A Patient's Guide to Prostate Cancer
Because cancer is a daunting word, let alone journey, we’ve created this guide to help you understand what it may mean for you or your loved ones.
Not necessarily. The treatment path you take depends on the potential development of the tumor. To understand your risk profile, the urologist assesses different facets of the tumor which are calculated using imaging and biopsy data. The first is its aggressiveness. This is measured on a scale called the Gleason Grading System. The second is its stage which is scored on the TNM system. This determines the location of the tumor (T), if it’s spread to nearby lymph nodes (N) and if it has spread (metastasized) to other parts of the body. A high Gleason grade and/or advanced stage likely means it’s time to move forward with severe interventions.1
To best guide you, your doctor will consider other factors such as your age, genetics, overall health and willingness to endure potential side effects of a given treatment. In all cases, get a second opinion. Most men with newly-diagnosed prostate cancer should be seen in consultation with a radiation oncologist and a urologist. A multidisciplinary prostate cancer care team can provide you with a full view of the available treatments and outcomes.2
If the prostate cancer is not clinically significant or invasive, your doctor may not recommend any treatment at all. Active surveillance is a management strategy built to closely monitor the cancer via DRE, PSA and imaging in order to avoid unnecessary side effects of treatment. Curative treatment may only be prescribed if the cancer shows signs of progression.1
This stealthy method uses targeted non-ionizing ultrasonic waves to create heat that destroys prostate cancer cells. The procedure is minimally invasive and has minimal potential side effects. HIFU has been recently approved by the FDA for prostate tissue ablation.2
This involves the partial or complete removal of the prostate, called a prostatectomy, by a surgeon or a robot, or overseen by one. This option is suitable for men who’s aggressive risk is too high, or his tumor risk is low and just prefers peace of mind.2
Radiation interferes with cell division by zapping the cells in a localized area with high energy rays. Because both normal and cancerous cells are affected, the treatment is given in small doses over a period of eight weeks. Men with low risk tumors may only require radiation, whereas those with more risky tumors may couple radiation with androgen deprivation therapy (ADT); a series of drugs that prevent the production of testosterone. This causes the prostate to shrink and the cancer cells go dormant, making them easier to eliminate.1
Cryotherapy (aka cryosurgery or cryoablation) uses extremely cold temperatures, via liquid injection, to freeze and rupture prostate cancer cells, usually with some collateral damage to normal tissue. Even though it is sometimes called cryosurgery, it is not actually a type of surgery. Cryotherapy may be an option for men with low-risk early stage cancer and for those who’ve undergone unsuccessful radiation therapy.9
The common side effects of surgery and radiation are incontinence and erectile dysfunction, which can last for weeks, months, even years. But fear not, you can always talk to your doctor and get a prescription for the little blue pill. Most men will experience both, but the severity will depend on the aggressiveness of the tumor and the intensity of treatment. Active surveillance can be a stressful waiting game, which carries its own risks. There’s a chance the tumor grows in unexpected ways. Each treatment has its downfalls, so talk to your doctor to figure out what’s best for you.1
1 Sullivan, E. (2018, May 08). An Optimist’s Guide To Your Prostate. Esquire. Retrieved from esquire.com
2 Prostate Cancer Canada (2018). About Prostate Cancer. Retrieved from prostatecancer.ca
3 Canadian Cancer Society (2018). Risk factors for prostate cancer. Retrieved from cancer.ca
4 Canadian Cancer Society (2018). Transrectal Ultrasound (TRUS). Retrieved from cancer.ca
5 Harvey, C. J., Pilcher, J., Richenberg, J., Patel, U., & Frauscher, F. (2012). Applications of transrectal ultrasound in prostate cancer. The British Journal of Radiology, 85(Spec Iss 1). doi:10.1259/bjr/56357549
6 John Hopkins Medicine (2017, January 01). Targeted Biopsy: A Smarter Way to Take Prostate Tissue Samples. Clinical Connection. Retrieved from clinicalconnection.hopkinsmedicine.org
7 Ferrari, N. Improved magnetic resonance imaging (MRI) may aid detection of prostate cancer (2009, March). Harvard Health.
Retrieved from health.harvard.edu
8 Bjurlin, M. A., Rosenkrantz, A. B., & Taneja, S. S. (2017). MRI-fusion biopsy: the contemporary experience. Translational Andrology and Urology, 6(3), 483-489. doi:10.21037/tau.2017.04.30
9 American Cancer Society. (2019, August 1). Cryotherapy for Prostate Cancer.