Prostate Cancer

Prostate cancer is a disease in which malignant (cancer) cells form in the tissues of the prostate.

The prostate is a gland in the male reproductive system located just below the bladder (the organ that collects and empties urine) and in front of the rectum (the lower part of the intestine). It is about the size of a walnut and surrounds part of the urethra (the tube that empties urine from the bladder). The prostate gland produces fluid that makes up part of the semen.

As men age, the prostate may get bigger and block the urethra or bladder. This may cause difficulty in urination or can interfere with sexual function. The condition is called benign prostatic hyperplasia (BPH), and although it is not cancer medical therapy or surgery may be needed to correct it. The symptoms of benign prostatic hyperplasia or of other problems in the prostate may be similar to symptoms of prostate cancer.

UC Davis Comprehensive Cancer Center provides multidisciplinary care for men with all stages of prostate cancer. The Prostate Cancer Program's internationally respected team of urologic oncologists is backed by a laboratory of 25 scientists with $4 million in prostate cancer research grants, as well as by one of the nation's largest clinical trials programs. For men with prostate cancer, this combination means access to treatment advances, early diagnostic approaches and prevention strategies that may not be readily available elsewhere.

UC Davis Comprehensive Cancer Center physician-researchers are at the forefront of efforts to develop chemopreventive treatments for men with early stage prostate cancer. The cancer center is a member of a prostate cancer "Dream Team" funded with a $10 million grant from Stand Up to Cancer, the Prostate Cancer Foundation, and the American Association for Cancer Research to study adaptive pathways in metastatic, treatment-resistant cancer. Other participants in the research include UC Los Angeles, UC San Francisco, UC San Diego, Oregon health & Science University and University of British Columbia. And they have entered into a pioneering research partnership with scientists at Lawrence Livermore National Laboratory, a collaboration that is bringing biodefense technologies to bear against prostate and other cancers.

UC Davis Comprehensive Cancer Center provides comprehensive, multidisciplinary care for patients with all stages of prostate cancer. Patients receive all of their care from a team of top academic physicians.

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Digital rectal exam (DRE): An exam of the rectum. The doctor or nurse inserts a lubricated, gloved finger into the rectum and feels the prostate through the rectal wall for lumps or abnormal areas. Prostate-specific antigen (PSA) test: A test that measures the level of PSA in the blood. PSA is a substance made by the prostate that may be found in an increased amount in the blood of men who have prostate cancer. PSA levels may also be high in men who have an infection or inflammation of the prostate or BPH (an enlarged, but noncancerous, prostate).

Transrectal ultrasound: A procedure in which a probe that is about the size of a finger is inserted into the rectum to check the prostate. The probe is used to bounce high-energy sound waves (ultrasound) off internal tissues or organs and make echoes. The echoes form a picture of body tissues called a sonogram. Transrectal ultrasound is used during a biopsy procedure.

Biopsy: The removal of cells or tissues so they can be viewed under a microscope by a pathologist. The pathologist will examine the biopsy sample to check for cancer cells and determine the Gleason score. The Gleason score ranges from 2-10 and describes how likely it is that a tumor will spread. The lower the number, the less likely the tumor is to spread. We use transrectal biopsy: The removal of tissue from the prostate by inserting a thin needle through the rectum and into the prostate. This procedure is usually done using transrectal ultrasound to help guide the needle. A pathologist views the tissue under a microscope to look for cancer cells.

Sources: National Cancer Institute and UC Davis Comprehensive Cancer Center

Weak or interrupted flow of urine
Frequent urination (especially at night)
Trouble urinating
Pain or burning during urination
Blood in the urine or semen
A pain in the back, hips, or pelvis that doesn't go away
Painful ejaculation

Sources: National Cancer Institute and UC Davis Comprehensive Cancer Center

Age is the strongest risk factor for prostate cancer. Prostate cancer is very rare before the age of 40, but the chance of having prostate cancer rises rapidly after age 50.

Other possible risk factors include:

Family history/genes: Prostate cancer seems to run in some families, and scientists have found several inherited genes that seem to raise prostate cancer risk.
Race/ethnicity: Prostate cancer occurs more often in African-American men than in men of other races.
Nationality: Prostate cancer is most common in North America, northwestern Europe, Australia, and on Caribbean island and less common in Asia, Africa, Central America, and South America.
Diet/exercise: Men who eat a lot of red meat or high-fat dairy products appear to have a slightly higher chance of getting prostate cancer. Exercise has not been shown to reduce prostate cancer risk in most studies.

