Prostate Cancer

Prostate cancer is one of the most frequently diagnosed cancers, with approximately 174,650 new cases reported in the U.S. every year (American Cancer Society, 2019). According to the American Cancer Society, men have a 1 in 8 lifetime chance of developing prostate cancer.

Better screening and more effective treatments have made a difference in the outlook for men with prostate cancer. The death rate for this disease in the U.S. has been going down since the mid-90s. In fact, many prostate cancers are survivable: Almost 100% of men diagnosed with prostate cancer that has not spread beyond the prostate gland or to nearby organs are alive five years or more after diagnosis.

Choosing experienced physicians for treatment of prostate cancer is critical to the best possible outcome. At Froedtert & the Medical College of Wisconsin, an entire team focuses its attention on treating prostate and other urological cancers.

Symptoms and Diagnosis

The prostate gland is located just below the urinary bladder in men. The gland produces a fluid that is one of the components of semen.

Prostate cancer doesn’t typically cause symptoms — unless it has become advanced, when men may experience trouble urinating, a slow urine stream, blood in the semen, pelvic area discomfort, bone pain or erectile dysfunction. If you experience any unusual symptoms, always see your doctor immediately. It’s important to talk with your doctor about prostate cancer screening, which can find prostate cancer early.

Because there are risks and benefits involved in prostate cancer screening, men should talk with their doctors about screening that makes sense for their individual age and medical/family history.

Screening includes a digital rectal examination to feel the prostate gland for abnormalities and a blood test to check the patient’s level of prostate-specific antigen (PSA), a marker for prostate cancer.

Patients with known or suspected prostate cancer may undergo several tests to confirm their diagnosis and assess the nature and extent of their disease:

Needle biopsy is used to confirm the presence of tumor cells. Using ultrasound guidance, a thin needle is inserted into the prostate gland to gather several tissue samples for pathological examination.
For some patients, physicians need to make sure the cancer has not spread outside the prostate. Magnetic resonance imaging (MRI) may be used to evaluate the area around the prostate gland. Computerized tomography (CT) can help detect the presence of cancer in lymph nodes. Bone scans may be used to check for potential spread of the prostate cancer to the bone.

Prostate Cancer Treatment

Treatment planning for prostate cancer must take into account several factors — the stage of the disease, the patient’s age and health, and the patient’s personal priorities.

Although it’s ideal to find prostate cancer early when you may have more treatment options, you should know that there are many effective treatments even for men diagnosed with later stages of prostate cancer or cancer that has spread beyond the prostate gland, including radiation therapy, hormonal therapy, targeted therapies, chemotherapy, immunotherapy and clinical trials.

When considering treatment options, it is important to keep in mind that prostate tumors usually grow slowly. Most patients live a long time with their disease, so while cancer control is critical, preserving physical function is an important part of making a treatment decision.

For some patients, “watchful waiting” provides the greatest chance of achieving the best overall health. Many other patients can benefit from several different therapies, provided either singly or in combination. The Prostate and Urologic Cancer Program at Froedtert & the Medical College of Wisconsin offers more prostate cancer treatment options than anywhere else in the state.

Brachytherapy (Internal Radiation Therapy)

Brachytherapy is a very effective way to treat early-stage prostate cancers. Brachytherapy allows physicians to deliver radiation to the prostate gland, keeping the doses to the surrounding healthy tissue low.

Learn more about Brachytherapy

External Beam Radiation Therapy

In external beam radiation therapy, cancer cells are destroyed by radiation fields generated by a device outside the body. It can be very effective at controlling cancer, and it offers an excellent option to limit side effects. External beam radiation can also be given in combination with brachytherapy and/or and drug (usually hormone) therapy.

External beam radiation therapy is used in several different scenarios. It often serves as a primary treatment for cancers that have not spread beyond the prostate. It can also be given if indicated following prostate surgery may be used for patients who are not good candidates for surgery because of age or other health problems. In addition, external beam radiation therapy can be part of treatment for men whose cancer has moved beyond the prostate gland. External beam radiation can also help relieve the pain of bone metastases.

