Prostate Cancer Resources for Patients

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 The Prostate and Prostate Cancer Screening

What is the prostate?

What is the prostate?

The prostate is part of the male reproductive system and its job is to make semen.  It is roughly the size of a walnut and sits right below the bladder, surrounding the urethra which is the tube that carries urine from the bladder out through the penis.

About 1 in 9 men will be diagnosed with prostate cancer.  Prostate cancer is a type of growth in the prostate cells, that is malignant. The good news is that localized prostate cancer is treatable. Most men who become diagnosed early can live long meaningful lives.

Who needs to be screened for prostate cancer?

Who needs to be screened for prostate cancer?

Screening is recommended if you are a man and meet one of the following criteria:
  • Between 55-69 years old
  • African American and over 40 years old
  • Have a family history of prostate cancer

This recommendation is from a guideline issued by the American Urological Association.

For a short video on if prostate cancer screening is right for you, please see below:

Download an informational document on prostate cancer screening

How is screening performed for prostate cancer?

How is screening performed for prostate cancer?

Two ways to help detect prostate cancer early are a prostate-specific antigen (PSA) blood test and digital rectal examination (usually performed by a doctor in the exam room). These tests are not perfect and abnormal results with either test may be due to an enlarged prostate rather than cancer.

What is the prostate-specific antigen, or PSA, blood test?

  • PSA is a blood test that detects prostate-specific antigen levels in the blood.
  • An elevated PSA might indicate prostate cancer, but other diagnoses such as an enlarged prostate can also cause PSA to to elevated.
  • Checking a PSA may help detect prostate cancer early.

For a short video on PSA testing, please see below:

What is a Digital Rectal Exam (DRE)?

  • A DRE is when a healthcare provider examines the prostate by placing a lubricated, gloved finger in the rectum after asking the patient to either bend over or lay curled on his side on an exam table.  The doctor feels for an abnormal shape or thickness to the prostate.
  • This test cannot detect early cancer by itself and should be done with a PSA test.


What are risk factors for prostate cancer?

What are risk factors for prostate cancer?

Although the cause of prostate cancer is unknown, there are many factors that can increase a man’s risk for the disease.  Some of these include:

 Age

  • Prostate cancer risk increases with age
  • Rarely found in men younger than 40

Race/Ethnicity

  • Some ethnic groups have a higher risk for prostate cancer
  • African American men are more likely to get prostate cancer at an earlier age and have aggressive tumors
  • 1 in 6 African American men will get prostate cancer
  •  Other ethnicities like Hispanic and Asian men are less likely to get prostate cancer

Family History

  • Men are 2-3 times more likely to get prostate cancer if their father, brother, or son had prostate cancer
  • Risk further increases with the number of relatives diagnosed with prostate cancer
  • A relative’s age at diagnosis is also an important factor

Smoking

  • Studies have shown that smoking may double your risk for prostate cancer
  • Smoking is linked to a higher risk of dying from prostate cancer
  • Within 10 years of quitting, a man’s risk of prostate cancer goes down to that of a non-smoker the same age

Geographic Location

  • Prostate cancer diagnoses and deaths vary, but higher rates are seen in North America and Northern Europe
  • The higher rate of diagnoses may be due to better or more frequent screening procedures, heredity, poor diets, lack of exercise, and environmental exposures

Diet

  • Diet may affect prostate cancer risk
  • Risk may be higher if patients eat more calories, animal fast, refined sugar, and not enough fruits or vegetables
  • Lack of exercise is linked to poor outcomes in patients after treatment

Understanding Prostate Cancer Symptoms and Diagnosis

What are the symptoms of prostate cancer?

What are the symptoms of prostate cancer?

In the early stages, prostate cancer often has no symptoms.  When symptoms do occur, they can be like those of an enlarged prostate called benign prostatic hyperplasia (BPH). Prostate cancer can also cause symptoms unrelated to BPH. If you have urinary problems, talk with your healthcare provider about them.

Symptoms of prostate cancer can be:

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

How is prostate cancer diagnosed?

How is prostate cancer diagnosed?

