Prostate Cancer

According to the American Cancer Society, prostate cancer is second only to skin cancer as the most common cancer affecting American men today. In fact, about one out of nine men will be diagnosed with prostate cancer in their lifetime. Annually, close to 175,000 men are diagnosed with prostate cancer in the United States. If you are diagnosed, knowing where to go for care can make all the difference.

While certain prostate cancers can spread quickly, most grow slowly. This underscores the importance of regular screenings and early detection – both of which drastically improve the chance of recovery.

At Memorial Hermann, our experienced team of affiliated urologists, radiation oncologists, radiologists, medical oncologists, pathologists and cancer specialists is available across Greater Houston to provide you with advanced care from diagnosis to treatment. Everything we do is focused on getting you back to living a healthy and productive life.

The prostate is a small gland located deep within the groin between the bladder and rectum. Found only in males, it plays an important role in the reproductive process by providing the seminal fluid that sperm from the testes use to travel and survive.

The size of the prostate can increase as men age, which can cause a host of bladder and liver issues. When cells in the prostate begin to rapidly divide and grow out of control, this often leads to the development of prostate cancer.

The overwhelming majority of prostate cancers are classified as adenocarcinomas. These are malignant tumors that develop in glandular structures and epithelial (tissue that forms the outer layer of the body’s surface) tissue. However, other types of prostate cancers do occasionally appear, including:

• Sarcomas
• Small cell carcinomas
• Neuroendocrine tumors (other than small cell carcinomas)
• Transitional cell carcinomas

In many cases, prostate cancer may cause no noticeable symptoms. On the other hand, what may seem like prostate cancer is often attributable to other problems like an enlarged prostate. To be safe, urologists affiliated with Memorial Hermann recommend contacting your doctor if you experience any of the following:

• Pain during urination
• Frequent urination, especially at night
• Pain in the upper thighs, hips or lower back Inability to urinate
• Blood in the semen or urine
• Painful ejaculation

It's not known what exactly causes prostate cancer, but on a basic level, cancer is caused by DNA mutations in an otherwise normal cell. These mutations are often passed down by our parents, which is why one of the most common risk factors for cancer is a person's family history. The following are just a few potential risk factors for prostate cancer:

• Age: Prostate cancer is rare for men younger than 40, but the risk rises dramatically after age 50. About 6 in 10 cases of prostate cancer are found in men older than 65.
• Race/ethnicity: Prostate cancer occurs more often in African-American men and Caribbean men of African ancestry when compared to men of other races. The reasons for these racial and ethnic differences are unclear at this time.
• Geography: Prostate cancer is most common in North America, northwestern Europe, Australia and the Caribbean islands. The reasons for this have not been confirmed, though it is believed that lifestyle differences, such as diet, may play a role.
• Family history: Having a father or brother with prostate cancer more than doubles a man’s risk of developing prostate cancer.

If you meet any of the above criteria, consider speaking with your doctor about a prostate cancer screening.

Memorial Hermann provides the following screening exam options for detecting potential prostate cancers:

• PSA Test: Approved by the FDA in 1986, a prostate-specific antigen (PSA) test measures the level of a specific protein produced by cells in the prostate gland. This simple blood test is often paired with a digital rectal exam (DRE) to test men who are not exhibiting symptoms for prostate cancer.
• Digital Rectal Exam: Most prostate cancers develop in what is called the peripheral zone near the rectum. A digital rectal exam (DRE), which involves the examination of the prostate by inserting a lubricated, gloved finger into the rectum to feel for abnormalities, is a common and useful prostate screening test.
• Biopsy: If your PSA results or other factors point to the possibility of cancer, your doctor may request a biopsy of the prostate. This involves the surgical removal of a small section of the prostate in order to accurately test for cancer cells.
• Advanced Multiparametric MRI (mpMRI): This advanced imaging test combines several imaging techniques to provide a more complete picture of the prostate. In addition to the standard MRI view, an mpMRI measures chemical concentrations, evaluates blood flow to tissue and the nature of the cells themselves.
• UroNav MRI-TRUS Fusion Biopsy: By fusing MRI images of the prostate taken before biopsy with ultrasound-guided images captured during the biopsy, UroNav allows physicians to more precisely target abnormal areas identified by mpMRI during biopsy. A sophisticated algorithm maintains the fusion of MRI and ultrasound images, even during movement.

Prostate Cancer Screening and Prevention

Current recommendations from the American Cancer Society, the American College of Radiology and the American Urological Association suggest that the following men should seriously consider scheduling annual prostate-specific antigen (PSA) and digital rectal exams:

• Age 50 for men who are at average risk of prostate cancer and are expected to live at least 10 more years.
• Age 45 for men at high risk of developing prostate cancer. This includes African Americans and men who have a first-degree relative (father, brother, or son) diagnosed with prostate cancer at an early age (younger than age 65).
• Age 40 for men at even higher risk – typically those with more than one first-degree relative who had prostate cancer at an early age.

