Small tumors and low-grade prostate cancer usually grow very slowly. Active surveillance for prostate cancer is a management strategy where the cancer is closely monitored rather than treated immediately - so no side effects. (Two of our Board members are on Active Surveillance - one of them for more than ten years.) 

Sometimes called “Watchful Waiting,” Active Surveillance is an approach in which a you and your medical provider actively monitor your condition, allowing time to pass before medical intervention or therapy is used. During this time, repeated testing may be performed - regular PSA testing and MRIs.

Hormone Therapy (also called Androgen Deprivation Therapy), is the use of medication or surgery (removal of testicles) to prevent cancer cells from getting the hormones needed to grow. In prostate cancer this means the hormone testosterone.

Methods include:

- LHRH agonists/antagonists

- Anti-androgens

- Orchiectomy (surgical removal of testicles)

While not cancer, BPH can cause similar symptoms to prostate cancer, including:

- Frequent urination, especially at night

- Weak urine stream

- Difficulty starting urination

- Feeling that the bladder isn't completely empty

A sample of tissue is taken from the body to be examined microscopically to ascertain if cancer is present. A doctor will recommend a biopsy when an initial test suggests an area of tissue in the body isn’t normal. It is the most important procedure in diagnosing cancer.

At PFOC, we have strong opinions about biopsies: if you're going to have a biopsy, get an accurate one. Until recently, most biopsies were systematic, meaning that a fixed pattern of samples (usually 12) were taken, hoping these were enough to find any cancer that might be present. In effect, that approach is random, and current guidelines prefer a targeted or fusion biopsy that uses MRI to target suspicious areas. You may have to insist on a targeted biopsy with some doctors.

The most common type is a transrectal ultrasound-guided (TRUS) biopsy, where 12-14 tissue samples are typically taken. Newer methods include:

- MRI-guided biopsy

- Fusion biopsy (combining MRI and ultrasound)

- Transperineal biopsy

Inhibits bone loss and fractures and relieves pain from prostate cancer in the bone.

Targets cancer cells that grow quickly including cancer cells metastasized to the bone.

Digital Rectal Exam (DRE) Finger wave! A health care provider inserts a gloved, lubricated finger into the rectum and examines the prostate for any irregularities in size, shape and texture.

Inability to have an erection suitable for intercourse. May be a result of an injury secondary to radiation therapy, surgical resection of the prostate, hormonal deprivation therapy, or other aspects of neurological, vascular or disease processes.

Common after prostate cancer treatment, particularly following surgery or radiation. Management options include:

- Oral medications (PDE5 inhibitors)

- Vacuum erection devices

- Penile injections

- Penile implants

- Counseling and sexual therapy

The FREE PSA test measures the percentage of unbound PSA; the PSA test measures the total of both free and bound PSA.

First an MRI looks for suspicious lesions. This is followed by a targeted biopsy to examine the suspect lesions.

How it works

A doctor first obtains an MRI of the prostate to identify suspicious areas, then uses a special device to fuse the MRI images with real-time ultrasound images during the biopsy.

Benefits

Helps doctors avoid missing aggressive prostate cancer, and may help find cancer at an early stage

Procedure

Outpatient procedure performed under local anesthesia that typically takes about 20 minutes

Risks

Possible side effects include difficulty urinating, bleeding, infection, pain, and allergic reaction

Compared to traditional core needle biopsies, which use random sampling, MRI fused ultrasound biopsies can help doctors avoid missing hard-to-find prostate cancer. The procedure can also help minimize the overdiagnosis of non-aggressive cancers.

Genetic testing (germline testing) in prostate cancer is important because an inherited gene mutation may be responsible for up to 10% of all prostate cancers. A family history increases a man’s risk for prostate cancer by up to 60%. 

How it's done

Genetic testing requires only a sample of your DNA, usually from a cheek swab or saliva. The collected sample is sent to a genetic testing laboratory. Technicians extract DNA from the sample and use various techniques to look for specific genetic changes, such as mutations in genes, changes in chromosomes, or variations in proteins.

1. Results:The results are usually available within a few weeks. They are sent to your healthcare provider or genetic counselor, who will explain what the results mean and discuss any next steps3.

2. Follow-Up:Depending on the results, you may need further testing or consultations with specialists.
   Genetic counseling is often recommended to help understand the implications of the test results for you and your family.
   

Risk Assessment: Identifies genetic mutations that may increase the risk of prostate cancer, helping to determine if an individual is at higher risk due to inherited factors.
Personalized Treatment: Helps in tailoring treatment plans based on the genetic profile of the cancer, potentially improving treatment outcomes.
Family Planning: Provides information that can be useful for family members, as certain genetic mutations can be inherited.
Key genes include:

- BRCA1 and BRCA2: DNA repair genes

- HOXB13: Developmental regulation gene

- ATM: Cell cycle checkpoint gene

- CHEK2: Cell damage response gene

Implications:

- May affect family member screening

- Can influence treatment decisions

- May qualify patients for specific clinical trials

- Important for precision medicine approaches

Genomic testing for prostate cancer (also called Biomarker testing or somatic testing) involves analyzing the genetic material (the entire genome) of prostate cells. It allows you and your medical team to make informed decisions about management and treatment of the disease.

Biomarker testing can be especially helpful for people who are newly diagnosed with prostate cancer that's still confined to the prostate. Genomic tests can cost between $3,800 and $5,000, but are usually covered by Medicare and some private insurers.

Important mutations include:

- PTEN loss

- TP53 mutations

- TMPRSS2-ERG fusion

- AR amplification

- DNA repair defects

Applications:

- Treatment selection

- Prognosis assessment

- Clinical trial eligibility

- Resistance monitoring

A Gleason score is a number (usually assigned by a pathologist) that describes the grade of prostate cancer and helps determine treatment options. A pathologist assigns a grade from 1 to 5 to the two most predominant cancer patterns in your biopsy and adds the two grades to give the  Gleason Score. In practice, scores are often expressed as a sum (e.g. 3+4, 4+3 indicating intermediate favorable and intermediate unfavorable).

A subjective method of measuring the differentiation of cells to classify tumors by their microscopic appearance and how aggressively the cancer cells may multiply. This system divides prostate cancer into five histological patterns ranging from 1-5. Patterns 1 and 2 represent well- differentiated tumors and are dealt with more easily; Gleason patterns 3 represents moderately well-differentiated tumor cells beginning to scatter; Gleason patterns 4 and 5 indicate poorly differentiated cells with the potential for fast growth. The total Gleason score is determined by adding a primary and secondary score pattern for each prostatic lesion i.e. 3+4=7. The most well-differentiated cancer cells would consist entirely of Gleason pattern 1 ( primary +secondary + 1+1 or Gleason 2 ) and the most poorly differentiated cancer cells would have a 5+5 or total Gleason score of 10.

This is an indication of the risk of your cancer, from Low (Group 1) through Intermediate (Grades 2 and 3) to High (Groups 4 and 5)

The stage of your cancer looks at where the cancer is present in your body. The grade of your cancer describes what the cancel cells look like under a microscope. See Gleason Score and Grade Group