  • Prostate cancer is diagnosed by a prostate biopsy
  • During a prostate biopsy procedure, tiny pieces of tissue are removed from the prostate and examined under a microscope by a pathologist, a doctor who will look at the tissue specifically for cancer cells
  • The pathologist provides a biopsy report to the doctor which includes useful information, to determine:
    • Is there cancer?
    • If there is cancer, a Gleason Score will be assigned. (see “What is a Gleason Score?” tab to learn more)

 

For a short video on what you should know about a prostate biopsy, please see below:

What is the Gleason Score?

What is the Gleason Score?

After a positive biopsy, a Gleason Score is assigned to each tissue sample to decide the risk of the disease and to make an accurate diagnosis.  The Gleason score and staging grades how quickly the cells are likely to grow and how likely they are to spread (how aggressive the cancer is)

Prostate cancer can be described as pattern 3, 4, or 5 (with 3 being the less abnormal and 5 being more advanced).  The Gleason Score is typically written as Pattern 1 + Pattern 2 = Overall Gleason Score.

Urologists also use the percent of the tissue that is cancerous to determine prostate cancer risk and help determine appropriate treatment.

Staging

Cancer stage is also measured and describes where the cancer is within the prostate, how extensive it is, and if it has spread to other parts of the body.  Staging prostate cancer is done by a DRE, biopsy, and special imaging studies.  These staging imaging tests are generally done for men with a Gleason grade 7 or higher and a PSA higher than 10. The system used for tumor staging is called TNM staging which stands for Tumor, Nodes, and Metastasis.

  • Tumor (T) Stage: Determined by biopsy or DRE results
  • Nodes (N) Stage: Determined by CT Scan
  • Metastasis (M) Stage: Determined by Bone Scan

Understanding Prostate Cancer Treatment Options

How do I make a decision about treatment?

The Choice of Treatment for Prostate Cancer is Based on a Shared Decision Between You and Your Urologist

The choice of treatment for prostate cancer depends on factors related to the severity and extent of the cancer, as well as, your preferences related to the benefits and downsides (or side effects) of each of the treatments. Talk to your doctor and your family as you consider what treatment option is best for you.

Making a Shared Decision

The TRUENTH app, created by the Movember Foundation, allows you to answer questions based on your preferences and receive tailored education about treatment options that can help prepare you for a conversation with your doctor about treatment options that are best suited for you.

The Michigan Urological Surgery Improvement Collaborative (MUSIC) is currently piloting the use of this app in some of our practices. If your urologist in Michigan enrolls you in the Personal Patient Profile-Prostate (or “P3P”), then we ask that you access this tool via the direct e-mail invitation or in the urologist’s clinic. Otherwise, you can click the link below to try the shared decision-making tool.

Shared decision-making tool

Download Personal Patient Profile-Prostate (P3P) Brochure

Please find a video briefly on treatment options available for men with localized prostate cancer. To learn more details about each treatment option, select the appropriate tab below.

What treatments did patients similar to me choose? (App)

If you want to find out the treatments men with similar biopsy results chose, use our treatment options app.
Treatment Options

What is active surveillance?

Active Surveillance

Active surveillance does not actively treat prostate cancer and includes active monitoring of the disease for patients with very low or low-risk prostate cancer. Regular monitoring occurs every 6 to 12 months and often includes repeat biopsies or imaging, PSA blood test, and DRE.  Active Surveillance may be a good option for men with no cancer symptoms, slow-growing prostate cancer, older, or who have other serious health issues.  The goal of surveillance is to allow men to keep their quality of life when the cancer is growing slowly. If things change, men may choose to transition to a treatment to more aggressively treat the cancer.

Benefit:

  • No sexual, urinary, or bowel side effects like other treatments have
  • Costs less than more active treatment
  • Very few treatment-related risks or side effects

Risk:

  • Potential for repeat biopsies
  • Frequent follow-ups with doctors for blood, rectal, and other tests
  • Cancer could grow and spread between follow-up visits, this could make the cancer harder to treat over time

What are the different phases of active surveillance?

The Phases of Active Surveillance

If you opt for Active Surveillance (AS), physicians will monitor your condition to ensure the cancer remains unlikely to cause significant health risks.

In order to simplify this process and make AS more approachable, experts in Michigan have broken surveillance down into two distinct phases. The remainder of this document will provide information about the phases of ActiveSurveillance, so you gain a broad overview of what can be expected throughout the course of AS.

