Learning about prostate cancer can be a scary and overwhelming undertaking for you or a loved one, regardless of whether you’re researching the topic proactively or seeking to find out more about a recent diagnosis. You’re likely filled with questions like:

• What is my risk of developing prostate cancer?
• Is there more than one type of prostate cancer?
• What does testing look like, and when should I start?
• If I am diagnosed with prostate cancer, what are my treatment options?
• Will there be any side effects of the treatment, and if so, how will my quality of life be impacted?
• Who should I turn to for support in my care?
  
  

With so much information online, it can be hard to find all the answers you need for these questions and more in one spot. We at Greater Boston Urology understand this and want to make this daunting task is as manageable as possible. 

In this guide, we’ll share some of the basics around prostate cancer, from the different types to the common risk factors, testing to treatment options, and how your specialized care team can support you throughout the entire process. However, it’s important to remember that each diagnosis is unique and that your doctor will be best able to advise on your care. 

The Facts About the Prostate and Prostate Cancer

Located beneath the bladder, the prostate is a walnut-sized gland that plays a vital role in a man’s reproductive health by creating fluids that protect and nourish sperm. As a man ages, his prostate changes, often becoming larger. This doesn’t necessarily mean that he has prostate cancer, as there are benign reasons for this change, like benign prostatic hyperplasia, or BPH.

Each year, about 13 out of every 100 men will receive a prostate cancer diagnosis, and it’s the second most common cancer in American men, with skin cancer being the first. Like with most things related to our health, it’s important to see your doctor often to ensure early detection. 

Though all men or those with a prostate are at risk of developing prostate cancer, it is rare for those under the age of 40. The risk increases once you reach 50 years old, and the majority of prostate cancer cases are found in those over the age of 65.

According to the most recent numbers, the relative survival rate for prostate cancer patients is high. Over 97% of those with prostate cancer were still alive within five years of their diagnosis. And while each case is different, not every type of prostate cancer requires treatment. 

Early detection can make all the difference in any cancer diagnosis, so knowing when to start screenings and how often you should get them is one of the best methods to follow.

Types of Prostate Cancer and Symptoms

Nearly all types of prostate cancers are adenocarcinomas, which means they develop from the gland cells that line the prostate. These cells are the ones that make the prostate fluid, which is then added to the semen. The vast majority of prostate cancer patients have this type of cancer.

Though rare, there are other types of prostate cancer:

• Small cell carcinomas: Affecting less than 2% of prostate cancer patients, this rare type of cancer grows more quickly than others and is similar to small cell carcinomas found in the lungs.
• Transitional cell carcinomas: Accounting for 2-4% of all prostate cancer cases, this type spreads from the bladder to the prostate (or, more rarely, from the prostate to the bladder).
• Neuroendocrine tumors: These tumors develop in response to electrical signals from the nervous system and are found in the cells that produce hormones in the prostate.
• Sarcomas: This tumor develops in connective tissues in and around the prostate.

Stages of Prostate Cancer

Staging is used in many cancer diagnoses to describe how far cancer has spread. For prostate cancer, there are four stages commonly used, though these may be split up further. In these instances, the higher the number and letter, the more the cancer has spread. Though each person’s cancer journey is unique, cancers with similar stages often have a similar outlook and receive similar treatments.

The graph below is meant to provide some general information about each of the four stages.

A more in-depth graph about these stages, as well as their related substages, can be found here. 

Common Risk Factors of Prostate Cancer

Though we continue to learn more about the disease every day, there are some common factors that increase your risk. Like many other types of cancer, some of the common risk factors include age, family history, and diet. Those over the age of 50 are at greater risk, as well as those who have a first-degree relative (father, son, or brother) who was diagnosed with prostate cancer. Men who have high-fat diets or have the BRCA gene mutation have also been found to be at a higher risk.

Additionally, Black Americans are nearly twice as likely as others to develop prostate cancer and get it at a much younger age. Black men also have a higher instance of being diagnosed with advanced disease. Though the reason for these differences is unclear, studies show that it may be connected to socioeconomic status as well as racial bias in the healthcare industry, further emphasizing the importance of early detection. It’s recommended that Black men start their screening as early as 40.

