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Prostate Cancer Treatment and Services Overview

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Care Plan

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First steps to consider

  • Prostate cancer should be diagnosed and treated by a team of urologists and radiation and medical oncologists (cancer specialists).
  • See a healthcare provider if you have any of these symptoms or history:
    • Unexplained weight loss or fatigue
    • Excruciating back or bone-related pain
    • Difficulties urinating
    • Blood in your urine

Emergency Care

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Go to the ER if you have any of the following symptoms:

  • Unable to urinate
  • Blood and clots in your urine
  • Sudden muscle weakness

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When to see a healthcare provider

You should see a healthcare provider if you have any signs of prostate cancer. If your prostate screening tests had any abnormal results, you should be seen by a team of doctors, which includes a urologist and cancer specialists.

Getting diagnosed

Prostate cancer screening is part of the yearly physical for men as they age. Most men will begin screening at age 55, although those at high risk might begin earlier. Screening typically stops at age 69.

The screening includes a blood test called a prostate specific antigen or PSA and a digital rectal exam (DRE). If one or both tests are abnormal, you will be referred to a urologist (who specializes in urinary tract and genital health).

At your visit, the urologist will ask you about your health, give you a physical exam (including a DRE), and look at your PSA levels. Taking into account your age, medical and family history, DRE exam, and PSA levels, they will determine if you are at risk of prostate cancer, and may recommend a prostate biopsy.

The biopsy will determine if you have prostate cancer. For the procedure, a prostate ultrasound probe is placed in the rectum and biopsies of the prostate are taken. You may be prescribed antibiotics before and sometimes after the procedure to prevent infection from the procedure.

After the biopsy, the samples are sent to the lab where a pathologist will look for prostate cancer.

What to expect from your visit

Based on the findings of your prostate cancer tests, your doctors will determine how advanced your cancer is, and that will help them decide which, if any, treatments you need.

Sometimes, prostate cancer is very low-grade and slow-growing and may not need to be treated, but this is based on very specific findings.

If you have low-grade prostate cancer your doctor may decide to carefully monitor you. This is called active surveillance and means you will likely have regular follow-up blood tests, rectal exams, and in some cases repeat biopsies of the prostate. This will help detect whether the cancer is progressing.

If your cancer is more advanced, or has spread to other parts of your body, you will work with a team of doctors to develop a treatment plan that may include radiation, chemotherapy, hormone therapy, surgery, and other procedures.

Your provider may prescribe different medications to help with your symptoms, like Flomax to help with urination, and pain medications.

Types of prostate cancer treatment

The type of treatments available depends on the severity and how much the cancer has spread.

Localized prostate cancer

The cancer is only within the prostate. Treatment options include:

  • Active surveillance: There is no actual treatment and is for people with low grade or low risk prostate cancer. The cancer is closely watched with tests 1–2 times a year.
  • Prostatectomy: This is surgery that removes the prostate. It may be done as open surgery or with laparoscopy (tools are inserted through small incisions).
  • High-intensity focused ultrasound: A procedure that uses ultrasound to heat and destroy prostate cancer cells.
  • Cryoablation: A procedure that uses very cold gasses to freeze and destroy the prostate. This is often only for people with a recurrence after radiation or who are too high risk for surgery or radiation.
  • External beam radiation therapy: This targets radiation to the prostate to treat the cancer cells.
  • Brachytherapy: This places radioactive seeds into the prostate to treat prostate cancer.

Local/regional spread

The cancer moves outside of the prostate but only spreads to the area around the prostate. Treatments include:

  • Prostatectomy: Depending on the extent of the spread, the prostate and the surrounding lymph nodes may need to be surgically removed.
  • Radiation: Primarily external beam radiation directly to the prostate, but sometimes radiation is delivered to the whole pelvis. This can be used alone or in combination with brachytherapy.
  • Androgen deprivation therapy (ADT): Medication that stops the body from producing androgens.

Spread to other organs

The cancer spreads beyond the prostate and local area to other organs and parts of the body. Treatments include:

  • Androgen deprivation therapy (ADT): Medication that stops the body from producing androgens.
  • Chemotherapy: Uses medications to kill cancer cells. These are given through  IV infusion.

Types of providers

  • A primary care provider to screen for prostate cancer
  • A urologist to determine your risk of prostate cancer and what diagnostic procedures you need. They will also be part of your treatment team if you have prostate cancer.
  • A radiation oncologist who provides special, localized radiation to treat prostate cancer
  • A medical oncologist who manages and provides systemic chemotherapy if the cancer has spread to other parts of the body.
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