How is Prostate Cancer Diagnosed?
If you’re showing signs of prostate cancer or believe you are at risk, a biopsy can confirm a diagnosis. During the procedure, a needle is inserted into the prostate gland to remove a small piece of tissue that is then evaluated for the presence of cancer cells. Your doctor can use specialized magnetic resonance imaging (MRI) scans or ultrasound to view the prostate, guide the biopsy, and gather information for prostate cancer treatment recommendations.
Prostate cancer screening
Recommendations for how often men should get a prostate cancer screening vary and are based on several considerations, including the presence of any symptoms and factors that may increase disease risk. Among these factors are the patient's age (risk increases after 50), race/ethnicity, and family history.
There is no single test for prostate cancer. Initial prostate cancer screening includes a blood test to measure the patient's prostate-specific antigen (PSA) levels and a digital rectal prostate exam. It's important to note that although an elevated PSA can reflect the presence of prostate cancer, it can also occur with benign (noncancerous) changes to the prostate.
At NewYork-Presbyterian, men with an elevated risk due to personal or family medical history are offered prostate cancer genetic counseling and testing. Our teams promote shared decision-making between doctors and patients regarding screening tests and biopsy decisions.
How is Prostate Cancer Treated?
One of the biggest challenges in prostate cancer care is distinguishing slow-growing tumors that can be watched without initiating treatment from more aggressive cancers that require prompt treatment. Our prostate cancer specialists and researchers are world leaders in combining imaging techniques with molecular markers to help make this distinction and improve diagnosis. We use the expertise of multiple disciplines, including surgery, radiation oncology, and medical oncology, to educate patients about their options. Therapy recommendations may change depending on the severity of the disease and the patient's response to treatment.
Your doctor may recommend a radical prostatectomy procedure—removal of the prostate and surrounding lymph nodes—if the cancer is confined to these structures. Patients who undergo this surgery may also be treated with other therapies to ensure that all cancer cells are destroyed.
If you need prostate cancer surgery, you and your doctor may opt for a robotic approach. This technique gives the surgeon an enhanced view of the surgical field and allows for a more precise minimally-invasive operation. Our urologic surgeons are highly experienced in the latest procedures, including nerve-sparing prostatectomy, designed to preserve erectile and urinary function.
Men with early-stage prostate cancer confined to the gland may receive localized radiation treatment instead of surgery, which spares nearby healthy tissues as much as possible and reduces the risk of side effects. These options include:
- Hypofractionated radiation therapy - Higher doses of radiation are given over a shorter period than standard radiation therapy
- Brachytherapy - Tiny radioactive seeds are implanted directly into the prostate. With computer-guided technology, physicians can plan and perform seeding during one procedure.
HIFU and cryosurgery
Two additional precision medicine techniques that may be appropriate for men with early-stage prostate cancer, either alone or with radiation therapy, include:
- High-intensity focused ultrasound (HIFU) - The application of MRI-guided high-energy sound waves to heat and destroy prostate cancer cells
- Cryosurgery - The insertion of needles into the prostate to freeze and destroy prostate cancer cells
Some men with advanced prostate cancer may benefit from hormone therapy that suppresses the production of androgens in the body, which are known to encourage the growth of cancer cells. Androgens include testosterone and dihydrotestosterone (DHT) and are produced by prostate cancer. They are also produced naturally in the body by the testicles and adrenal glands.
Although chemotherapy (chemicals administered to destroy cancer cells) is not a cure for prostate cancer, it can slow the progression of the disease, relieve symptoms, and sometimes prolong life. Chemotherapy may be given together with hormone therapy to achieve a better outcome. These medications are administered intravenously. NewYork-Presbyterian's modern infusion centers are staffed with a team of specialists who monitor your treatment and ensure your comfort throughout the process.
Targeted therapy for cancer is a newer treatment designed to affect cancer cells only, thereby minimizing some of the side effects that other medications can cause. (This contrasts with chemotherapy, which affects all cells in the body.) Prostate cancer patients with a particular mutation in their DNA may benefit from targeted therapy with drugs called PARP inhibitors that can block cell death.
Immunotherapy, drugs that stimulate the patient's immune system to destroy cancer cells, is another potential option for men with advanced prostate cancer. There are two kinds of immunotherapy available. The first is a cancer vaccine developed with the patient's immune cells. The second is immune checkpoint inhibitors (also called immunomodulators), which prevent cancer cells from "turning off" the body's natural immune system response. Additional research in this area is ongoing.
Our investigators are continually studying prostate cancer in order to conduct clinical trials of new therapies, including groundbreaking approaches like molecular imaging to visualize and treat prostate cancer that has spread to other parts of the body (called metastasis). If you’re interested in participating in a clinical trial, your care team will let you know if you are eligible.
Survival rates for cancer patients are usually measured as a percentage of those affected at five years following their diagnosis. In the United States, the five-year prostate cancer survival rate is 97-98%. It's important to understand that this number will vary depending on the severity of the disease at the time of diagnosis, among other factors. Your doctor is the best person to consult about your specific prostate cancer prognosis.
Researchers have not identified the cause or causes of prostate cancer. Some men are more likely to develop the disease owing to advancing age, inherited or acquired mutations to their DNA, or living in a certain part of the world.
Some common signs and symptoms of prostate cancer include pain or a weak flow when urinating, blood in the urine or semen, painful or difficult ejaculation, and stiffness, pain, or swelling in the lower back and legs. It's important to note that some men who develop prostate cancer do not experience any disease symptoms.
In addition to the pain and/or difficulty some men have with urination or ejaculation, patients may experience stiffness, pain, or swelling in the lower extremities (from the hips down to the feet). In more advanced cases of prostate cancer, fatigue and/or bone pain may be present.
At the time of diagnosis, prostate cancer is assessed by stage, with a lower number indicating a less severe case of the disease and a higher number indicating more advanced or aggressive cancer. These bullets provide an overview of how doctors stage prostate cancer:
- Stage I - Cancer has been found in the prostate gland from a digital rectal exam or an ultrasound
- Stage II - The tumor is still restricted to the prostate gland. The patient has a higher PSA level than those with Stage I cancer.
- Stage III - Cancerous cells may have spread beyond the prostate to other tissues close to the gland. These tissues and organs can include the rectum, bladder, and/or the wall of the pelvis.
- Stage IV - Prostate cancer may have spread to the lymph nodes and/or parts of the body that are distant from the prostate gland
In the United States, one in eight men are diagnosed with prostate cancer. According to current estimates, as many as three million men in this country live with prostate cancer.
Trust NewYork-Presbyterian for Prostate Cancer Treatment
To learn more about prostate cancer treatment options, schedule a screening at one of NewYork-Presbyterian's multiple locations throughout New York City, Westchester, or the Hudson Valley. If you are dealing with prostate cancer symptoms, our highly experienced specialists in urologic cancer can walk you through diagnosis and available treatment options, including the latest developments in care.