Prostate cancer occurs when prostate cells grow out of control. It is important to note that an enlarged prostate due to an increase in the number of normal prostate cells (benign prostatic hyperplasia) is not a form of cancer.

Our online Learning Center has up-to-date, evidence-based information about numerous topics related to prostate cancer, including diagnostic tests, treatment options, management of treatment side effects, and more.

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These resources are not a substitute for the guidance of your physician but can help you learn more about prostate cancer and what to expect during treatment. All content is provided courtesy of the Mayo Clinic Health Library.

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).
• A number of genes have been implicated in prostate cancer, including the BRCA-2 gene. BRCA-2 is known to cause breast and ovarian cancer in women, as well. Currently, there is no routine genetic testing performed in men.
• 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.
• Diet:
• Increased Risk: A diet high in fats from foods such as red meat and dairy products.
• Decreased Risk: A diet high in lycopene (antioxidant found in tomatoes, watermelon, red grapefruit, and asparagus), selenium, and vitamin E.

Early 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. 

When should I get screened? 

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.
• Prostate Biopsy: The doctor will remove 10-12 small tissue samples from the prostate, and these will be examined for abnormal and cancerous cells. The procedure is done after an abnormal PSA or DRE and can be done in the doctor's office with a local anesthetic. The biopsy takes approximately 20 minutes, and results will be available in seven to 10 days.

UroNav MRI-Guided Biopsy

Middlesex Health is proud to offer UroNav, an innovative approach to prostate biopsies. The UroNav system fuses traditional ultrasound images with MRI images taken before your biopsy, to create clear images of the prostate and potential cancers. This allows your doctor to take biopsy samples from specific locations, reducing the number of biopsies needed to make a diagnosis. 

• What does this mean for me? 

• A UroNav MRI-Guided Biopsy is highly targeted, reducing the need for repeat testing. This means less stress and less pain for patients.

• How is this different from a traditional biopsy?

• During a traditional biopsy, doctors use ultrasound images alone to guide the biopsy needle and decide which areas of the prostate to sample. Ultrasound images are not clear enough to see cancers, so tissue samples are taken from the prostate at random. This means that a cancer can easily be missed, and patients often need additional biopsies. 

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.

SpaceOAR^®* hydrogel is an injectable gel that is naturally eliminated from the body over time. 

SpaceOAR^® goes into the body as two liquids—one of which is water. This is why SpaceOAR^® is called a hydrogel. When the two liquids combine, they quickly form a soft gel, which allows SpaceOAR^® to stay in position in your body. The other material is a synthetic that has been shown to be safe and biocompatible; it is used in other medical procedures, as well.

*The name of this product, SpaceOAR^®, stands for "Spacing Organs at Risk (OAR)."

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—the cancer doctors who provide radiation therapy—more room to treat the prostate.

Why is this space important?
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—the last section of the large intestine—can be damaged during treatment. This damage may result in side effects such as bleeding, diarrhea, discomfort, and more.

The diagram below illustrates how SpaceOAR creates this helpful, protective space.

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

Treatment is Unique for Every Patient
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.

SpaceOAR® hydrogel is injected into the body using a minimally invasive procedure, and it will remain in the body during your treatment. 

When your treatment is finished, your body will slowly absorb the hydrogel and eliminate it through your urine.

We provide SpaceOAR® at both of our locations:

• Middlesex Health Cancer Center, Middletown
• Middlesex Health Cancer Center, Westbrook

If SpaceOAR^® will be a part of your cancer treatment—or the treatment of a loved one—you will receive education, instructions, and support before, during, and after therapy. Your doctors, nurses, and radiation therapists will be able to answer any specific questions you may have. 

You can also check out the resources below to hear from doctors who use SpaceOAR^® and patients who have had radiation therapy with SpaceOAR^®. You can also learn more about the scientific evidence supporting the use of this innovative technology.

Videos

Patient-Physician Testimonial: AnMed Health (South Carolina)

SpaceOAR Hydrogel - Data that Matters

Living Healthy Chicago - UroPartners and SpaceOAR Hydrogel

Brochures & Slides

SpaceOAR® Hydrogel Patient Brochure

SpaceOAR® Hydrogel Slides for Patients

^{*The materials provided here are not a substitute for the advice of your doctor or other medical professional. If you have questions, concerns, or are interested in learning more about how SpaceOAR could work for you or a loved one, please contact your doctor's office or the Middlesex Health Cancer Center.}