Prostate Cancer

Prostate cancer is a form of cancer that develops in the prostate, a walnut-sized gland in men that produces seminal fluid to nourish and transport sperm. It is one of the most common types of cancer in men, particularly in those over age 50. Prostate cancer typically grows slowly and initially remains confined to the prostate gland, where it may cause few or no symptoms and may not cause serious harm. However, while some prostate cancers grow slowly and may need minimal or no treatment, others are aggressive and can spread quickly. Early detection, when the cancer is still confined to the prostate, offers the best chance for successful treatment. Many men with prostate cancer, especially those with slow-growing tumors detected early, may never need treatment and can be monitored through active surveillance. For those who do require treatment, options include surgery, radiation therapy, hormone therapy, and other approaches depending on the cancer's aggressiveness, stage, and the patient's overall health and preferences.

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What Causes It?

Age - Risk increases significantly after age 50, with most cases diagnosed in men over 65.

Race and ethnicity - Higher incidence and mortality in Black men; lower in Asian men.

Family history - Risk is higher if close relatives (father, brother) had prostate cancer.

Genetic factors - Mutations in genes such as BRCA1, BRCA2, and HOXB13 increase risk.

Geographic location - More common in North America, northwestern Europe, Australia, and the Caribbean; less common in Asia, Africa, Central and South America.

Diet - High consumption of red meat and high-fat dairy products may increase risk; while diets rich in fruits, vegetables, and fish may decrease risk.

Obesity - Associated with more aggressive prostate cancer and increased risk of recurrence.

Inflammation - Chronic inflammation of the prostate (prostatitis) may play a role.

Hormonal factors - High levels of androgens (male hormones) may increase prostate cancer risk.

Environmental exposures - Certain chemicals, such as Agent Orange, may be linked to increased risk.

Smoking - May increase risk of aggressive prostate cancer and death from prostate cancer.

Vasectomy - Some studies suggest a small increased risk, though this remains controversial.

Signs & Symptoms

Early prostate cancer often causes no symptoms.

When symptoms do occur, they may include:

Difficulty urinating - Weak or interrupted urine flow.

Increased frequency of urination, especially at night (nocturia).

Difficulty emptying the bladder completely.

Pain or burning during urination.

Blood in the urine or semen.

Painful ejaculation.

Discomfort in the pelvic area.

Bone pain, especially in the lower back, hips, or ribs (usually in advanced cases).

Unexplained weight loss or fatigue (in advanced cases).

Leg swelling or weakness (from advanced cancer pressing on the spinal cord).

Note: These symptoms can also be caused by non-cancerous conditions like benign prostatic hyperplasia (BPH).

How We Diagnose

Our specialists use advanced diagnostic methods to accurately identify and assess your condition

Prostate-Specific Antigen (PSA) Test

A blood test measuring PSA levels, which may be elevated in prostate cancer, though also in non-cancerous conditions. Results are typically considered alongside other factors, as PSA levels can vary based on age, race, certain medications, and medical procedures.

Digital Rectal Exam (DRE)

A physical examination where the doctor inserts a gloved, lubricated finger into the rectum to feel the prostate for abnormalities in size, shape, and texture. Often performed alongside PSA testing as part of screening or initial evaluation.

Prostate Biopsy

If abnormalities are detected by PSA or DRE, a biopsy may be recommended. This involves removing small tissue samples from multiple areas of the prostate, typically using a thin needle guided by transrectal ultrasound. The samples are examined under a microscope to check for cancer cells and determine their aggressiveness (Gleason score).

Transrectal Ultrasound (TRUS)

Uses sound waves to create images of the prostate, helping guide needle placement during biopsy and estimate prostate size. It may show some abnormal areas but cannot definitively diagnose cancer on its own.

MRI Fusion Biopsy

An advanced technique that combines MRI images with real-time ultrasound to guide biopsy needles more precisely to suspicious areas, potentially improving cancer detection rates compared to standard biopsies.

