What to Know About Prostate Cancer Management

Prostate cancer is the second most common type of cancer experienced by patients assigned male at birth (AMAB). It is more frequently diagnosed in older patients and Black patients. . This article provides a brief overview of the disease, discusses grading and staging of the condition and focuses on common treatment and management methods. It is important for patients to have individualized discussions about next steps and options with their healthcare provider, as this article is intended for educational purposes only.

What is Prostate Cancer?

The prostate is a gland found in the male reproductive system that produces the fluid found in semen. Prostate cancer can develop when cells in the prostate grow out of control, sometimes spreading to other regions of the body in advanced cases. Because the prostate is involved in and adjacent to the urinary system, prostate cancer can also cause urinary issues and symptoms.

If the cancer is diagnosed and treated before reaching advanced stages, the survival rate is high. Multiple treatments and medications are available to prolong and improve the patient’s quality of life. Several underlying factors also affect outlook, such as overall health, age at diagnosis, grading and staging and other individualized aspects not reflected in statistics. A prostate cancer diagnosis can be serious, but treatments and detection methods continue to improve and evolve.

What are the signs and symptoms of prostate cancer?

In early stages, patients may not experience symptoms, and many cases are discovered during routine health screenings. In later stages, possible symptoms may include:

Unexplained fatigue: Feeling unusually tired.
Urinary issues: Such as difficulty urinating or urinating more frequently than usual.
Unexpected weight loss: Losing weight without intending to.
Erection difficulties: Struggling with erections.
Bloody semen or urine: These may be indicators of prostate cancer.
Bone pain: In advanced cases, there may be bone pain.

The presence of these symptoms does not necessarily indicate prostate cancer. Some may result from common effects of aging, urinary tract infections or other benign health conditions. It is important to consult your healthcare provider with any symptoms or concerns so they can offer personalized care and recommendations.

Diagnosing prostate cancer

There are multiple aspects to diagnosing prostate cancer. Some methods may be used in conjunction with one another. Diagnostic methods may include:

Digital rectal exam: This is one of the most common techniques. The doctor carefully inserts a gloved finger into the rectum to feel for signs such as an enlarged prostate or lumps. If anything is detected, additional testing may be performed.
Prostate-specific antigen (PSA) tests: PSA blood tests measure levels of this antigen, which may indicate prostate cancer. However, there are several noncancerous reasons for elevated results.
Ultrasound: Ultrasound uses high-frequency sound waves to create images of internal structures. The waves bounce off organs and bones, producing pictures that can be studied. In the case of prostate cancer, the handheld ultrasound device, called a transducer, is inserted into the rectum for more targeted views of the prostate. This can help detect nodules, growths or prostate enlargement.
MRI: Magnetic resonance imaging (MRI) uses radio waves and strong magnets to produce detailed internal images. MRI scans are useful for detecting growths and abnormalities in the prostate and may also show whether the cancer has spread.
Biopsy: A small sample of tissue, cells or fluid is removed from the prostate for analysis. A pathologist examines the sample for cancer cells, which may help determine grading and Gleason score details.

Important prostate cancer factors

Prostate cancer has specific stages, grading and Gleason scores, which help indicate how aggressive the cancer is, whether it has spread and guide treatment decisions. Below is a brief overview of how these factors are determined.

Stages

Prostate cancer staging can be somewhat complex and detailed, with various sub-stages and classifications. Here is a simplified overview of how prostate cancer is staged:

Stage I: Cancer cells are only detected in the prostate, meaning the cancer has not spread to other areas of the body. This is often called localized prostate cancer.
Stage II: Also considered localized, this stage involves more cancer cells than Stage I, or cancer in both prostate lobes. It still has not spread beyond the prostate.
Stage III: Often called locally advanced, this stage indicates that cancer cells have spread to nearby lymph nodes or seminal vesicles.
Stage IV: Referred to as metastatic or advanced prostate cancer, this stage means the cancer has spread to bones, organs or other parts of the body.

Gleason Score

The Gleason score uses a patient’s biopsy results to help assess the likelihood of prostate cancer spreading. The more irregular and abnormal the cancer cells appear, the higher the Gleason score and the more aggressive the cancer is believed to be. Lower scores may indicate slower-growing cancer, which is usually easier to treat.

The score is determined by a pathologist, who assigns a number to the cancer cells based on how different they appear from typical, healthy cells. Scores range from 1 (non-aggressive) to 5 (very aggressive), though in modern practice, prostate cancer cases are typically scored at a minimum of 3. This is because lower scores (1 and 2) represent cell patterns that are rarely diagnosed as cancer today.

From there, the numbers from the two most common cell patterns are then added together to form the Gleason score. For example, if a patient has a large number of cells scored as 3 and 4, these are added to produce a Gleason score of 7.

