Prostate Cancer

Risk factors are traits that may put people at greater risk of developing lung cancer.

• Age: Although prostate cancer can strike at any time, the risk of developing the disease increases with age. Men over 65 represent two-thirds of all cases.
• Race: For reasons unknown, African-Americans are twice as likely as Caucasians to develop prostate cancer. Asians and American Indians have the lowest incidence.
• Family History: A family history of prostate cancer can raise a person’s risk. This is especially true if the disease has hit several relatives or developed before age 60. Some men could benefit from genetic counseling to assess their risk for cancer.
• Nutrition: Studies suggest a diet rich in vegetables may reduce the risk of developing prostate cancer, while a high-fat diet may increase the odds of contracting the disease.

• Enlarged prostate (This could be a benign condition called prostatic hyperplasia)
• Problems urinating
• Blood in the urine
• Frequent pain in the lower back, hips or other bones

A simple test to detect the presence of prostate-specific antigen (PSA) in the blood can screen the prostate gland for cancer. PSA is a protein produced in the prostate. Patients with an elevated PSA may be at higher risk of having prostate cancer. Often, a more detailed evaluation including prostate MRI may be helpful. Some patients benefit from prostate biopsy. Tissue extracted during a biopsy provides more information to make an accurate diagnosis.

A physician may recommend a core needle biopsy for men with an elevated PSA level and abnormal digital rectal exam. During a biopsy, the physician inserts a narrow needle into the prostate to remove tissue samples for a pathologist to examine. If cancer cells are found, further tests are done to determine the extent and aggressiveness of the disease.

Pathologists determine the aggressiveness of prostate cancer using the Gleason grading system. This estimates the cancer’s potential to grow and spread. Cells with a low Gleason grade pose less of a threat. Tumors with a high Gleason grade (7 or above) are more likely to grow and spread beyond the prostate.

Various imaging tests are used to determine the stage or extent of the prostate tumor and whether cancer cells have spread to nearby tissues or other parts of the body. These tests may include:

• Artemis
• Bone scans
• Computed tomography (CT)
• Magnetic resonance imaging (MRI)
• Positron emission tomography (PET)
• Ultrasound

For a complete list of imaging resources at Greenwich Hospital, see Radiology Services.

Often, prostate cancer does not require treatment. In the vast majority of patients, low risk prostate cancer can safely be monitored, with some patients receiving treatment in the future. This allows patients to delay or avoid entirely the potential risks of treatment, while achieving excellent cancer outcomes. Men who are older, have other medical issues, or do not want to experience potential side effects from treatment may take this approach.

Surgeons perform a radical prostectomy to remove the prostate and some surrounding tissue when the cancer has not spread to other parts of the body. The goal is to eliminate the cancer while preserving normal urinary and sexual functions as much as possible.

At Greenwich Hospital, robotic technology with the da Vinci surgical system offers men with prostate cancer better outcomes with fewer side effects. Another option called cryotherapy uses sub-zero temperatures to destroy cancer cells in the prostate.

To learn more about robotic-assisted surgery for the prostate, see Urology Services.

Learn more about Surgery at Greenwich Hospital

Chemotherapy, for patients whose prostate cancer has spread and for whom hormone therapy has failed, can prolong life, reduce pain and increase quality of life.

While undergoing chemotherapy, patients often experience fatigue. Patients who experience other symptoms should call a physician or nurse right away.

People with advanced prostate cancer may require hormone therapy, sometimes in combination with radiation, surgery and chemotherapy. Hormone therapy may benefit patients whose prostate cancer has spread or has recurred after treatment. These treatments usually reduce the levels of the hormone testosterone, which stimulates the growth of prostate cancer cells.

Radiation oncologists can deliver higher doses of radiation to the prostate with fewer side effects using techniques such as intensity-modulated radiation therapy (external radiation). These techniques target cancer cells while sparing healthy tissue.

Greenwich Hospital now offers Xofigo, commonly referred to as Radium 223, a new radiation oncology therapy for patients with stage 4 hormone-refractory prostate cancer (HRPC). This is especially significant for patients whose cancer has spread to the bone and who, until now, had only chemotherapy – and all the side effects associated with it – as a last treatment option. Radium 223 can prolong a patient’s life and reduce the often debilitating pain experienced with advanced state metastatic cancer.