Prostate Cancer

What is Prostate Cancer?

Prostate cancer is cancer that occurs in the prostate. The prostate is a gland in males that produces the seminal fluid that nourishes and transports sperm.

Common Symptoms

Prostate cancer may cause no signs or symptoms in its early stages.

Prostate cancer that's more advanced may cause symptoms such as:

• Bone pain

• Losing weight without trying

• Trouble urinating

• Decreased force in the stream of urine

• Blood in the urine

• Blood in the semen

Diagnosis

Prostate screening tests might include:

• Digital rectal exam (DRE). During a DRE, your doctor inserts a gloved, lubricated finger into your rectum to examine your prostate, which is adjacent to the rectum. If your doctor finds any abnormalities in the texture, shape or size of the gland, you may need further tests.

• Prostate-specific antigen (PSA) test. A blood sample is drawn from a vein in your arm and analyzed for PSA, a substance that's naturally produced by your prostate gland. It's normal for a small amount of PSA to be in your bloodstream. However, if a higher than usual level is found, it may indicate prostate infection, inflammation, enlargement or cancer.

If prostate cancer screening detects an abnormality, your doctor may recommend further tests to determine whether you have prostate cancer, such as:

• Ultrasound. During a transrectal ultrasound, a small probe, about the size and shape of a cigar, is inserted into your rectum. The probe uses sound waves to create a picture of your prostate gland.

• Magnetic resonance imaging (MRI). In some situations, your doctor may recommend an MRI scan of the prostate to create a more detailed picture. MRI images may help identify small cancers that are not detectable by DRE or ultrasound

• Transrectal ultrasound-guided (TRUS) biopsy. To determine if there are cancer cells in the prostate, your doctor may recommend a procedure to collect core samples from your prostate. Prostate biopsy is often done using a thin needle that's inserted into the prostate to collect tissue. The tissue sample is analyzed in a lab to determine whether cancer cells are present.

Treatment

Surgery

A radical prostatectomy is a procedure that removes the entire prostate gland from the body. It also requires the reconstruction of the bladder so that it attaches back to the urethra. This can be completed through an “open” approach (single lower abdominal incision) or with the assistance of a robot (available at larger, academic hospitals).

Radiation

Administration of radiation energy to the prostate is another effective means of treating prostate cancer. With this approach, surgery is not required and the prostate is left in place. Radiation treatments aim to eradicate the cancer cells while leaving the normal prostate in place. This may require multiple treatments to deal with the cancer and is available at regional cancer centres through a referral to an Oncologist.

Active Surveillance (AS)

An approach designed to reserve management of prostate cancer until it is necessary. Some prostate cancers are considered low risk and may not ever require treatment. AS is a strategy that involves close monitoring of the cancer, with a plan to remove the cancer if it ever demonstrates more aggressive behaviour.

Watchful Waiting (WW)

An approach designed to avoid the risks of surgery (radical prostatectomy) and radiation. Often reserved for men with significant health issues or short life expectancy, this management plan includes close monitoring of the cancer, with a plan to start treatment to suppress the cancer once it displays more aggressive behaviour.

Focal Therapy - NanoKnife (non-OHIP)

The NanoKnife, also known as Irreversible Electroporation (IRE) therapy, is an emerging form of focal treatment for prostate cancer. Short pulses of electricity using very high voltage are passed between the electrodes. This causes micropores to occur in all cells, including the cancer cells, which leads to their death.

Only cancer cells are damaged. Other structures, such as the nerves, urethra, and sphincter, are unaffected. Hence, continence and erections are less likely to be affected.

Ask your Urologist at Muskoka Urology about an expedited referral to a NanoKnife provider

Other Resources

Canadian Urological Association: Active Surveillance for Prostate Cancer