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Screening, Diagnosis and Treatment Options

Screening and Diagnosis: Get Checked

If your doctor thinks you should be screened for prostate cancer, there are a few tests that you may have to have. During this process, you will be referred to a medical oncologist. Tests that you may undergo include:

  • Digital rectal exam (DRE): The DRE is usually the first step that your doctor will take. During this test, the doctor will insert a gloved finger into your rectum. At this point, he will feel your prostate and determine if it is the proper size and shape. If something seems wrong, he will order further tests.
  • Prostate-specific antigen (PSA) test: This blood test measures the level of PSA in your blood. A high level could indicate prostate cancer or an infection.
  • Transrectal ultrasound: During this test, a doctor will insert a probe into your rectum. Sounds waves will help take pictures of your prostate, which will show if it is enlarged or has tumors and calcifications.
  • Prostate biopsy: If a problem is suspected, a doctor will insert a probe into your rectum and takes a small tissue sample from your prostate. This sample will help the doctor determine if cancer is present and how advanced the cancer is.

In the event that prostate cancer is found, your doctor may perform additional tests to determine if the cancer has spread beyond the prostate. These include:

  • Bone scan
  • Ultrasound
  • Computerized tomography (CT) scan
  • Magnetic resonance imaging (MRI)

At this point, your doctor will determine what stage the cancer is in.

  • Stage I: Your cancer is confined to a small area, usually microscopic. Your doctor cannot feel it.
  • Stage II: Your cancer is still confined to the prostate gland, but your doctor can feel it.
  • Stage III: Your cancer has spread beyond the prostate and to nearby tissues.
  • Stage IV: Your cancer has spread to the bones, lymph nodes, lungs or other organs.

Treatment: Get Better

If you are diagnosed with prostate cancer, you will probably have many questions. Take time to write them down and discuss them with your doctor. Be sure to bring along a friend or family member who can offer support and remember details.

Depending on your individual situation, the suggested treatment for your cancer will vary. Factors include your overall health, how fast the cancer is growing, and how far it has spread.

Watchful waiting: In some cases, no treatment will be recommended. Instead, your doctor will suggest regular blood tests to monitor your PSA level, as well as further rectal exams and biopsies.

Radiation therapy: There are two types of radiation-one that is used outside your body and one that is used inside your body.

  • External beam radiation is a type of radiation that occurs outside your body. During this procedure, you will lie on a table while a machine moves around you, generating high-powered x-rays toward your cancer. This treatment usually takes place five days a week for several weeks.
  • Brachytherapy is delivered inside your body. Your doctor uses needle, guided by ultrasound, to place tiny radioactive seeds in your prostate tissue. This produces a low dose of radiation over a long period of time. After a while, the seeds stop giving off radiation and they do not need to be removed.

Both types of radiation carry side effects including painful, frequent or urgent urination, as well as erectile dysfunction.

Hormone therapy: In order to decrease the amount of testosterone in your body, your doctor may recommend a few different strategies.

  • Medication that will stop your body from producing testosterone
  • Medication that stops the testosterone from reaching the cancer cells
  • Surgery to remove the testicles

Any of these options should help shrink the tumors and keep the cancer from spreading. Sometimes, hormone therapy is also used to decrease tumor size before radiation therapy. However, hormone therapy comes with some risks and side effects. Among these are:

  • Hot flashes
  • Decreased sex drive/Impotence
  • Loss of bone and muscle mass
  • Increased risk of heart disease

Prostate surgery: Depending on how advanced your cancer is, your doctor may recommend surgery to remove your prostate and its surrounding tissue. This can be done in a few different ways.

  • Retropubic surgery involves the doctor making an incision in your lower abdomen. This procedure carries a low risk of nerve damage.
  • Perineal surgery requires that the doctor make an incision between your scrotum and anus. There is usually a quicker recovery time with this procedure, but the chance of nerve damage is higher.
  • Laparoscopic radical prostatectomy involves the doctor making several small incisions in the abdomen. Through these incisions, the doctor inserts surgical instruments and a slender tube with an attached camera (a laparoscope), which helps guide the surgery. Recovery time for this procedure is usually shorter than for the other surgeries.
  • Robotic laparoscopic surgery allows the doctor to sit at a monitor and use hand controls to guide a robot's movements. This procedure may enable the doctor to be more precise.

Any of these surgeries carries the risk of erectile dysfunction, urinary incontinence, bleeding and infection.

Chemotherapy: The anti-cancer drugs of chemotherapy can be delivered through an IV or in pill form. Either way, your treatment may last several months. Each treatment is followed by a recovery period. During this time, you may feel very tired and nauseated. Side effects often include nausea and fatigue.

Follow-up: Keep Watch

In the months and years after you have received treatment, it's important that you monitor your health. If you remain vigilant, you can help keep your cancer at bay. Though follow-up strategies are not set in stone, there are some guidelines. Contact your doctor right away if you have these symptoms:

  • Difficulty urinating
  • Bone pain

At St. Anthony's, we encourage you to set up a schedule of check-ups. You should have an annual physical, which includes a DRE. Additionally, you should have your PSA checked every three months for the first two years after treatment, and then every six months after that. Your doctor may also use bone scans, MRIs, and other tests if anything seems suspicious.

As you recover, take time to meet other people in your situation. Join a support group or talk to other patients. Sharing your stories and experiences will go a long way in helping you regain your health.

For more information on prostate cancer care and screenings at The Cancer Center at St. Anthony’s Hospital, please call (727) 825-1253.

St. Anthony's Cancer Center
1201 5th Ave. N., Suite 130
St. Petersburg, FL 33705
Phone: (727) 825-1253
Fax: (727) 825-1332