Sources: National Cancer Institute and UC Davis Comprehensive Cancer Center

Active Surveillance

Active Surveillance is closely monitoring a patient’s condition with PSA and prostate biopsies and treating if there is evidence of progression from very low risk prostate cancer to low or intermediate risk.

Surgery

Patients in good health are usually offered surgery as treatment for prostate cancer. The following types of surgery are used:

Radical prostatectomy: A surgical procedure to remove the prostate, surrounding tissue, and seminal vesicles. There are 2 types of radical prostatectomy:
- Robotic prostatectomy: A surgical procedure to remove the prostate through 5 small incisions (cuts) made in the abdomen. The daVinci robot is used in this laparoscopic minimally invasive approach. This is the primary form of prostate removal used at UC Davis. Learn more about Urologic Robotic Surgery
- Retropubic prostatectomy: A surgical procedure to remove the prostate through an incision (cut) in the abdominal wall. Removal of nearby lymph nodes may be done at the same time.
Transurethral resection of the prostate (TURP): A surgical procedure to remove tissue from the prostate using a resectoscope (a thin, lighted tube with a cutting tool) inserted through the urethra. This procedure is sometimes done to relieve symptoms caused by a tumor before other cancer treatment is given. Transurethral resection of the prostate may also be done in men who cannot have a radical prostatectomy because of age or illness.
High-Intensity Focused Ultrasound (HIFU): HIFU technology ablates prostate tissue by focusing high-intensity ultrasound waves on the affected area, causing localized heating that destroys the cells in the gland without damaging the healthy surrounding tissue. The real-time imaging allows for precise local ablation in one session under general anesthesia, repeatable, if necessary, with a low risk of side effects such as incontinence and erectile dysfunction. It is a non-invasive procedure, with no blade, no scar, no radiation, and no incision.

Impotence and leakage of urine from the bladder may occur in men treated with surgery. In some cases, doctors can use a technique known as nerve-sparing surgery. This type of surgery may save the nerves that control erection. However, men with large tumors or tumors that are very close to the nerves may not be able to have this surgery.

The penis may be 1 to 2 centimeters shorter after a radical prostatectomy. The exact reason for this is not known.

Radiation therapy

Radiation therapy is a cancer treatment that uses high-energy x-rays or other types of radiation to kill cancer cells or keep them from growing. There are two types of radiation therapy:

External radiation therapy uses a machine outside the body to send radiation toward the cancer.
Internal radiation therapy uses a radioactive substance sealed in needles, seeds, wires, or catheters that are placed directly into or near the cancer.

The way the radiation therapy is given depends on the type and stage of the cancer being treated.

There is an increased risk of bladder cancer and/or rectal cancer in men treated with radiation therapy.

Impotence and urinary problems may occur in men treated with radiation therapy.

Hormone therapy

Hormone therapy is a cancer treatment that removes hormones or blocks their action and stops cancer cells from growing. Hormones are substances produced by glands in the body and circulated in the bloodstream. In prostate cancer, male sex hormones can cause prostate cancer to grow. Drugs, surgery, or other hormones are used to reduce the production of male hormones or block them from working.

Hormone therapy used in the treatment of prostate cancer may include the following:

Luteinizing hormone-releasing hormone agonists can prevent the testicles from producing testosterone. Examples are leuprolide, goserelin, and buserelin.
Antiandrogens can block the action of androgens (hormones that promote male sex characteristics). Two examples are flutamide and nilutamide.
Drugs that can prevent the adrenal glands from making androgens include ketoconazole and aminoglutethimide.
Orchiectomy is a surgical procedure to remove one or both testicles, the main source of male hormones, to decrease hormone production.
Estrogens (hormones that promote female sex characteristics) can prevent the testicles from producing testosterone. However, estrogens are seldom used today in the treatment of prostate cancer because of the risk of serious side effects.

Hot flashes, impaired sexual function, loss of desire for sex, and weakened bones may occur in men treated with hormone therapy. Other side effects include diarrhea, nausea, and pruritus (itching).

Clinical Trials

New types of treatment are being tested in clinical trials at UC Davis Comprehensive Cancer Center. Speak to your doctor to find out if a clinical trial to treat prostate cancer is right for you.

Sources: National Cancer Institute and UC Davis Comprehensive Cancer Center