ZERO Prostate Cancer, a national non-profit focused on prostate cancer prevention and education, put together a guide for Black men to help navigate prostate cancer screenings, diagnosis, and care. Read it here. 

Testing and Screening for Prostate Cancer

Your primary care doctor does this testing, but they might recommend you see a specialist, depending on your results. There are common tests routinely done for screening: the digital rectal exam (DRE) and a prostate-specific antigen (PSA) blood test.

For the latter, it’s important to remember that an elevated PSA doesn’t necessarily mean that you have prostate cancer. It’s not uncommon for this level in the body to naturally rise as you age, but your doctor may advise additional testing to get a better understanding of why these levels have risen.

“Really, part of the screening of prostate cancer with the PSA is to parse out whether the elevated PSA is more likely due to a malignant disease or more likely due to a benign disease.” - Dr. Michael Geffin. 

So, what happens if your doctor recommends additional screenings for prostate cancer? 

There are various options out there, and your urologist will explain which is best for you. They may use only one or a combination of a few to ensure the most accurate picture. Some of the most common methods are listed in the table below. 

“With prostate cancer, we can definitely change the course of the disease by screening men early and often. If they get treated early, the long-term survival will be impacted in a positive way.” - Dr. Michael Geffin.

While each test has its advantages and disadvantages, it will help your doctor create a treatment path that is most advantageous should a patient be diagnosed with prostate cancer by telling them exactly what type they have and where it’s located.

Prostate Cancer Treatment Options

Once a diagnosis is found, your urology team will work with you to plan out a treatment path that works with your needs and the type of prostate cancer you have. No two treatment plans may look alike, and in some cases, you may decide to opt for a wait-and-see approach.

“Standard care for treatment involves multiple depending on the individual and the prostate cancer. They can be led to either having surgery or radiation (which there are a number of forms). Some men option for watchful waiting and doing nothing [for the time being].” - Dr. Michael Geffin

Some of the common treatment paths used by the team at Greater Boston Urology are:

• Active surveillance, which is primarily used by those in the early stages of prostate cancer and includes scheduled biopsies and tracking molecular markers, such as the OncotypeDX Prostate Cancer Test.
• Radical prostatectomy which is used in cases of later-stage prostate cancer. This procedure involves removing the prostate and reconnecting the bladder to the urethra.
• External or internal radiation (the latter is known as brachytherapy or radioactive “seeds”).
• High intensity ultrasound energy, or HIFU, which involves using concentrated energy to treat the cancer and destroy the cancerous tissue.
• Focal cryotherapy, which is a targeted approach that freezes the cancer cells in the prostate.

For those dealing with advanced prostate cancer, the idea of starting treatment may be both overwhelming and frightening. In these cases, treatment options can vary widely and are based on each patient’s unique case and needs. Your doctors will work closely with you to determine which method might be right for you. These may include one or more of the following:

• Chemotherapy
• Hormone therapy
• Immunotherapy (PROVENGE)
• Antibody to PSA treatment, which uses radiotherapy to target the cancer cells in the PSA.

Each treatment may have different side effects, and your urologist will do their best to try to make them minimal. The two most common are incontinence (trouble controlling your bladder) and erectile dysfunction. It’s understandable if these potential changes also impact your mental health and/or personal relationships. Should they occur, your doctor will walk you through how to manage them as well.

Additional Resources for Managing Side Effects Can Be Found Here

Questions to Ask Your Doctor About Prostate Cancer

As we’ve talked about before, our goal with this guide is to help ensure you have the information you need to feel confident dealing with your prostate cancer diagnosis. Your urologist will likely proactively answer many of these questions during your appointments, but knowing what to ask can provide some peace of mind. Along with any specific ones you may have, like how your job may be impacted, these can help guide your conversation with your urologist.

After a Prostate Cancer Diagnosis

• Do I need to start treatment at this time, or should we monitor it with active surveillance? If the latter, how often should I be retested, and what kinds of tests should I do?
• What other tests should I do before we start talking about a treatment plan?
• Does it appear that the cancer has spread beyond my prostate? If so, how does this impact potential treatment plans?
• What stage and risk groups does my cancer fall into? What does this mean for me going forward?