1. Consideration Phase

This is a period where you and your doctor will consider all of the information available at the time of diagnosis to determine whether AS is appropriate for you. Specifically, in this phase, you and your doctor will consider what is known about your prostate cancer in the context of your general health and age to determine if AS is appropriate.

It is likely that additional testing will be needed in this phase to better understand the aggressiveness of your cancer before starting AS. The additional tests obtained in this phase will likely include some combination of a repeat biopsy, a MRI test, and/or genetic tests of the prostate cancer tissue. This process typically should be completed within 6 months of your initial diagnosis.

2. Surveillance Phase

If you and your doctor, after confirmatory testing, decide AS is the path that you want to pursue, then you will be routinely monitored to ensure the cancer does not change and pose a greater health risk over time. Repeat tests designed to monitor cancer risk will be recommended intermittently. Tests during this phase may include PSA blood tests, rectal examination to feel for prostate cancer, repeat biopsies of the prostate, magnetic resonance imaging tests (MRI), or genetic tests of the prostate cancer tissue.

Two different pathways with varied intensity of testing are outlined below. Based on disease characteristics, your preferences, and your doctor’s opinion, there is some variation in how aggressive repeat testing will be during the surveillance phase. Together with your doctor, you will decide on the pathway that is most appropriate for your situation.

High-Intensity Surveillance Plan

This involves the more rigorous course of testing, with both blood tests and digital rectal exams recommended every six months. A biopsy or MRI is recommended every 12 months.
Download a High Intensity Surveillance Patient Calendar

Low-Intensity Surveillance Plan

This course of monitoring requires less frequent testing: blood tests (to measure PSA level) and digital rectal exams every 12 months and a biopsy or MRI about every three years.
Download a Low Intensity Surveillance Patient Calendar

If I start active surveillance, how long will I stay on it?

Transitions to Treatment or Watchful Waiting

When you start active surveillance, you may wonder how long you will be on surveillance. The answer to this is different for every man. However, it is possible for everyone on surveillance that at some point continued surveillance may no longer be the ideal management option. In such a situation, a discussion of a transition in management may become necessary.

Possible Reasons for a Transition

  1. If clinical tests indicate your prostate cancer may be behaving more aggressively, it might become necessary for you and your physician to discuss transitioning to treatment.
  2. Even if there has been no change in the cancer’s aggressiveness, some patients may prefer to discontinue AS because of personal preferences, like anxiety over the monitoring process or resistance to having to undergo repeated tests. In that case, you may also consider moving to active treatment.
  3. In some cases, less frequent testing than recommended while on AS may make sense. For instance, if your cancer is deemed very unlikely to cause harm, or other health problems arise,a discussion of less frequent testing may be warranted. This strategy of less frequent testing is typically referred to as Watchful Waiting.

Regardless of the circumstances, a decision on how long to undergo active surveillance and whether to proceed with it is ultimately your choice and can be made in consultation with your doctor.
Download Active Surveillance Patient Brochure

What should I know about surgical removal of the prostate (also known as radical prostatectomy)?

Radical Prostatectomy

Radical prostatectomy is a treatment choice that involves surgically removing the prostate from the body.   Surgery may be a good option for men with: stages T1 or T2 prostate cancer (cancer confined to the prostate), men healthy enough to handle a major operation and live 10 years or more, your personal wishes as some men may want their cancer completely remove.

Benefit:

  • If your cancer is confined to the prostate (has not spread outside the prostate) the chance of cure with surgery alone at 10 years is more than 90%
  • Can help your doctor know if you need more treatment

Risk:

  • Potential for surgery-related risks, including bleeding or infection
  • Not everyone has the same side effects for the same amount of time. How serious your side effects may be is based on your age, health, and the type of surgery you select. See below, for side effects you may deal with

Side Effect:

  • Erectile Dysfunction
  • Urinary Incontinence
  • Change in penis length
  • Bleeding
  • Blood Clot
  • Changes in orgasm
  • Infertility

Information on surgery for prostate cancer

How will I feel if I have my prostate surgically removed?

How will I feel if I have my prostate surgically removed?

