Most people with prostate cancer do not have symptoms until the disease is in its later stages. Symptoms may include:

• Decreased urine flow
• The feeling of not fully emptying your bladder
• Needing to get up often during the night to urinate
• Blood in the urine
• Swelling of the penis, scrotum, legs and feet
• Difficulty getting an erection
• Pain in the hips, thighs, and lower back

Many diseases of the male urinary tract have similar symptoms. If you are experiencing any of the above, please contact your doctor. 

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Early detection of cancer can be key to successful treatment, so it is important to understand what increases your risk of prostate cancer. Current research has shown that key risk factors include:

• Family History: This is the most important risk factor for prostate cancer. Men with one first-degree relative (a father or brother) with prostate cancer have twice the risk of developing prostate cancer. Men with two or three first-degree relatives with prostate cancer have five and eleven times the risk (respectively).
• Age: The risk of prostate cancer increases as men age. After age 50, 30% of men will be diagnosed with prostate cancer. After age 80, this number increases to 60-70%.
• Race and Ethnicity: African-American men have a 70% higher risk of having prostate cancer. They are also more likely to be diagnosed with prostate cancer at higher stages and are more than twice as likely to die of prostate cancer.

arly-stage prostate cancer usually does not cause noticeable symptoms. This makes early detection - which is key to successful treatment - more difficult. Therefore, prostate cancer screening is very important.

At Middlesex Health, we recommend that men begin prostate cancer screening at the following ages:

• Men with Higher Risk: Begin yearly screenings at 40 years old
• Men with Normal Risk: Begin yearly screenings at 70 years old

There are many different recommendations for prostate cancer screening from organizations such as the American Cancer Society, American Medical Association, American Urological Association, and the National Comprehensive Cancer Network. There is also debate over the benefits of screening. The most important step you can take is to discuss screening with your doctors and determine the best plan based on your health and risk level.

Prostate cancer screening and diagnosis takes place using a combination of tests, including:

• PSA (Prostate-Specific Antigen): A test to determine the level of this protein in the blood. It is produced by healthy and cancerous prostate cells, and it is often elevated in men with prostate cancer.
• DRE (Digital Rectal Exam): A test in which your doctor inserts a gloved, lubricated finger into the rectum to feel the prostate, which lies in front of the rectum.
• UroNav MRI-Guided Biopsy: Middlesex Health offers UroNav, an innovative way to do prostate biopsies. UroNav combines regular ultrasound images with MRI images taken before the biopsy. This creates clear pictures of the prostate and possible cancers. With UroNav, doctors can take biopsy samples from specific spots, which reduces the number of biopsies needed for diagnosis. Unlike traditional biopsies that use only ultrasound images to guide the needle and choose which parts of the prostate to sample, UroNav's MRI-guided biopsy is much more precise. This lowers the chance of missing a cancer and needing extra biopsies. UroNav brings less stress and pain to patients by making the process more targeted. 

There are many ways prostate cancer can be treated, and the evidence-based plan your doctors choose is based on a number of factors: type of cancer, grade and stage of the cancer, your overall health, and your treatment preferences. Doctors will also consider your PSA value and how fast it is increasing.

Active Surveillance (Watchful Waiting)

If your prostate cancer is determined to be low-risk, the best course of action may be to postpone treatment and watch carefully to see if the disease progresses.

• What is a low-risk cancer? 

• A low-risk prostate cancer either grows very slowly or not at all. It is not an agressive form of prostate cancer. 

• What is the benefit of postponing treatment?

• In cases of low-risk cancer, treatment may be postponed in order to avoid over-treatment.  Some patients can avoid surgery or radiation all together. 

• What if my prostate cancer starts to advance/progress?

• Your doctor will closely monitor your cancer. If there are changes, which would show up in repeat PSA testing, DRE testing, or biopsies, your doctor will develop an appropriate treatment plan.

• Is there scientific evidence supporting this approach? 

• Yes, the American Urological Association and the National Comprehensive Cancer Network recommend active surveillance in carefully-selected cases.

Surgery

The expert physicians at Middlesx Urology Group provide surgical treatment for prostate cancer patients at Middlesex Health. Surgical options include:  

• Radical Prostatectomy: A treatment for localized cancer (in or near the prostate) that includes removal of:
• the prostate
• some surrounding tissue (if needed)
• nearby lymph nodes in the pelvis (if needed)
• daVinci® SI Robot-Assisted Surgery: A robotic system used by specially trained Middlesex Health Surgeons to complete complex surgeries through just a few tiny incisions.

