The prostate is part of the male reproductive system. It is about the same size as a walnut and weighs about an ounce. The main job of the prostate is to make fluid or semen. During ejaculation, sperm made in the testicles moves to the urethra. At the same time, fluid from the prostate and the seminal vesicles also moves into the urethra. This mixture - semen - goes through the urethra and out the penis.

Prostate cancer is the most common form of cancer in men, but because of its complexity does not respond well to a “one size fits all” mentality. In some cases, the risk associated with early-stage prostate tumors is small and the patient will likely die with prostate cancer, rather than die from it. In other cases, men have an aggressive form of the disease that may be life threatening.

A common problem in almost all men as they grow older is an enlarged prostate. This is called benign prostatic hyperplasia, or BPH. It does not raise your risk of prostate cancer. But, it can increase your prostate-specific antigen (PSA) blood test result.

If you need treatment for prostate cancer, then you need the experience and expertise of a team of physicians who focus on treating prostate cancer.

Known as a major innovator in the treatment of prostate cancer, as well as the home of a major research center devoted to understanding prostate cancer, patients at the Comprehensive Cancer Center receive the best possible care. Our experience in performing delicate prostate surgeries - both the open, traditional approach as well as the minimally invasive, robotic approach - is matched by our team’s caring and compassionate approach to patient and families.

Prostate Cancer Symptoms

With early prostate cancer, there are often no symptoms.

The PSA blood test may done to screen men for prostate cancer. Often, PSA level rises before there are any symptoms.

The symptoms listed below can occur with prostate cancer as it grows larger in the prostate. These symptoms can also be caused by other prostate problems:

  • Delayed or slowed start of urinary stream
  • Dribbling or leakage of urine, most often after urinating
  • Slow urinary stream
  • Straining when urinating, or not being able to empty all of the urine
  • Blood in the urine or semen

When the cancer has spread, there may be bone pain or tenderness, most often in the lower back and pelvic bones.

Prostate Cancer Diagnosis

An abnormal digital rectal exam may be the only sign of prostate cancer.

Your doctor may recommend a biopsy if:

  • You have a high PSA level
  • A digital rectal exam reveals a hard or uneven surface

The biopsy result is reported using what is called a Gleason grade and a Gleason score.

The Gleason grade tells you how fast the cancer might spread. It grades tumors on a scale of 1 through 5. You may have different grades of cancer in one biopsy sample. The two most common grades are added together. This gives you the Gleason score. The higher your Gleason score, the more likely the cancer can spread beyond the prostate:

  • Scores 2 through 5: Low-grade prostate cancer
  • Scores 6 through 7: Intermediate- (or in the middle) grade cancer. Most prostate cancers fall into this group
  • Scores 8 through 10: High-grade cancer

The following tests may be done to determine whether the cancer has spread:

  • CT scan
  • Bone scan
  • MRI scan - State-of-the-art MRI techniques can accurately diagnose and localize areas of cancer with the prostate gland. This information is then used to guide a biopsy as well as provide information on tumor stating, which is critical to choosing the correct therapy for each individual patient. 

The PSA blood test will also be used to monitor your cancer after treatment.

Prostate Cancer Treatment Options

There are many factors when considering treating prostate cancer including the grade and stage of tumor, age, functional status, expectations, personality and lifestyle.

Wake Forest Baptist offers the most technologically advanced radiation therapies available, which are used as a primary treatment or together with surgery.

Advanced treatments may include:

Robotic-Assisted Surgery. Our urologic surgeons are pioneers in the field of robotic surgery used in the treatment of prostate cancer. Robotic-assisted surgery involves the surgeon directing the robot to make tiny incisions to remove the tumor. This type of precision could not be achieved without the da Vinci® Surgical System. The importance of this precision is critical to patients’ retention of sexual and bladder function, as well as capturing the malignant tissues of the tumor.

Brachytherapy. The implantation of radioactive seeds directly into the prostate. The seeds are delivered into the prostate using needles that are inserted under ultrasound guidance. Wake Forest Baptist has one of a few Digital Integrated Brachytherapy (IBU) Units in the U.S. With this technology, all aspects of treatment are provided in a single, shielded room.

Intensity Modulated Radiation Therapy (IMRT) and Image-Guided Radiation Therapy (IGRT). IMRT focuses radiation on the tumor and surrounding at-risk tissues while sparing nearby normal tissues. Anatomic CT or MRI images are used in combination with computer-generated radiation dose calculations and a computer-controlled linear accelerator to conform or “paint” the radiation dose very precisely to match the shape of the tumor to be treated, avoiding critical structures that may be only millimeters away. The addition of daily IGRT allows reliable delivery of sophisticated IMRT plans despite the fact that the prostate changes shape due to normal digestive patterns. This combination holds great promise for improving local tumor control and survival.

MR-Fusion Guided Prostate Biopsy. An advanced technique utilizing the information from an MRI to precisely target areas of tumor in the prostate gland.

MR-Fusion Guided High Intensity Focused Ultrasound. A noninvasive therapy for the focal treatment of areas of tumor without the need for surgery. 

Why Multidisciplinary Teams Matter, No Matter What Stage

We create teams of the different specialists who focus on urologic cancers. What this means is that at every stage of your cancer journey, you will meet with doctors who only focus on the type of cancer you have. Together, with other specialized experts, they will decide on the best treatment for you, personalizing your treatment directly to your condition and lifestyle.