Before and During Prostate Cancer Treatment Plan

• Are there any lifestyle changes I can make to help improve the success of my treatment, like dietary changes or exercise?
• If I have questions about costs and insurance coverage, who should I speak with?
• What are the pros and cons of the treatments you’re recommending for me?
• How long will treatment last, and what will it be like?
• Am I eligible for any clinical trials that you would recommend?
• How will we know if my treatment plan is working?
• Are these symptoms or side effects I should make you aware of immediately? If so, what’s the best way to get in contact after hours, or on holidays or weekends?
• What activities should I avoid, and is there any limit to what I can do?
• What side effects should I expect, and what steps can I take to manage them should they occur?
• Do you have any recommendations for support groups or mental health professionals I can talk to if I start to feel overwhelmed or depressed?

After Prostate Cancer Treatment

• How often should I follow up with you to check if my cancer has returned? What kind of tests will be done?
• What side effects should I alert you of if they occur?
• Does it seem like my cancer is likely to come back, and if so, what signs should I be looking out for?
• What are my options should it return?
• Are there any steps I should take to help support my body holistically now that treatment is over?

Note that these are just some of the questions you may ask, and other members of your care team, like nurse practitioners, can help answer them. 

Prostate Cancer Stories: Jim Anderson

Jim Anderson first came to Greater Boston Urology after his primary care doctor noticed his PSA levels had risen over the course of a few months and recommended that he look into getting a biopsy. From his own research, Jim found an option that really resonated with him: an MRI-guided, or Fusion, biopsy. Because of its precision and, thus, the peace of mind it brought, he knew this was what he wanted to seriously discuss this option with his urologist, Dr. Michael Curran.

“They didn’t have that at that practice, so they sent me to Greater Boston Urology and, more specifically, to Dr. Curran,” Jim said. 

For this procedure, Jim first got an MRI that was combined with an ultrasound so that Dr. Curran could see exactly where to pull a sample for the biopsy. All in all, the procedure was about ten minutes long, and Dr. Curran determined that Jim had a small, slow-growing speck of cancer. After walking him through what this meant, Dr. Curran assured Jim that the best approach was to monitor it over time and only seek additional treatments if it continued to grow.

With so much specific information about his cancer and an understanding of what the next steps would look like, Jim felt confident in following Dr. Curran’s recommendations. 

“That made me feel more comfortable,” Jim said.

When seeking help for additional prostate-related issues, Jim continued to work with his team at Greater Boston Urology. His experience showed that they treat patients holistically and look at how everything works together to give them the best quality of life going forward.

Dr. Curran also discovered small crystals forming on the inside of Jim’s bladder, which were causing urinary problems like a slow flow and frequent urination during the night. Dr. Curran told him that these crystals would eventually turn to stones if left untreated and would be painful to pass. To help open up the pathway in his prostate and allow urine to flow more freely, Jim underwent the transurethral resection of the prostate (TURP) procedure. 

Like when he was undergoing his biopsy, Jim felt well prepared for what to expect before, during, and after the procedure.

“There was no pain at all, just some minor discomfort that Tylenol could take care of,” Jim said. “I was just so happy that it was pain-free and that it worked.”

Researching care options or practices to work with, Jim said the process can cause a lot of fear. But he advises anyone starting this research to review reputable resources and find practices known for top-quality care, like Greater Boston Urology. This, he believes, has made all the difference in improving his prostate health. 

“They’re the best that there is and so you’ve got every confidence that the procedure will be done well, and you’ll be very well taken care of.”

Hear More About Jim's Story

How GBU Can Help

Whether you’ve already received a diagnosis, are looking for a second opinion, or just want a preventive check-up, our board-certified urologists are here to help and be with you every step of the way. Our work is centered around our patients and their unique situations, and we ensure they have all the information they need from their first appointment.

Contact Greater Boston Urology today to discuss your options by visiting our website or calling (855) 505-3335. With nine locations throughout eastern Massachusetts, we make it easy for you to find an appointment close to home so you can easily get in and get out.