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Prostate cancer is the growth of malignant cells in the prostate, a walnut-sized male sex gland that surrounds the urethra. It is the second most common cancer among older American men – one in six will be diagnosed during his lifetime. Thanks to modern detection methods and innovative treatments, the five-year survival rate for men with prostate cancer has increased from 73 percent to 99 percent in the past 30 years.
It is important that you choose an experienced medical team to treat your prostate cancer. Leading the way, with advanced training and years of practice are our urologic surgeons, who perform all of the surgery for urologic cancers at Dana-Farber Brigham Cancer Center. In their role as surgical oncologists, they collaborate with a group of internationally renowned experts, creating an individualized care plan – just for you.
Factors that contribute to an increased risk for developing prostate cancer include:
The prostate gland produces a substance called PSA, prostate specific antigen. A simple blood test checks PSA levels. Even among those with PSA levels less than one, the chance of prostate cancer is 10 percent. In 2012, the U.S. Preventive Services Task Force recommended against PSA screening. As a result, PSA screening rates have decreased in the US, as first shown by work done by BWH Urology researchers. Dr. Adam S. Kibel, chief of urology at Brigham and Women’s Hospital, however, believes that PSA screenings save lives. Since PSA testing began in the 1980s, prostate cancer deaths have been reduced by 10,000 men per year. Before PSA screening, prostate cancer claimed over 40,000 lives annually; now, prostate cancer claims fewer than 30,000.
Dr. Kibel said the task force based its recommendation on U.S. and European prostate cancer trial results. In his opinion, the U.S. trial did not adhere to proper test controls, screening men who were not recommended for screening. In the European trial, screening procedures were followed correctly. The larger European trial showed a clear benefit for PSA screening with a 20 percent decrease in the risk of prostate cancer deaths.
Brigham and Women’s Hospital PSA Recommendations:
BWH physicians continue to research new markers that could identify men at risk for prostate cancer.
Since most men do not present with symptoms, prostate cancer may not be discovered in its early stages. Signs and symptoms of advanced prostate cancer may include:
After 50, men should discuss pros and cons of testing with their doctor. If they are African American or have a father or brother who had prostate cancer before 65, they should have this meeting with their doctor at age 45. Screenings include:
How often men are tested will depend on their PSA level.
If prostate cancer is caught early, the prognosis is excellent. Men with symptoms of advanced disease, elevated PSA levels, or enlarged prostates may also have these diagnostic tests:
After a biopsy confirms prostate cancer, the cancer grade and stage will be determined based on the aggressiveness of the cancer and whether it is confined to the prostate or has metastasized (spread to structures beyond the prostate).
Our multidisciplinary team will manage your care in a personal and individualized way. Treatment options depend on your age, overall health, disease aggressiveness, potential adverse effects and your personal preferences. BWH urologic surgeons often recommend a combination of innovative treatments to ensure the best possible outcome for prostate cancer patients. Treatment may include:
Men with localized prostate cancer have many options to treat this disease. The standard surgical treatment for men with intermediate and high-risk prostate cancer is radical prostatectomy to remove the entire prostate gland. On the other end of the spectrum, men with low-risk prostate cancer may opt for active surveillance to avoid possible side effects of treatment, including urinary incontinence (being unable to control urine) and erectile dysfunction (problems getting or keeping erections). Focal therapy such as HIFU is a middle path for some men with low risk, and low-volume, intermediate risk prostate cancer who want a less intensive treatment than surgery but who aren’t suitable for (or are unwilling to pursue) active surveillance. It can also be used in selected cases for men who have recurrent cancer after radiation.
HIFU is non-invasive image guided procedure performed under general anesthesia. The procedure uses high-intensity ultrasound waves to heat and destroy prostate tissue under image guidance. For men with small prostate cancers, HIFU can be used to treat only the area of the prostate with cancer. Because it leaves a portion of the prostate gland untreated, HIFU is generally associated with fewer side effects than traditional surgery, radiation or chemotherapy. Because it only treats a small area of the prostate, men who choose HIFU will need to be followed with PSA checks and MRIs and a portion of them will need repeat treatments.
If your urologic surgeon has recommended HIFU as a treatment option, please first check with your health insurance provider to confirm this procedure will be covered under your insurance plan.
Watch video case study of a robotic-assisted radical prostatectomy.
As you go through treatment for prostate cancer, it is critical that you communicate with your physician so that you have the most accurate information available. We recommend that you bring a loved one or friend with you during initial appointments to help you absorb all the information you will receive. Here are 12 questions to pose to your urologist:
You will receive a thorough diagnostic evaluation and receive clinically-proven treatment by a board-certified urologist who specializes in prostate cancer. Your experience post-treatment will vary depending upon the stage of your cancer. Early detection and the involvement of an experienced urologic surgeon are important to the successful outcome for prostate cancer treatment. After treatment, routine life-long surveillance is necessary.
Read patient stories to learn about the experiences of prostate cancer patients.
In this video, Anthony D'Amico, MD, PhD, Chief of Genitourinary Radiation Oncology, discusses the criticality of determining a prostate cancer patient's risk level to determine the appropriate prostate cancer therapy. Read the video transcript about why determining a prostate cancer patient's risk is critical to determining the appropriate prostate cancer therapy.
Brigham and Women’s Hospital (BWH) practices a multidisciplinary approach to patient care, collaborating with colleagues in other medical specialties. Dana-Farber Brigham Cancer Center gives you access to the world’s best cancer experts. The Division of Urology’s surgical oncologists work hand-in-hand with medical oncologists and radiation oncologists to create an individualized care plan. Specialists also include radiologists, pathologists, nurse specialists, social workers, palliative care specialists and dietitians.
To learn more about our cancer partnership, visit the Dana-Farber Brigham Cancer Center.
BWH’s Division of Urology is dedicated to expanding the boundaries of medicine through research.
Adam S. Kibel, MD, Chief of Urology and an internationally-regarded expert in prostate cancer treatment, is leading biomarker studies. The ability to accurately identify cancer risk is critical, since no two tumors and no two cancer patients are alike. Biomarkers are indicators of a disease state, such as a rising prostate-specific antigen (PSA). PSA screenings can help identify prostate cancer. Biomarkers also help clinicians more precisely define a patient’s risk and potential benefit. Dr. Kibel and his colleagues are developing and validating additional biomarkers that can more effectively detect prostate cancer as well as other urological cancers. During Dr. Kibel’s time at Washington University in St. Louis, where he was the Director of Urology Oncology, he investigated several tumor markers and genetics. His studies examining microvesicles (fragments of plasma membrane) and PCA3 (a prostate cancer biomarker) provide new ways to identify patients at risk, saving many from biopsies and unnecessary treatment. Dr. Kibel plans to use his research results to advance the study of prostate cancer at BWH while also growing a prostate cancer patient database to conduct new investigations into diagnosis and treatment.
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