montoya’s at TUCC for a few years. After monitoring his prostate health, he decided that it was time to remove his prostate. Dr. Montoya was able to operate using the da Vinci robot at Swedish Medical Center 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 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 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. He shares his experience as a radiation therapy patient at The Urology Center of Colorado and his road to survivorship. He talks about how he realized that while prostate cancer is scary, it isn’t 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

TUCC radiation oncology patient and prostate cancer survivor Jim Hasemeyer describes his experience at TUCC and the impact it had on his treatment. His story begins when he learns about his diagnosis of prostate cancer, and he talks about his decision to have radiation oncology, as well as 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.

The Best Prostate Cancer Doctors in Colorado

TUCC is known across the country and around the Rocky Mountain region as a prostate cancer treatment center of excellence. From diagnosis to treatment and survivorship resources, we are committed to providing patients with technologically advanced, compassionate care.

FAQ

Prostate Cancer FAQs

  • Pain and/or a “burning sensation” when urinating or ejaculating
  • Frequent urination, especially during the nighttime
  • Trouble starting urination or stopping urination once in progress
  • Sudden erectile dysfunction
  • Blood in either urine or semen

It all depends on severity and the aggressiveness of the prostate cancer. Generally speaking, more than 95 out of 100 (more than 95 percent) will survive their prostate cancer for one year or more; more than 85 out of 100 (more than 85 percent) will survive their cancer for five years or more; and almost 80 out of 100 (almost 80 percent) will survive their cancer for 10 years or more.

Yes. When caught and treated early, prostate cancer can be cured. In fact, it is among the most successfully treated types of cancer when it’s detected and treated in the early stages.

This depends on the aggressiveness and stage of your prostate cancer. You and your physician will discuss your options and plan the best possible course of treatment.

Like all cancers, there is always the possibility that your prostate cancer will return. Follow-up care and surveillance is your first line of defense against the cancer coming back.

We’re here to help.

For appointments at any TUCC location, request an appointment online.