PROSTATE CANCER Early-stage Prostate Cancer Patient Guide Table of Contents Urology Care Foundation Prostate Health Committee Patient Story . 3 Chair Introduction . 3 Anne E . Calvaresi, DNP, CRNP, RNFA GET THE FACTS What is the Prostate? . 4 Committee Members What is Early-stage Prostate Cancer? . 4 Alexander Kutikov, MD, FACS What Causes Prostate Cancer? . 4 Daniel W . Lin, MD What are the Signs of Prostate Cancer? . 5 Brian Keith McNeil, MD, FACS GET DIAGNOSED Kevin T . McVary, MD, FACS Blood Tests . 5 Daniela A . Wittmann, PhD, LMSW Digital Rectal Exam . 5 Biopsy . 5 Staging and Grading . 6 GET TREATED Active Surveillance . 7 Watchful Waiting . 8 Surgery . 8 Radiation Therapy . 8 Cryotherapy . 9 HIFU and Focal Therapy . 9 OTHER CONSIDERATIONS Erectile Dysfunction (ED) . 10 Incontinence . 10 Lifestyle Changes . 11 Emotional Stress . 11 Questions to Ask Your Doctor . 11 GLOSSARY . 12 2 Ken's Story Ken* was diagnosed with prostate cancer just three days before Christmas . He had no symptoms, but at a routine health exam, his doctor found his PSA level was 20, quite high . “At that point we learned I would need treatments .” Ken found a surgeon skilled in robotic surgery . Due to his age and his wish to remove the tumor, he chose to have a radical prostatectomy . The surgery and radiation were a success . Though Ken faced some lasting side effects from treatment, he feels grateful to have had a great health care team on his side . If Ken could offer men in a like place some help, he would tell them to be patient and to stay positive . Ken believes making a choice based on knowledge is always best . *Name has been changed. Introduction About 1 in 9 men will get prostate cancer in his lifetime . men who are diagnosed, it is better if it is caught early . Prostate cancer is the second-leading cause of cancer death Survival rates for men with prostate cancer have grown over for men in the U .S . Most men who discover it early can live the years, thanks to better testing and treatment options . long lives . Today, 99% of men with prostate cancer will live for at least As men grow older, it is common to have urinary symptoms . five years after diagnosis . Many men who have treatment Things like a slower urine stream and more trips to pass are cured . One in three men will survive after 5 years, even if urine may come with prostate growth . Urinary symptoms the cancer has spread to other parts of the body . may also be a sign prostate cancer is growing in the Some prostate cancers grow so slowly that treatment prostate . Because there are no clear alerts for prostate may not be needed at all . Others grow fast and are life cancer, many doctors advise tests to detect it early . threatening . Deciding what treatment to get can be Many men with prostate cancer will not die from it . For complex . Get the facts and ask questions to help make the right choice for you . 3 GET THE FACTS nearby tissue or other parts of the body . These growths What is the Prostate? can be removed and may grow back slowly (but often do not grow back) . • Cancerous growth, such as prostate cancer, can spread The prostate* and seminal vesicles are part of the male (metastasize) to nearby organs and tissues such as the reproductive system . The prostate is about the size of a bladder or rectum, or to other parts of the body . If the walnut . The seminal vesicles are two smaller pairs of glands abnormal growth is removed, it can still grow back . attached to the back of the prostate . The prostate sits Prostate cancer can be life threatening if it spreads far below the bladder, in front of the rectum . It surrounds the beyond the prostate (metastatic disease) . urethra, a small tube that carries urine from the bladder out through the penis . The main job of the prostate and seminal vesicles is to make What is Early-stage Prostate Cancer? fluid for semen . During ejaculation, sperm moves to the urethra . At the same time, fluid from the prostate and the Prostate cancer stays “localized” when cancer cells are seminal vesicles also moves into the urethra . This mixture— found only in the prostate or even a little bit beyond it semen—goes through the urethra and out of the penis as (extra-prostatic extension), but do not move to other parts ejaculate . of the body . If the cancer moves to other parts of the body, Male Reproductive System it is called “advanced” prostate cancer . Prostate cancer is often grouped into four stages . • Early Stage | Stages I & II: The tumor has not spread beyond the prostate . This is often called “early stage” or “localized” prostate cancer . • Locally Advanced | Stage III: Cancer has spread outside the prostate, but only to nearby tissues . This is often called “locally advanced prostate cancer .” • Advanced | Stage IV: Cancer has spread outside the prostate to other parts such as the lymph nodes, bones, liver or lungs . This stage is often called “advanced prostate cancer .” What Causes Prostate Cancer? The cause of prostate cancer is unknown, but researchers know many things can increase a man's risk for the disease . • Age: As men age, their risk of getting prostate cancer What is Prostate Cancer? goes up . Harm to the DNA (or genetic material) of prostate cells is more likely for men over the age of 55 . Cancer is the result of abnormal cell growth, which takes • Ethnicity: African American men have a higher rate of over the body’s normal cell function, making it harder the disease . One in six African American men will be for the body to work the way it should . Prostate cancer diagnosed with prostate cancer . Prostate cancer occurs develops when abnormal cells form and grow in the less often in Asian American and Hispanic/Latino men prostate gland . Not all abnormal growths, also called than in non-Hispanic white men . tumors, are cancerous (malignant) . Some tumors are not • Family History: Men who have a grandfather, father or cancerous (benign) . brother with prostate cancer face a higher risk of getting • Benign growths, such as benign prostatic hyperplasia the disease . Having family members with breast and (BPH), are not life threatening . They do not spread to ovarian cancer also raises a man’s risk for prostate cancer . * All words that appear in blue italics are explained in the glossary. 4 • Weight: Studies link being overweight in your 50s Talk with your health care provider if you have any of these and later to a greater risk of advanced prostate cancer . symptoms: Doctors advise keeping to a healthy weight to reduce • Dull pain in the lower pelvic zone risk . • Frequent need to pass urine • Trouble passing urine, pain, burning or weak urine flow What are the Signs of Prostate Cancer? • Blood in the urine (hematuria) • Painful ejaculation In its early stages, prostate cancer may have no symptoms . • Pain in the lower back, hips or upper thighs When symptoms do occur, they can be urinary symptoms • Loss of hunger like those of an enlarged prostate or Benign Prostatic Hyperplasia (BPH) . • Loss of weight • Bone pain GET DIAGNOSED The American Urological Association (AUA) recommends is also used to screen for and stage cancer, or track how talking with your doctor about the benefits and harms of well treatment is going . During this test, the doctor feels screening (testing) for prostate cancer . If you fall into any of for an abnormal shape, consistency, nodularity or thickness the groups below, you should think about talking to your to the gland . For this exam, the health care provider puts a doctor to see if screening is right for you: lubricated gloved finger into the rectum . • Between 55–69 years old The DRE is safe and easy, but cannot spot early cancer by • African American itself . It is often done with a PSA test . Together, the PSA and • Have a family history of prostate cancer DRE can help to find prostate cancer early, before it spreads . Early prostate cancer treatment may stop or slow the spread • Have symptoms of cancer . Blood Tests The PSA blood test measures a protein in your blood called the prostate-specific antigen (PSA) . Only the prostate and prostate cancers make PSA . Results for this test are usually shared as nanograms of PSA per milliliter (ng/mL) of blood . The PSA test is used to look for changes to the way your prostate produces PSA . It is used to stage cancer, plan treatment and track how well treatment is going . A rapid rise in PSA may be a sign something is wrong . In addition, your doctor may want to test the level of testosterone in your blood . The PSA test is not used alone to make a diagnosis . Your doctor may also use a digital rectal exam (DRE) test for a better sense of your prostate health . Biopsy Digital Rectal Exam If screening tests show an issue with the prostate, a The digital rectal exam (DRE) is a physical exam used to prostate biopsy may be performed . This helps make an help your doctor feel for changes in your prostate . This test accurate diagnosis . A biopsy is a tissue sample taken from 5 your prostate or other organs to look for cancer cells . There Tumors found only in the prostate are more successfully are many approaches to prostate biopsies . These can be treated than those that have metastasized (spread) outside done through a probe placed in the rectum, through the the prostate . Tumors that have metastasized are incurable skin of the perineum (between the scrotum and rectum) and require drug-based therapies to treat the whole body .