Multiparametric MRI

A specialized type of MRI that creates detailed images of the prostate, potentially helping identify suspicious areas that might require biopsy. Sometimes used before biopsy or to monitor men during active surveillance.

Staging Imaging

If cancer is diagnosed, additional imaging such as bone scans, CT scans, PET scans, or specialized prostate-specific membrane antigen (PSMA) PET scans may be used to determine if the cancer has spread beyond the prostate.

Genomic Testing

Advanced tests examining genes in the cancer cells may help predict how aggressive the cancer is and guide treatment decisions, particularly in borderline cases where the best approach isn't clear from traditional measures.

Treatment Options

Personalized treatment plans tailored to your specific needs and condition

Active Surveillance

For low-risk, early-stage prostate cancer, closely monitoring with regular PSA tests, DREs, and periodic biopsies, without immediate treatment. Treatment begins only if tests show the cancer is growing or changing. This approach aims to avoid or delay the side effects of treatment for cancers that may grow so slowly that they never cause problems.

Radical Prostatectomy

Surgical removal of the entire prostate gland and some surrounding tissues, including the seminal vesicles. This may be performed as open surgery, laparoscopically, or with robotic assistance. The goal is to remove all cancer while preserving urinary and sexual function when possible, though side effects can include urinary incontinence and erectile dysfunction.

Radiation Therapy

Uses high-energy rays to kill cancer cells. External beam radiation delivers radiation from outside the body, while brachytherapy involves placing radioactive seeds directly into the prostate. Modern techniques like intensity-modulated radiation therapy (IMRT) and proton therapy aim to maximize radiation to the prostate while minimizing exposure to surrounding tissues.

Hormone Therapy (Androgen Deprivation Therapy)

Reduces levels of male hormones (androgens) that stimulate prostate cancer growth. Methods include medications that stop androgen production or block their action, or surgical removal of the testicles (orchiectomy). Often used for advanced cancer, before radiation to shrink the tumor, or for recurrent cancer.

Chemotherapy

Anti-cancer drugs that kill rapidly dividing cells throughout the body. Typically used for prostate cancer that has spread beyond the prostate and is not responding to hormone therapy, or in combination with hormone therapy for newly diagnosed metastatic cancer.

Immunotherapy

Treatments that help the immune system recognize and attack cancer cells. For prostate cancer, this includes sipuleucel-T (Provenge), a cellular immunotherapy for certain cases of advanced prostate cancer with minimal or no symptoms.

Targeted Therapy

Drugs that target specific abnormalities within cancer cells. For prostate cancer, these include PARP inhibitors for cancers with certain genetic mutations, particularly BRCA1 or BRCA2, and drugs targeting other specific pathways important for prostate cancer growth.

Focal Therapies

Treatments that target just the cancer while sparing most of the prostate, including cryotherapy (freezing), high-intensity focused ultrasound (HIFU), or focal laser ablation. These are still being studied and are generally considered investigational, though they may be options in specific situations.

Home Remedies

Healthy Diet

Focus on a diet rich in fruits, vegetables, whole grains, and lean proteins. Limit red meat, high-fat dairy products, and processed foods. Some evidence suggests that tomatoes (containing lycopene), cruciferous vegetables (broccoli, cauliflower), green tea, and foods rich in omega-3 fatty acids may be beneficial for prostate health.

Regular Exercise

Maintain an active lifestyle with at least 150 minutes of moderate exercise or 75 minutes of vigorous exercise weekly. Physical activity may help manage treatment side effects, reduce fatigue, improve mood, and potentially slow cancer progression in some cases.

Pelvic Floor Exercises (Kegels)

These can help manage urinary incontinence, a common side effect of prostate cancer treatment. Identify the correct muscles by stopping urination midstream, then practice contracting these muscles for 3 seconds, relaxing for 3 seconds, and repeating 10-15 times, several times daily.

Stress Management

Practice stress-reduction techniques such as deep breathing, meditation, yoga, or guided imagery. Chronic stress may impact immune function and overall health, while stress management can improve quality of life during cancer treatment.

