Our doctors provide leading-edge expertise and advanced therapies to treat prostate cancer at all stages. Whenever possible, we use the most minimally invasive treatments to preserve your function and quality of life.
About Prostate Cancer
Prostate cancer is the most common cancer in men. Many people have prostate cancer without knowing it and will not experience any symptoms in their lifetime. However, when prostate cancer spreads, it can quickly become life-threatening.
What is prostate cancer?
Prostate cancer develops in the prostate gland, a walnut-sized organ that sits deep in the pelvis. The prostate is located right beneath the bladder and in front of the rectum. It produces semen that nourishes and transports sperm. Most prostate cancers grow slowly and stay within the prostate gland at first. Some grow aggressively and spread quickly to other parts of the body.
What causes prostate cancer?
It’s not yet clear what causes prostate cancer. Prostate cancer happens when genetic material in cells changes abnormally, and the cells grow out of control. When enough of these abnormal cells build up, they can form a tumor in the prostate that may be felt during an exam or seen on imaging.
We do know that certain risk factors increase your likelihood of getting prostate cancer. These include increasing age, family history, and race.
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Prostate Cancer Symptoms
In its early stages, prostate cancer does not cause symptoms. As the cancer grows or spreads to other parts of the body, you may experience:
- Bone pain
- Pain in the pelvic area
- Unexplained weight loss
Symptoms such as a need to urinate frequently or trouble urinating are not usually signs of prostate cancer. Rather, these symptoms suggest an enlarged prostate. An enlarged prostate often develops with age and can be treated with medications.
Prostate Cancer Types
Almost all prostate cancers are adenocarcinomas (a cancer that develops in glands). Rarer types of prostate cancer include sarcomas, small cell carcinomas, and transitional cell carcinomas.
Doctors also classify prostate cancer based on its location:
- Localized prostate cancer is contained in the prostate.
- Metastatic prostate cancer has spread beyond the prostate to other parts of the body.
Prostate Cancer Risk Factors
Risk factors are things that increase your chance of having prostate cancer. Prostate cancer risk factors include:
- Age: As you get older, your likelihood of developing prostate cancer increases.
- Family history: You face an increased risk if you have a close relative with prostate cancer (father or brother), particularly prostate cancer that developed at an early age. Having a strong family history of breast, ovarian, colorectal, or pancreatic cancer also increases your risk of prostate cancer.
- Race: African Americans are at a greater risk for aggressive prostate cancers and developing prostate cancer at a younger age.
Prostate Cancer Screening
Prostate cancer screening can lead to early identification and treatment to prevent aggressive cancers from spreading. Screening is especially important if you have a family history of prostate cancer.
Prostate cancer screening tests include:
- Digital rectal exam (DRE): Your doctor inserts a gloved, lubricated finger inside your rectum to feel your prostate for abnormalities in texture, shape, or size.
- Prostate-specific antigen (PSA) test: This blood test evaluates the amount of a prostate-specific substance in your bloodstream. A high PSA can be a sign of prostate cancer, although other non-cancerous conditions such as infection, inflammation, or an enlarged prostate may also increase the PSA level.
Prostate Cancer Stages
When your care team determines your diagnosis, they also assess how advanced the cancer is, also called its stage. Your prostate cancer stage depends on how quickly the tumor has grown, whether the cancer spreads, and where it spreads. To help assign a stage, pathologists who specialize in analyzing cancer tissue examine the structure of cancer cells under a microscope.
We use a system called TNM staging to describe how much prostate cancer has grown or spread within the body. In TNM staging, each letter describes an aspect of the cancer:
- Tumor size, which tells your doctor how large the tumor has grown and how likely it is to have spread
- Nodes, meaning whether cancer is present in nearby lymph nodes and, if so, how may
- Metastasis, meaning whether the cancer has spread elsewhere in the body, such as the bones.
After each letter, an “X” or a number tells you about each aspect. “X” means the aspect can’t be measured, while the numbers describe the extent of the cancer. Higher numbers indicate more advanced cancer. T ranges from TX-T4, N ranges from NX-N1, and M ranges from MX-M1. For example, you may see a stage written as T1N0MX.
Pathologists also assign a Gleason score to prostate cancer. They add up subscores of specific cancer characteristics for a total Gleason score ranging from 6 to 10. A low Gleason score (6) means the prostate cancer is not aggressive, suggesting a better outcome. A Gleason score of 7 indicates a cancer with intermediate aggressiveness. A higher Gleason score (8-10) means the prostate cancer is more aggressive, suggesting a poorer prognosis.
Cancer Stages 1-4
Prostate cancer can also be assigned a stage from Stage 1 through Stage 4. These groups take into consideration TNM staging, Gleason score, and PSA levels to describe cancer in a simpler way. A lower stage means the cancer is confined within the prostate gland, and the Gleason score and PSA levels remain low. Higher stages describe more aggressive cancer that has spread. In these cases, the Gleason score and PSA levels are high.
We start your care by establishing or confirming a diagnosis. An accurate diagnosis is critical to ensuring that you receive the right treatment. Our team consists of experienced urologists (doctors who specialize in prostate cancer diagnosis using a procedure called a biopsy), radiologists (doctors who specialize in diagnosing disease with imaging technology) and pathologists (specialists who analyze tissue samples) who focus solely on prostate cancer.
Wherever you are in the diagnosis process, your doctor and care team will work closely with you to determine which tests you need to complete your diagnosis. Diagnostic tests may include:
To understand your cancer completely and precisely, your doctor may schedule you for different imaging tests for the prostate. If you have received imaging elsewhere and received abnormal results, we may perform additional follow-up tests.
A radiologist will interpret your imaging results to understand the precise location and size of a tumor. Imaging tests may include:
- Multiparametric magnetic resonance imaging (MRI)
- Prostate-Specific Membrane Antigen (PSMA) PET/CT scan or PET/MRI scan
- Transrectal ultrasound
If your imaging or other screening tests show that you may have prostate cancer, you may need a prostate biopsy. This short procedure takes small samples of cells from your prostate to check for cancer. We use the least invasive biopsy procedure possible, minimizing discomfort while still obtaining enough cells to make a diagnosis.
We offer several options for prostate biopsy, including:
- Core (transrectal) biopsy: We most frequently perform a core biopsy. This procedure uses a thin, hollow needle to take a tissue sample from your prostate. Your doctor numbs the area and accesses your prostate through the wall of your rectum.
- Transperineal biopsy: With this procedure, your doctor accesses your prostate through your perineal skin (the area between the scrotum and anus) rather than going through your rectum. Your rectum may contain bacteria that can enter your prostate on the needle, which poses a risk to people with a history of infections or a weakened immune system. By avoiding your rectum, this approach significantly reduces your risk of infection.
- Image-guided biopsy: We specialize in this approach (also called targeted prostate biopsy) for both transrectal and transperineal biopsies. Your MRI images show us the exact location of abnormal tissue. Guided by ultrasound imaging during the procedure, we target that abnormal tissue for a more accurate biopsy.
Blood lab tests can provide a variety of information about your blood cells, organ function, and the spread of cancer. During a blood test, a provider draws your blood so it can be tested at a lab. The results help your doctor establish a diagnosis and plan your course of prostate cancer treatment.
At any stage of prostate cancer, our team of specialists can help. Learn more about our advanced prostate cancer diagnosis and treatment options.
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