Conformal radiation: A key goal in external beam therapy is producing radiation fields that are tightly conformed to the tumor target. “Conformal” radiation enables physicians to deliver a higher dose of radiation to cancer cells (very important for any patient not in the most favorable disease category) while sparing healthy tissue. The results are greater ability to destroy cancer while avoiding damage to bowel, bladder and sexual function.
Several technologies: Froedtert & the Medical College of Wisconsin offer several different radiation systems for providing conformal radiation to patients with prostate cancer. One class of systems employs Intensity Modulated Radiation Therapy (IMRT), a technique for precisely delivering dozens of thin radiation beams (rather than a few wide beams) to a tumor. A computer determines the best way to deliver treatment by “modulating” the intensity of each beam. The Clinical Cancer Center’s TomoTherapy unit is an advanced IMRT system that combines precise 3-D imaging from an onboard CT scanner with highly targeted radiation fields.

Cryosurgery

Cryosurgery is the use of cold energy to destroy cancer cells by freezing them. During a cryosurgery procedure, a physician inserts one or more thin needles into the prostate gland. Each needle has a special probe tip that can be cooled to sub-zero temperatures. When a probe is activated, surrounding tissues are engulfed in a ball of ice. The ice crystals rupture the cells of the tumor, killing the cancer.

Traditionally, cryotherapy has been used to treat the entire prostate gland. There is now increasing data showing that not all patients need to have their entire prostate destroyed. For select patients, focal cryotherapy (freezing just part of the prostate) can result in successful treatment with fewer side effects.

Open Prostatectomy

Treatment for prostate cancer sometimes requires surgery to remove the prostate gland. Open prostatectomy is a traditional “open” surgical procedure, which means the surgeon accesses the prostate gland through a standard surgical incision. Learn more about the risks and benefits of open prostatectomy.

Hormone Therapy

Prostate cancer cells require male sex hormones (such as testosterone) to grow. Patients with advanced prostate cancer can benefit from a variety of drug therapies that turn off hormone production. Some drugs reduce the body’s natural testosterone production from normal to very low levels, which can “starve” prostate cancer cells. These drugs are normally administered by injection. Other agents are able to block the action of male sex hormones.

Hormone therapy is the standard therapy for men whose cancer has returned after surgery or radiation therapy. It is also a standard treatment for prostate cancers that have spread to other parts of the body (metastatic disease). Hormone therapy is also known as androgen deprivation therapy.

Patients respond positively to hormone therapy for an average of two years. The main side effect of hormone therapy is impotence. Other side effects include fatigue, weight gain, reduced muscle mass and hot flashes. For these reasons, it is important to weigh the potential benefits of hormone therapy against the likely side effects. Given the relatively slow growth of most prostate cancers, not all patients need to be treated.

Chemotherapy

Patients who have stopped responding to hormone therapy can benefit from chemotherapy. Docetaxel, a drug that blocks the rapid division of cancer cells, has been proven effective for patients with hormone-resistant prostate cancer. Combined with another chemotherapy drug, it can extend survival by several months. For patients with metastatic disease, docetaxel can also reduce the pain of bone metastases. Most patients tolerate docetaxel very well and experience only mild side effects.

Interventional Radiology

Prostate cancers that have spread to the bone (or other parts of the body) can also be treated with minimally invasive interventional radiology (IR) procedures. These procedures can serve either as a primary therapy for bone metastases or as a follow-up to external beam radiation or chemotherapy.

Radiofrequency ablation (RFA): An interventional radiologist uses imaging technology to position a special probe at the tumor site. A high-frequency current passed through the probe destroys the tumor with heat.
Cryoablation: In this procedure, one or more needle probes with super-cooled tips are used to destroy the tumor through freezing. Most bone tumors are treated with two freeze-thaw cycles.

Clinical Trials for Prostate Cancer

Patients in the Prostate and Urologic Cancer Program have access to a large number of investigational therapies for the treatment of prostate cancer. Many of these clinical trials are examining new ways to use chemotherapy drugs and novel approaches to hormone therapy. There are also several trials for radiation therapies, including an investigation aimed at shortening radiation treatments. The Prostate and Urologic Cancer Program is also taking part in a national trial for using high-intensity ultrasound to destroy prostate cancer cells.

These clinical trials are carefully evaluated and planned, and they offer real potential for patient benefit. View current prostate cancer clinical trials.

Prostate Cancer Second Opinion

Whenever you are diagnosed with cancer, it makes sense to get a second opinion — to confirm your diagnosis and take a fresh look at all your treatment options. Learn more about our Cancer Second Opinion Program.