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Medical Oncology

• Hormone Therapy: Androgen Deprivation Thearpy (ADT)
• Some male hormones, such as testosterone (an androgen), feed the development and growth of prostate cancer. Removing or blocking these hormones will cause most prostate cancers to shrink.  
• Anti-androgens are available as oral or injectable medications.
• Orchiectomy, or surgical removal of the testicles, is also an option for men with advanced disease or who do not want long term medical thearpy. Because testicles produce the body's testosterone, there removal immediately causes the body's hormone levels to drop.
• Chemotherapy & Immunotherapy

• Chemotherapy for prostate cancer involves the use of medications to shrink or kill cancerous cells. These medications may be taken intravenously (IV) or as pills.

  The board-certified medical oncologists, nurses, and technicians at Connecticut Oncology Group provide the most effective, advanced care with warm, personal attention and support for patients and their families. Your medical oncology team will work closely with your other providers and help provide access to clinical trials.

Radiation Oncology

Radiation oncology is the highly-controlled use of radiation to cure or treat symptoms of your cancer.

Learn more about radiation therapy options at Middlesex 

Alternative Treatments

• High-Intensity Focused Ultrasound (HIFU): A treatment that destroys prostate cancer using ultrasound. This is an outpatient procedure under ultrasound guidance and general anesthesia. 
• Cryotherapy: This method destroys prostate cancer by freezing it. Middlesex Health does not offer this service; if you are interested, please speak with your doctor.

Robot-assisted prostate surgery is a high-tech method for radical prostatectomy. Radical prostatectomy is used for localized cancer (in or near the prostate), and it involves the removal of:

• The prostate
• Some surrounding tissue (if needed)
• Nearby lymph nodes in the pelvis (if needed)

The da Vinci® Robot allows your surgeon to be incredibly precise. This means that the delicate nerves near the prostate can be preserved so that you can maintain as much urinary control and sexual function as possible.

The da Vinci® system includes a powerful, high-definition camera that gives the doctor crystal clear 3D images of the surgical area. The ability to see fine anatomical details is key to nerve preservation.

Men with prostate cancer that is localized to the prostate gland (has not spread in the body) may be candidates for robot-assisted surgery.

Your physician will review your treatment options with you, and together you will determine the best course of action.

Orchiectomy, or surgical removal of the testicles, is also an option for men with advanced disease or who do not want long-term medical therapy. Because testicles produce the body's testosterone, their removal immediately causes the body's hormone levels to drop.

If your prostate cancer is determined to be low-risk, the best course of action may be to postpone treatment and watch carefully to see if the disease progresses.

What is a low-risk cancer? 

• A low-risk prostate cancer either grows very slowly or not at all. It is not an aggressive form of prostate cancer. 

What is the benefit of postponing treatment?

• In cases of low-risk cancer, treatment may be postponed to avoid over-treatment. Some patients can avoid surgery or radiation altogether. 

What if my prostate cancer starts to advance/progress?

• Your doctor will closely monitor your cancer. If there are changes that would show up in repeat PSA testing, DRE testing, or biopsies, your doctor will develop an appropriate treatment plan.

Is there scientific evidence supporting this approach? 

• Yes, the American Urological Association and the National Comprehensive Cancer Network recommend active surveillance in carefully selected cases.

Chemotherapy for prostate cancer involves the use of medications to shrink or kill cancerous cells. These medications may be taken intravenously (IV) or as pills.

Radiation oncology is the highly-controlled use of radiation to cure or treat symptoms of your cancer.

Middlesex Health's Radiation oncologists may use an innovative new product called SpaceOAR® hydrogel to provide a more effective treatment. 

SpaceOAR®* is an injectable gel that is naturally eliminated from the body over time. When injected, the gel creates about one centimeter (1/2 inch) of extra space between the prostate and the rectum, which gives the radiation oncologists more room to treat the prostate.

Radiation therapy targets tumors—but it can also impact nearby healthy tissue. Because the prostate and rectum are very close together in the body, there is a risk that the rectum can be damaged during treatment. This damage may result in side effects such as bleeding, diarrhea, discomfort, and more.

The extra room around the prostate created by SpaceOAR® gel means that you have:

• The ability to receive higher, more effective doses of radiation
• Decreased chance of bowel and rectal injury, which can lead to bleeding and diarrhea during radiation
• Reduced risk of urinary incontinence

It is important to remember that every patient—and every cancer—is unique. This means that your doctor will determine whether SpaceOAR® is appropriate for your customized treatment plan. If SpaceOAR® is not right for you, your doctor will share why and will explain the options that are best—and safest—for you.