Prostate Cancer

Screening and diagnostic tests can show whether you have signs of prostate cancer that require more testing:

• PSA blood test. The prostate produces a protein called prostate-specific antigen (PSA). Higher-than-expected PSA levels can be a sign of prostate cancer. However, PSA levels can also be elevated due to noncancerous conditions, such as an enlarged prostate, inflammation or prostatitis.
• Imaging. Imaging tests, such as a prostate MRI or transrectal ultrasound, create detailed pictures of the prostate that help identify suspicious areas that may be cancer. Imaging results can help your doctor decide whether to perform a biopsy.
• Auxiliary tests. There are various urine-based or blood-based tests that can be used along with standard screening to assess the risk for prostate cancer. Talk to your urologist about these options.
• Digital rectal exam. In some cases, your doctor may perform a digital rectal exam (DRE) to feel the prostate for firm areas, lumps or other abnormalities that may be signs of cancer. A DRE is not necessary for every patient and is done infrequently compared with other tests like an MRI. But it is one of several tools that may be used when evaluating prostate health.
• Biopsy. A prostate biopsy involves removing small samples of prostate tissue so they can be examined under a microscope. A biopsy is the only way to confirm prostate cancer and determine how aggressive it is. Additional testing of the tissue, including genetic or molecular analysis, may help guide treatment decisions.

Active surveillance is the preferred management approach for many men with low-risk prostate cancer and some with favorable intermediate-risk prostate cancer. Patients with certain low-grade cancers and some small-volume tumors may be good candidates for this approach.

Rather than treating the cancer immediately, active surveillance involves closely monitoring it over time with regular PSA testing, imaging and, in some cases, repeat biopsies. Because many low-risk prostate cancers grow very slowly, active surveillance can help patients to avoid or delay unnecessary treatment while ensuring treatment is started if the cancer shows signs of progression.

Surgery may be used to remove the prostate, particularly for localized disease. A radical prostatectomy, which removes the diseased prostate gland, often successfully eliminates prostate cancer that has not spread. When possible, surgeons use minimally invasive techniques to reduce recovery time and side effects.

Depending on your diagnosis and treatment goals, our surgeons offer several surgical approaches to remove prostate tumors, including:

• Multi-port robotic prostatectomy.
• Single-port robotic prostatectomy.
• Retropubic (open) prostatectomy.

Patients who receive prostate cancer care at MUSC benefit from clinicians with expertise in all these approaches.

Traditional robotic surgery uses several robotic arms, or ports, through which surgical instruments and a camera are placed via multiple small incisions. With single-port surgery, all instruments and the camera are inserted using one robotic arm through a single incision. For appropriately selected patients, this minimally invasive approach may result in less pain, faster recovery and minimal scarring.

Focal therapy is a newer form of treatment that destroys tumors inside the prostate. A doctor may recommend this treatment if the cancer is low risk and has not spread. Many of these treatments are still considered experimental.

Cryotherapy, or cryoablation, is a treatment that uses extreme cold to destroy tissue (often via probes that freeze tumors).

It can be used in different ways:

• Whole-gland treatment for targeting the entire prostate.
• Focal treatment for targeting only part of the organ.

High-intensity focused ultrasound (HIFU) uses precise, high-frequency sound waves to thermally destroy solid tumors.

NanoKnife irreversible electroporation (IRE) uses precise, high-voltage electrical pulses to create microscopic holes in cell membranes.

Radiation therapy uses targeted energy beams, such as X-rays or protons, to destroy cancer cells at specific sites in the body. The radiation is usually delivered daily over several weeks. Radiation may be used alone or in combination with other therapies like chemotherapy.

• Brachytherapy involves placing radioactive seeds inside the prostate. It kills cancer cells while preserving surrounding healthy tissue.
• External beam radiation therapy (EBRT) involves targeting the tumor with strong X-rays. Advanced types can target the cancer while sparing healthy tissue.
• Stereotactic body radiotherapy (SBRT) involves using focused X-rays to target prostate cancer very precisely in five or less treatments.

Chemotherapy uses strong medicines to attack cancer cells. Some are injected in a vein, and others come in a pill form. It is not commonly used for early-stage prostate cancer but may be recommended for advanced or metastatic disease. The specific medicines used and how often you receive them will be determined by your care team.

Androgens are male hormones that can fuel prostate cancer growth. Hormone therapy lowers testosterone levels or blocks their effects, helping slow cancer growth or shrink tumors.

Other treatment options for prostate cancer can include:

• Targeted therapy.
• Immunotherapy (drugs that help the body’s immune system fight off cancer).
• Clinical trials.

The prostate is a small gland, about the size of a walnut, that sits below the bladder. It is part of the male reproductive system and helps produce fluid that makes up semen.

In many cases, yes. Prostate cancer is often highly treatable, especially when it is found early and has not spread outside the prostate. Even when prostate cancer is more advanced, treatments can often control the disease for many years and help people maintain a good quality of life.

There is no guaranteed way to prevent prostate cancer. However, maintaining a healthy lifestyle, such as eating a balanced diet, staying physically active, maintaining a healthy weight, not smoking and limiting alcohol, may help reduce risk and support overall prostate health. Regular discussions with a healthcare provider about screening can also help detect prostate cancer early, when it is most treatable.

The Gleason score is a prostate cancer grading system that indicates the cancer's aggressiveness and likelihood of spreading based on how abnormal the cells appear under a microscope. Scores range from 6 (low grade) to 10 (high grade), with higher scores indicating a more aggressive cancer and a greater risk of spread.