Gleason Grade Group System

While the Gleason score is useful, it doesn’t necessarily reflect whether the patient has more cancer cells rated at higher scores. For example, if a patient has more cells rated as 4 and fewer as 3, the total will be 7. If a different patient has more cells rated as 3 and fewer as 4, they will also have a total score of 7. However, the aggressiveness of their cases may differ due to the different ratios of these cell patterns. That’s where the newer Gleason Grade Group system comes in, providing a more accurate grading:

Grade Group 1: Gleason score of 6 or less
Grade Group 2: Gleason score of 3 + 4 for a total of 7
Grade Group 3: Gleason score of 4 + 3 for a total of 7
Grade Group 4: Gleason score of 8
Grade Group 5: Gleason score of 9 to 10

Monitoring prostate cancer

For some prostate cancer cases, treatment will be delayed or decided against for various reasons. Here is an overview of these two approaches.

Watchful waiting

Watchful waiting for prostate cancer means the disease is not actively treated. Instead, it may be occasionally monitored through PSA tests or medical imaging, or evaluated only if symptoms worsen. This approach may be preferred for cases such as older patients with early-stage cancer who are more likely to die of other causes than from the disease itself. It is also referred to as observation.

Active surveillance

Similar to watchful waiting, active surveillance postpones treatment for prostate cancer. Instead, the patient undergoes regular testing at set intervals, such as blood tests every few months. The progression of the disease is closely monitored, allowing the patient to delay treatment until it becomes needed and avoid unnecessary side effects from treatments.

For some patients, the cancer may grow slowly enough that they never need treatment, especially if diagnosed at an older age. If surveillance indicates any changes or concerns, treatment options or next steps can then be discussed with a medical professional.

Treating prostate cancer

Here is an overview of the more common prostate cancer treatments currently available.

Surgery

When necessary, the prostate may be surgically removed, along with affected lymph nodes and seminal vesicles when applicable. This procedure is called a radical prostatectomy, and there are different techniques to how it can be performed:

Radical retropubic prostatectomy: An incision is made in the lower abdomen, extending to the pubic bone, and the prostate is surgically removed,often along with seminal vesicles and adjacent tissues. Patients typically have a temporary catheter inserted to allow urination during healing, which is usually removed after one to two weeks.
Radical perineal prostatectomy: This less commonly used method involves an incision in the area between the scrotum and anus to access and remove the prostate. The lymph nodes are not accessible with this approach, but if they do not need to be removed, it may be a suitable option for some patients.
Laparoscopic radical prostatectomy: A thin, lighted tube called a laparoscope is inserted through a small abdominal incision. The laparoscope includes a camera, allowing the surgeon to see inside the body during the procedure. Long, thin instruments are inserted through additional small incisions to remove the prostate.
Robotic prostatectomy: Also called a robotic assisted laparoscopic radical prostatectomy, this is the most frequently used method. The surgeon controls robotic arms and tools to perform the surgery, which gives them more precision. It is otherwise performed similarly to a laparoscopic radical prostatectomy. Recovery times tend to be shorter with this type of surgery, and blood loss is typically reduced as well.

Radiation therapy

Radiation therapy involves the use of high-energy rays, such as X-rays, to destroy cancer cells or prevent them from spreading. Some radiation methods include:

External beam radiation therapy (EBRT): Radiation is delivered using equipment outside the patient’s body. Typically, treatments are administered five days a week for several weeks. In some cases, higher doses may be given over fewer sessions, a method known as hypofractionated radiation. Advances in radiation techniques allow doctors to minimize exposure to healthy tissue while focusing more precisely on cancerous areas.
Three-dimensional conformal radiation therapy (3D-CRT): A more precise method of delivering radiation, using specialized computers to accurately target the prostate.
Intensity-modulated radiation therapy (IMRT): A type of 3D-CRT in which the radiation equipment moves around the patient while delivering treatment. Because it can target the prostate from multiple angles and adjust the intensity of the beams, it allows for higher radiation doses than some other forms of radiation therapy.
Stereotactic body radiation therapy (SBRT): SBRT uses advanced imaging and guidance techniques to deliver larger doses of radiation, allowing the full course of treatment to be completed in just a few days instead of several weeks. However, this higher-dose approach may increase the risk of more pronounced side effects.
MRI-guided radiation: A machine called an MRI-linac takes real-time MRI images while delivering radiation, allowing for more precise targeting of the prostate gland.
Brachytherapy (internal radiation therapy): Small radioactive pellets, about the size of a grain of rice, are placed directly into the prostate to deliver radiation from within. These may be left in place for weeks or months as the radiation gradually diminishes. There are several variations of this general technique.

Hormone therapy

Many types of cancer use hormones as a fuel source to grow and spread, and prostate cancer is no exception. Hormone therapy uses medications that target specific hormones, such as androgens, which are male hormones like testosterone. By blocking or reducing these hormones, treatment can help shrink or destroy cancer cells. This approach may also help prevent the cancer from spreading to other parts of the body.

