Prostate Cancer Treatment
Prostate cancer is very common among men. Each year, more than 250,000 men are diagnosed in the United States, and 1 in 3 men older than 70 has a trace of the condition in their body.
Although most patients do not die from prostate cancer, the condition still ranks as the second leading cause of cancer death among American men.
“Prostate cancer that's just in the prostate is generally not very dangerous,” says Paul L. Nguyen, MD, a Mass General Brigham radiation oncologist. “But, if it spreads to other places, it can sometimes lead to death.”
Dr. Nguyen is vice chair for clinical research at Brigham and Women’s Hospital. He explains prostate cancer risk factors, signs and symptoms, and treatment options.
What causes prostate cancer?
The prostate is a walnut-sized organ found in men. It connects the bladder and several reproductive organs to the penis.
Like any organ in the body, the prostate constantly makes new cells as old ones die. The body creates new cells by copying healthy, existing cells, almost like a photocopier. Unfortunately, mistakes can happen during this process. Sometimes the photocopier loses control of how many copies it prints, or smudged ink alters the appearance of a photo.
Similar errors happen when creating new cells. These errors, called mutations, may trigger cells to reproduce too rapidly or produce cells unable to function. When normal prostate cells transform and behave abnormally, prostate cancer occurs.
According to Dr. Nguyen, doctors don’t know the exact causes of prostate cancer. However, some factors put men at a higher risk for the condition. These include:
Family health history: Some men inherit mutations. If you have family members who’ve had prostate cancer, you’re more likely to develop the condition.
Race: African American men are diagnosed at a rate more than 60% higher than white men.
How is prostate cancer diagnosed?
Doctors feel for any unusual lumps or bumps on the prostate during a routine prostate exam. A prostate-specific antigen (PSA) test also helps doctors diagnose the condition.
During the test, a doctor draws blood from a patient and tests for microscopic proteins unique to the prostate. These proteins, called antigens, serve as “breadcrumbs” for prostate cells. If the prostate grows abnormally fast, it leaves behind more breadcrumbs than usual, which can leak into the bloodstream.
Prostate cancer is not the only condition capable of elevating PSA levels, however. According to the National Institutes of Health, harmless conditions, such as an inflamed or enlarged prostate, can cause PSA levels to spike.
“A PSA test can’t diagnose cancer by itself,” says Dr. Nguyen. “If a score is suspiciously high, we need to figure out why by ordering more tests.”
Doctors concerned by a PSA test can order two additional tests to determine a diagnosis.
MRI (magnetic resonance imaging): Imaging the prostate can reveal tumors on its surface.
Needle biopsy: Extracting a tiny tissue sample from the organ allows doctors to assess for any cancerous cells.
Prostate cancer signs and symptoms
While many cancers produce symptoms, prostate cancer hardly produces any. In fact, symptoms of prostate cancer may only occur in more advanced stages of the condition.
A few common signs of advanced prostate cancer include:
Difficulty urinating, or controlling when to urinate
Blood in urine or semen
Pain in the hips, back, or chest
Prostate cancer stages
Prostate cancer exists in one of several stages:
Stage 1: The cancer is low risk and doesn’t spread to other parts of the body. It stays in the prostate.
Stage 2: The cancer has not yet spread to neighboring structures. However, it is more aggressive and presents an intermediate risk to a patient’s health.
Stage 3: The cancer has become high risk because it has either spread beyond the prostate capsule, or has caused a very high PSA, or is of an aggressive grade, making it more difficult to cure.
Stage 4: The cancer has spread to the lymph nodes or bones, making it much more difficult to cure, or not possible to cure at all.
Is prostate cancer curable?
The stage of someone’s prostate cancer typically determines the best treatment option.
The good news? Most prostate cancers do not spread beyond the prostate.
Prostate cancer treatments
Dr. Nguyen recommends most of those with stage 1 prostate cancer to keep a close eye on the cancer. He urges them to monitor any changes by undergoing:
PSA tests every 6 months
MRIs or needle biopsies every few years
Those with stage 2 or stage 3 prostate cancer often consider two standard treatment options:
Surgery: If the cancer has not spread too far, a doctor can remove part of the prostate or the entire organ.
Radiation: Doctors use radiation to destroy a tumor internally.
Hormone therapy has emerged as another treatment option for the condition in its early and advanced stages. At high enough levels, certain hormones, like testosterone, can fuel the growth of cancer cells. Hormone therapy offsets these levels to prevent the cancer from growing any further.
Doctors might use hormone therapy in tandem with radiation. They can also use it to treat recurrence, or a return of the cancer.
Multidisciplinary care
A diverse team of specialists can tailor treatment to meet a patient’s needs. Personalized care keeps a patient’s quality of life front-of-mind before and after treatment.
Typical care teams now consist of:
A urologic surgeon
A radiation oncologist
A medical oncologist
“It's very important to have a multidisciplinary consultation,” says Dr. Nguyen. “The best thing to do is to see all three doctors so you can get all the treatment options and make the decision that's best for your individual needs.”
The future of prostate cancer care
Dr. Nguyen believes prostate cancer outcomes will continue to improve. Several developments fuel his optimism.
Early testing
Catching cancer in its earliest stages often produces the best results. But not all men need to undergo testing for prostate cancer at an early age. Shared decision making between a doctor and patient can help drive the process.
The American Cancer Society recommends that men with average or high risks of prostate cancer discuss testing with their doctor at an earlier age than usual. The organization suggests that men with an average risk begin the discussion at age 50. If considered high risk, begin the discussion at 45.
High-risk patients include African American men and anyone with a father or brother diagnosed with prostate cancer at a young age.
Advanced treatments
Mass General Brigham doctors continue to improve radiation options for prostate cancer. A few of the most cutting-edge techniques include:
Proton beam radiation: Proton beam therapy uses high-energy, focused “beams” to target the prostate with more precision than standard radiation therapy.
MRI-guided radiation: MRI imaging helps doctors target cancers with standard radiation. The imaging keeps radiation focused on cancers that can move from a set location, keeping healthy tissue protected from harmful exposure.
Stereotactic radiation: Patients receive higher doses of radiation in fewer visits.
Brachytherapy: Radioactive seeds implanted into the prostate deliver a concentrated dose of radiation.
Equitable care
As part of its United Against Racism initiative, Mass General Brigham launched the Prostate Cancer Outreach Clinic (PCOC) to address inequities in prostate cancer care. PCOC is a joint effort between the Brigham and Women’s Hospital Division of Urology and the Massachusetts General Hospital Department of Urology.
The center assists patients with navigating the complex prostate cancer care process, their transportation needs, and active follow up, in addition to providing multidisciplinary screening, diagnosis, and treatment. Patients and clinicians review every aspect of their care plan together, and patients are encouraged to ask questions at every step.