Adequate Sleep

Prioritize quality sleep, aiming for 7-8 hours nightly. Create a relaxing bedtime routine, maintain a consistent sleep schedule, keep the bedroom dark and cool, and limit screen time before bed. Good sleep supports immune function and overall well-being.

Stay Hydrated

Drink plenty of water throughout the day, but consider timing fluid intake if you're experiencing urinary frequency or urgency (common with prostate conditions). Reducing fluids a few hours before bedtime may help minimize nighttime urination.

Social Support

Connect with friends, family, or support groups specifically for men with prostate cancer. Sharing experiences and concerns with others who understand can provide emotional support and practical advice for coping with diagnosis and treatment.

Complementary Approaches

Some men find benefit from acupuncture, massage therapy, or relaxation techniques for managing treatment side effects like pain, fatigue, or anxiety. Always discuss these with your healthcare team, as some complementary approaches may interfere with treatment.

Prevention Tips

Discuss prostate cancer screening with your doctor, particularly if you're over 50 or have risk factors.

For men at higher risk (Black men, those with family history), screening discussions should begin at age 45 or earlier.

Understand the potential benefits and limitations of PSA testing and digital rectal exams.

Maintain a healthy weight through balanced nutrition and regular physical activity.

Eat a diet rich in fruits, vegetables, fish, and plant-based proteins; limit red meat and high-fat dairy.

Consider including tomatoes, cruciferous vegetables, green tea, and foods rich in omega-3 fatty acids in your diet.

Avoid smoking and limit alcohol consumption.

For men undergoing active surveillance, adhere to recommended monitoring schedule.

After treatment, attend all follow-up appointments and complete recommended PSA testing.

Report any new or worsening symptoms to your healthcare team promptly.

Consider participating in prostate cancer research studies or registries.

If you have a family history of prostate cancer, consider genetic counseling to assess your risk.

Maintain open communication with your healthcare team about sexual and urinary function concerns.

For advanced cancer, discuss palliative care options early to optimize quality of life.

Surgical Solutions

Advanced surgical procedures performed by our expert specialists

Open Radical Prostatectomy

Traditional surgical approach where the prostate is removed through a single incision in the lower abdomen or between the scrotum and anus (perineal approach). The surgeon directly visualizes and accesses the prostate and surrounding structures. While this approach has largely been replaced by minimally invasive techniques in many centers, it remains an effective option, particularly for complex cases or when robotic surgery is unavailable.

Robotic-Assisted Laparoscopic Prostatectomy

The most common surgical approach for prostate cancer in many countries. The surgeon controls robotic arms through small incisions in the abdomen, with enhanced visualization through a high-definition 3D camera. This technique offers advantages including improved precision, better visualization, less blood loss, and potentially faster recovery. The robotic system provides increased dexterity and range of motion compared to traditional laparoscopy.

Conventional Laparoscopic Prostatectomy

A minimally invasive approach using several small incisions and specialized instruments, but without robotic assistance. The surgeon directly manipulates the instruments while viewing the surgical field on a monitor. This technique requires significant skill and experience but offers many of the benefits of minimally invasive surgery, though it has largely been superseded by robotic-assisted techniques in many centers.

Nerve-Sparing Prostatectomy

A technique that can be used with any surgical approach, focused on preserving the neurovascular bundles responsible for erectile function. The decision to perform nerve-sparing surgery depends on cancer location, stage, and pre-operative erectile function. This technique aims to maintain sexual function while achieving complete cancer removal, though recovery of function varies considerably among patients and may take up to two years.

Pelvic Lymph Node Dissection

Often performed during radical prostatectomy, this procedure removes lymph nodes in the pelvis to check for cancer spread and guide further treatment decisions. The extent of dissection (standard vs. extended) depends on the patient's risk of lymph node involvement. This additional step is typically recommended for intermediate or high-risk prostate cancer cases.

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