Chemotherapy

Chemotherapy is a common method for treating various types of cancer. It uses specialized drugs to kill cancer cells and help prevent them from spreading. These medications can be given intravenously, taken orally or used in combination. Because chemotherapy drugs travel through the bloodstream, they can reach cancer cells throughout the body. For this reason, chemotherapy is often used in more advanced cases of prostate cancer that have metastasized.

Targeted therapy

Targeted therapy uses specialized medications that focus on specific genetic components of a cancerous tumor. This can help kill cancer cells or slow their spread. Patients may be genetically tested to determine whether their cancer is compatible with this type of treatment. One example of this method is poly (ADP-ribose) polymerase (PARP) inhibitors. Normally, PARP helps repair healthy DNA in non-cancerous cells. However, prostate cancer cells may also rely on PARP to grow and spread. Medications that inhibit PARP may help reduce or eliminate the cancer. Other genetic components or molecular targets may also be used, depending on the individual case.

Immunotherapy

Immunotherapy uses drugs that help boost the patient’s immune system, enabling it to more effectively recognize and fight cancer cells. There are several different approaches to immunotherapy, with various types of drugs that affect the immune system in different ways. Healthcare providers work with the patient to decide which immunotherapy is best suited for their individual case.

Getting your results

Turnaround times for prostate cancer imaging results can vary depending on the facility and your doctor’s availability. Often, patients wait a week or more and receive their results during a follow-up appointment. With PocketHealth, you don’t have to wait as long—your results are securely accessible as soon as the imaging or report are available, allowing you to review them before your follow-up visit.

When you do gain access to your results, it’s common to find medical terminology somewhat confusing, but Report Reader helps you to better understand your report by offering clear, straightforward definitions for medical terms—simply tap or click on any underlined words to reveal their meaning. This is paired with illustrations and highlights of anatomy in your imaging to help you better understand your results and prepare for follow-up appointments.

Frequently asked questions

Here are some common questions regarding prostate cancer.

What are some common side effects of prostate cancer treatments?

Prostate cancer treatment side effects may vary depending on the specific treatment and the individual’s overall health. Common side effects may include:

Fatigue: Feeling unusually tired.
Nausea: A common side effect of many cancer-fighting medications.
Temporary hair loss: This may occur with chemotherapy but usually grows back after treatment ends.
Increased risk of infection: Chemotherapy can temporarily weaken the immune system, making it harder to fight infections during treatment.
Skin irritation: Radiation may cause sunburn-like symptoms on the skin.
Urinary incontinence: This may happen after prostate removal surgery, though it is usually temporary.
Erection difficulties: Also a possible side effect of prostate removal. However, various medications and treatments may help improve this.

If you are preparing for treatment, it’s important to talk with your doctor about possible side effects, as well as ways to manage or reduce them. In many cases, there are effective options to help alleviate discomfort or complications.

What’s the difference between watchful waiting and active surveillance?

As the name suggests, active surveillance is typically more involved than watchful waiting. Patients on active surveillance may undergo prostate cancer evaluations and testing more frequently than those following a watchful waiting recommendation.

How common is prostate cancer?

Currently, 13 out of 100 American patients assigned male at birth (AMAB) will be diagnosed with prostate cancer during their lifetime. This likelihood increases with age. Black patients or patients with a family history of prostate cancer may also have a higher risk. If you believe you may be at increased risk, it may be recommended to speak with your healthcare provider about the possibility of early screenings.

What is prostate cancer screening?

There is currently no official standard test or timing for prostate cancer screening. However, healthcare professionals often begin with a digital rectal exam and/or a prostate-specific antigen (PSA) blood test to check for elevated levels. These are commonly used as initial screening tools.

Getting support

While it may feel overwhelming to manage a prostate cancer diagnosis, it is important to remember you’re not alone. There have been numerous improvements to detection, diagnosis and treatment methods, which can improve outcomes and quality of life. Support resources can also be helpful during this time. Your doctor will likely have local resources and contacts for you. Meanwhile, here are some online organizations that focus on helping prostate cancer patients through treatment and recovery:

Take control of your health journey

PocketHealth makes it simple to keep track of your prostate scans. All of your vital imaging is in one secure location and can be accessed online anytime. Imaging and reports can also be easily shared with other physicians in your care team, if needed. Additionally, it makes it easy to track health changes over time, such as with repeat imaging. When used in conjunction with your medical provider’s professional advice, it is a powerful tool for organizing and understanding your imaging results and your health.

PocketHealth MyCare Navigator gives personalized insights into your health and identifies any recommended follow-up steps. This functionality can also generate individualized questions to ask your doctor based on the findings in your report, ensuring you make the most of your consultation. A prostate cancer diagnosis may feel overwhelming, but working closely with your providers can give you the best chance of managing your condition and protecting your health.