Every patient’s journey is a little different, but some of the common side effects following this surgery are leaking of urine and problems with erections.

To understand your journey and help measure how your recovery is progressing, your urologist may ask you to provide information about your urinary and sexual symptoms both before and at several time points after surgery. This program is called the Patient Reported Outcomes, or PRO, program. Here is a brochure with more information: Download Patient Reported Outcomes (PRO) Brochure

What can I do to prevent problems after surgical removal of the prostate?

What can I do to prevent problems after surgery?

Urinary symptoms are common after surgery. Pelvic rehabilitation, sometimes called “pelvic rehab therapy”, may help prevent or decrease urinary symptoms (such as urine leakage). Some doctors refer all patients to pelvic rehab after surgery. Other doctors make referrals to pelvic rehab based on how you feel after surgery. We recommend that you discuss with your urologist whether you may benefit from pelvic rehab prior to undergoing surgery.

Another common side effect following surgery is abdominal pain, which most commonly a result of an ileus. An ileus is a form of severe constipation where you are unable to pass gas or have a bowel movement. We recommend reading through our ileus pamphlet to learn how an ileus can be prevented or treated, which may potentially save you a trip to the emergency room. Download a Patient Educational Ileus Pamphlet

What should I know about radiation therapy?

Radiation Therapy

Radiation therapy uses high-energy beams to kill or slow the growth of cancer cells. Radiation may be a good option for men whose: cancer is only in the prostate, cancer has spread outside of the prostate and is using hormone therapyhad their prostate removed but are at risk for it returning, prostate cancer has returned, or who has advanced prostate cancer and wish to reduce symptoms.

Benefit:

  • No surgery
  • Less invasive
  • Effective for early-stage prostate cancer

Risk:

  • Main side effect is incontinence and bowel problems (additional side effects are listed below)
  • Fatigue/Tiredness

Side Effect:

  • Incontinence
  • Bowel Problems
  • Erectile Dysfunction
  • If radiation and hormone therapy are used together the following side effects can occur:
    • Loss of sex drive, hot flashes, weight gain, feeling tired, decreased bone thickness, and depression
    • Once hormone therapy is stopped, they most often go away

What are the different types of radiation therapy?

Types of Radiation Therapy

Radiation is either given externally (outside the body) or internally (inside the body). You may get help from both types. The type offered will depend on the stage and grade of cancer, your total health and life expectancy, and goals for treatment.

External Beam Radiation Therapy (EBRT):

Aimed beam of radiation sent from outside to the prostate, delivered in daily doses for a certain number of weeks.

Standard EBRT:  
  • Uses protons (x-rays)
  • Photon based external based x-rays may damage nearby healthy tissue; causing side effects
  • May be able to use an alternative newer machine to allow surrounding healthy tissue to be protected
Proton Beam Therapy:
  • Uses a machine called a cyclotron  to send  high energy protons deeper into body tissue
  • Does not go beyond the tumor; nearby tissue is not changed; fewer side effects
Stereotactic Body Radiation Therapy:
  • Large doses of proton radiation to exact areas, like the prostate, with advanced imaging
  • The course of treatment is a few days

Internal Radiation Therapy:

Radioactive material placed directly into the prostate using a hollow needle.

LDR Brachytherapy:
  • A thin needle is used to insert radioactive “seeds” (size of a rice grain) into the prostate
  • These “seeds” send out radiation, killing prostate cancer cells nearby. They are left in the prostate even after treatment
HDR Brachytherapy:
  • Radiation placed into your prostate using a slightly larger hollow needs to insert a thin catheter
  • The catheter remains in until treatment is complete, removed once treatment is complete

Download an informational document on radiation therapy

What should I know about chemotherapy to treat recurrent or advanced prostate cancer?

Chemotherapy:

Chemotherapy uses drugs to kill cancer cells and is given either intravenously (with a needle in the vein) or by mouth over several months. It is often used with other treatments.  Chemotherapy may be a good option for men with: advanced stage of prostate cancer, cancer that has spread outside of the prostate, advanced prostate cancer that no longer responds to hormone therapy.

