Understanding Prostate Cancer Diagnosis and Treatment

After a prostate cancer screening, you may be asked to go back into the doctor’s office for more testing. While it sounds scary, the urology team at Crystal Run Healthcare want you to know how important follow-up tests are and if you are diagnosed with prostate cancer, what questions to ask your doctor.

What happens when you get asked back to the office after your prostate screening?

There are many reasons to be asked to return to the doctor’s office after your prostate cancer screening. If the screening revealed an abnormal result, your provider may want to discuss your results, conduct a digital rectal exam if only blood testing was completed before or recommend diagnostic testing. If diagnostic testing is recommended as the next step, your provider may recommend a prostate biopsy as an option. A prostate biopsy involves removing small tissue samples from the prostate gland for examination. 

Who should undergo a prostate biopsy?

A prostate biopsy is typically recommended for men with abnormal prostate-specific antigen (PSA) test results or an abnormal digital rectal exam (DRE). Your provider can help you decide if a biopsy is right for you based on individual risk factors, medical history and test results. Not all patients who receive abnormal or positive cancer screenings need to get a biopsy. Some providers may suggest other diagnostic testing options like blood or urine testing, imaging scans and genetic testing, before considering a biopsy for their patients.

At Crystal Run, prostate biopsies can be performed in-office. Your urologist will apply local anesthetic to prevent pain from the biopsy. They will then take several small samples from your prostate to test for cancer cells. Since the samples are taken from inside the anus, there are instructions to follow both before and after the biopsy to reduce the risk of infection or pain. 

What is my Gleason score/TNM score?

If cancer is found, your provider may explain your results using a Gleason or TNM score. The Gleason score is a measure of how abnormal the cancer cells look under a microscope. It's a scale from 2 to 10, with higher scores indicating more aggressive cancer. If cancer cells are identified, your provider may suggest an evaluation or additional testing to see if the cancer has spread. After diagnostic testing, your provider may describe the stage of your cancer using the Tumor, Nodes and Metastasis system. The Tumor, Nodes and Metastasis (TNM) staging system is used to classify the extent of the cancer including whether it has spread and if so, how far. The TNM score includes the tumor size, if there is involvement of nearby lymph nodes and if the cancer has metastasized. Metastasized means cancer cells have spread to other areas of the body. If prostate cancer is caught during the tumor phase, it is considered ‘localized’ or early-stage prostate cancer. An advanced cancer diagnosis means that the cancer cells have spread to the lymph nodes or other areas of the body.

What treatment is available for early-stage prostate cancer?

Treatment options for early-stage prostate cancer depend on the stage, grade and overall health of the patient. The main treatment options include:

• Active Surveillance: Monitoring the cancer with regular PSA tests, DREs and biopsies, without immediate treatment.
• Surgery: Removing the prostate gland, either through open or robotic-assisted surgery.
• Radiation Therapy: Using high-energy rays to kill cancer cells.
• Cryotherapy: Using a controlled method to freeze the cancerous cells.
• Focal therapy: For men with small tumors, they may be able to use treatment that targets the individual tumor and not the whole prostate.

There are several different types of treatment options for prostate cancer. This makes it even more important for patients to understand the risks and benefits of each option and to talk to their doctor about all options before making a decision.

What treatment is available for advanced prostate cancer?

Advanced prostate cancer is often a lifelong disease. That means most treatment options for advanced prostate cancer involve managing symptoms, slowing the growth of the tumor and prolonging the life of the patient. Treatments like targeted therapy, chemotherapy and hormone therapy have been effective at managing the growth and spread of prostate cancer. As a result, many people with prostate cancer may not die from the cancer.

What is hormone therapy (androgen deprivation therapy)?

Hormone therapy, also known as androgen deprivation therapy, may be recommended for patients with advanced prostate cancer. This treatment can reduce the levels of male hormones (androgens) that are linked to cancer growth. Hormone therapy can be used alone or in combination with other treatments.

How will my cancer be monitored after treatment?

After treatment, your doctor will monitor your cancer with regular PSA tests, DREs and imaging tests (such as CT or bone scans). The frequency and type of monitoring will depend on your individual health needs, medical history and treatment plan. The goal is to detect any signs of cancer remission or progression early, so that your treatment plan can be adjusted if needed. Your provider can also help with any side effects from treatment, like incontinence or erectile dysfunction.

Comprehensive urology care at Crystal Run

At Crystal Run Healthcare, our academically trained urologists treat everything from erectile dysfunction (ED) and kidney stones to urinary tract infections and prostate cancer. With access to state-of-the-art technology, our urologists are able to perform various procedures in our urology office. Tests we can perform on-site include cystoscopy (inspection of the inside of the bladder and urethra), prostate biopsy, urodynamics (tests of bladder function) and vasectomy. Patients in our urology center are in and out in the same day and experience minimal recovery time.

NCCN Guidelines for Patients: Advanced-Stage Prostate Cancer

Early-Stage Prostate Cancer What You Should Know - Urology Care Foundation

Prostate Health Playbook - Urology Care Foundation

Early-Stage Prostate Cancer What You Should Know - Urology Care Foundation

After a Prostate Cancer Diagnosis

After Treatment: Living as a Prostate Cancer Survivor | American Cancer Society 

Tests for Prostate Cancer | Prostate Cancer Diagnosis | American Cancer Society