At present, there is no known foolproof method for preventing the occurrence of prostate cancer. The best course of action to lower your lifetime risk is through maintaining a healthy diet and exercise regimen as well as scheduling regular prostate cancer screenings with your doctor.

A diagnosis of prostate cancer can be confusing, oftentimes leaving men with more questions than answers. What are my treatment options? Which therapy is right for me? What is the prostate cancer prognosis?

Memorial Hermann Cancer Centers bring together cancer-focused specialists in one location to talk with you directly and answer any of your questions. This allows you and your team of cancer specialists to work together in the planning and delivery of your treatment. The team includes:

• Surgeons
• Radiotherapists
• Medical oncologists
• Dietitians
• Nurse navigators (cancer nurse specialists)

Unlike many other types of cancers, there are numerous options for prostate cancer treatment. There is no one definitive course of treatment, and often, a combination of therapies can be the best option.

Traditional and Robotic Surgery

Memorial Hermann offers a broad range of surgical options as an effective method for treating cancer that is confined to the prostate. Once cancer is confirmed, either through a biopsy or pelvic lymphadenectomy (surgical removal of lymph nodes from the pelvic), your doctor may recommend surgical removal of your prostate, surrounding tissues and area lymph nodes. This is known as a radical prostatectomy, and it is available as both a traditional and robotic-assisted surgical procedure.

At Memorial Hermann, our experienced surgeons currently provide three surgical approaches for prostate cancer treatment. The stage of cancer, along with your individual medical history, will determine the most effective approach for your specific situation. The three surgical approaches include:

• Retropubic Prostatectomy is a traditional surgical procedure where an incision is made in the abdominal wall and the prostate is removed. Area lymph nodes may also be removed.
• Perineal Prostatectomy is a similar traditional surgical procedure, but instead the incision is made in the perineum (area between the scrotum and anus) and the prostate is removed. Area lymph nodes may also be removed.
• Robotic-Assisted Radical Laparoscopic Prostatectomy is a new, less invasive approach to prostate removal surgery. This robotic-assisted procedure  allows surgeons to perform a very precise, nerve-sparing operation using only five small incisions. By using this advanced technology, the chances are greater that you may see a more complete eradication of cancer, as well as retention of bladder control and sexual potency.

Advanced Radiation Therapies

Radiation therapy may be used as the sole form of treatment for early stages of prostate cancer or for those patients who are not candidates for surgery. Radiation therapy may also be used in addition to surgery in more advanced stages.

Memorial Hermann offers advanced radiation therapies for qualified patients which can dramatically reduce damage to surrounding healthy tissue. Forms of therapy are dependent upon the prostate cancer stages and the intended purpose of treatment, and include:

• For external beam radiotherapy treatments such as Intensity-Modulated Radiation Therapy (IMRT), a linear accelerator is used to deliver beams of high-energy X-rays directly to the site of a tumor. IMRT uses a state-of-the-art system to precisely shape radiation beams to the shape of the tumor.
• High dose radiation (HDR) therapies such as brachytherapy are a type of internal radiation treatment that involves the implantation of a low-dose radioactive source (or seed) into or near the prostate. Depending on your course of treatment, this implant may be temporary or permanent.

Chemotherapy

According to the American Cancer Society, chemotherapy is not considered standard treatment for early-stage prostate cancer. However, it remains an option for patients with cancers that have not responded well to hormone therapy or other treatments, and chemotherapy may be paired with prostate cancer surgery to increase the overall likelihood of success.

The affiliated medical oncologists at Memorial Hermann have experience with treating many different types of cancer using advanced chemotherapy treatments , and we offer both inpatient and outpatient chemotherapy services at convenient locations all across the Greater Houston area.

Potential Side Effects of Prostate Cancer Treatment

While advances in prostate cancer treatment have helped reduce the severity and frequency of side effects, there is still a chance that you may experience a few of the following common side effects related to prostate cancer treatment:

• Incontinence and urinary dysfunction
• Bowel dysfunction
• Erectile dysfunction
• Infertility
• Depression
• Fatigue

The probability of experiencing side effects depends on a few factors, including the type of treatment, severity of prostate cancer and your overall level of health. It’s important to maintain a healthy lifestyle and positive attitude in order to improve your chances of a positive treatment outcome. Your urologist can give you more specific information about possible side effects and how they may impact you and your family.

Why Choose Memorial Hermann for Prostate Cancer Treatment?

To get checked for prostate cancer, schedule an appointment with your regular physician today. If you need a physician, Memorial Hermann can help you find one.

For more information about Memorial Hermann Cancer Centers, including how to get connected to our support services or an affiliated provider, call (833) 770-7771 or fill out the form on this page to be connected to one of our Oncology Nurse Navigators.