Benefit:

  • Kills rapidly growing prostate cancer cells

Risk:

  • Can also kill healthy cells
  • Side effects depend on your health, the drug, dose, and how long treatment lasts (see a list of some potential side effects below)

Side Effect:

  • Fatigue/Tired
  • Nausea and Vomiting
  • Hair loss
  • Change in taste and touch(feeling numb)
  • Increased chance of infections

Most of these side effects can be managed, and lessen once treatment ends.

Download an informational document on chemotherapy

 Immunotherapy:

Immunotherapy is designed to boost the body’s immune system to fight cancer cells to slow cancer cell growth in advanced prostate cancer. While the potential for immunotherapy is exciting, clear successful results have not yet been shown.

What should I know about hormone therapy?

Hormone Therapy (Androgen Deprivation Therapy – ADT):

Androgen deprivation therapy (ADT) uses drugs to block or lower testosterone as well as other male sex hormones that fuel cancer to grow. It can help slow down the cancer and ease symptoms, but it cannot cure the cancer. Hormone therapy may be a good candidate for men with:  advanced cancer, cancer that has come back after treatment, pursuing radiation therapy. Over time, prostate cancer can “learn” how to outsmart this treatment. If it does, other treatments may be needed to manage your cancer.

Benefit:

  • Cancer can shrink or stop growing

Risk:

  • Has been linked to heart disease and increased risk of heart attack
  • May lead to diabetes
  • For a list of side effects, please see below

Side Effect:

  • Hot flashes
  • Anemia
  • Decreased mental capacity
  • Fatigue/Tiredness
  • Osteoporosis (loss of bone strength)
  • Swollen and tender breasts
  • Loss of sex drive and erectile dysfunction

Download an informational document on hormone therapy

What is watchful waiting? How is it different from active surveillance?

Watchful Waiting

Watchful waiting is a less involved system of monitoring the cancer without treating it. Unlike active surveillance, it does not involve regular biopsies, imaging blood tests, or DREs . Watchful Waiting may be a good option for men who: do not want therapy, cannot have therapy, have other medical conditions that would be affected by more aggressive treatment.

Benefit:

  • No treatment-related risks, complications, or side effects
  • Low cost

Risk:

  • Cancer could grow and spread between follow-up visits, this could make the cancer harder to treat over time

Additional information

What questions should I ask my doctor?

Questions to Ask Your Doctor

The following questions may be helpful to ask your doctor to better understand your diagnosis and available treatment options that are best suited for your prostate cancer care.

Diagnosis: 

  • What is my Gleason score, the grade and the stage of my cancer?
  • How aggressive is this cancer? Is it likely that my cancer will spread? (Has it spread?)
    • If the cancer has spread, where?
  • Do I need more tests now?
  • What type of schedule should I be on to track changes with this cancer?

Treatment:

  • What are my treatment choices (including surveillance, localized therapy or systemic therapy)?
    • What are the advantages and disadvantages of each?
    •  What are the time considerations and costs for each?
    • What is your experience with each option?
    • Would I have to go somewhere special to get treatment?
  • Why do you recommend one type of therapy over another?
  • What are the chances for each treatment to manage my cancer and for how long?
  • What are the chances of complications from each treatment?
    • What kinds of complications are likely from each?
    • When are they likely to occur?
  • What if I choose no treatment (watchful waiting or active surveillance)?
    • How often will I need to take follow-up tests?
  • If I use hormone therapy, what type do you suggest and why?
    • How would we manage potential side effects from hormone therapy?
  • What are the chances that my cancer will return after treatment – and if it does, what options for treatment do I have then?
  • Can we develop a short and long-term plan for my care?
  • Is there someone you would recommend for another opinion?

Side Effects & Recovery:

  • What are the potential side effects of the treatment you recommend: both immediately and in the long term?
  • How can I manage side effects?
    • How would we manage potential urinary dysfunction and for how long?
    • How would we manage potential erectile dysfunction and for how long?
    • What other side effects should I consider?
  • How much recovery time will be required after surgery?
  • Will I need to take time off from work or other activities to manage treatment and treatment side effects?

What can I expect as a caregiver during the prostate cancer journey?

Please find caregiver videos of those whose loved ones underwent prostate cancer care, below.

Video 1: What makes an impact in care for prostate cancer patients?

 

Video 2: How to balance self-care while caring for your loved one with prostate cancer?