Prostate Cancer Doctors in Northwest Indiana

Prostate cancer is a malignant tumor that starts growing in the prostate gland. Several types of cells are found in the prostate, but almost all prostate cancers develop from the gland cells (the cells that make the prostate fluid that is added to the semen). The medical term for a cancer that starts in gland cells is adenocarcinoma.

In the United States, prostate cancer is the second most common type of cancer among men, with 1 in 9 receiving a diagnosis in their lifetime. However, because of regular screening and advances in prostate cancer treatments, most men with prostate cancer do not die from it.

Prostate cancer is somewhat different from other types of cancers. This is because it’s typically slow-growing and can sometimes be monitored for years before treatment is needed. Discussing your options with a prostate cancer specialist is important to be informed about whether you can watch and wait for now or if you need to start treatment. At Northwest Cancer Centers, our oncologists work with each patient to recommend a personalized treatment plan.

Diagnosing Prostate Cancer

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Stages of
Prostate Cancer

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Treatment for Prostate Cancer

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Diagnosing Prostate Cancer

It’s important to talk to your doctor about prostate cancer screening once you’re approximately 50 years old. That’s because prostate cancer typically doesn’t show any symptoms until it’s grown for a while. By age 40, talk to your doctor about prostate cancer screening. They are likely to ask about your personal and family medical history to see if there is a reason to start screening earlier than average.

The actual screening tests for prostate cancer include:

Digital rectal exam (DRE): An exam of the rectum where the doctor or nurse inserts a lubricated, gloved finger into the rectum and feels the prostate through the rectal wall for lumps or abnormal areas.
Prostate-specific antigen (PSA) test: A test that measures the level of PSA in the blood. PSA is a substance made by the prostate that may be found in higher than normal amounts in the blood of men who have prostate cancer. PSA levels may also be high in men who have an infection or inflammation of the prostate, or BPH (an enlarged but non-cancerous prostate). The doctor will repeat this test periodically to see if there is a sudden rise in PSA that would suggest further tests are needed, such as:
PHI (Prostate Health Index) test: A more accurate blood test used for men who have a PSA between 4 and 10.
Prostate cancer urine test: This test detects the gene PCA3 in the urine. Too much PCA3 can indicate that prostate cancer is present, and biopsy is likely to be suggested.
Transrectal ultrasound: The doctor inserts a probe into the rectum to check your prostate for abnormal areas. The probe sends out sound waves that people cannot hear (ultrasound). The waves bounce off the prostate, and a computer uses the echoes to create a picture called a sonogram.
Transrectal biopsy: A biopsy is the removal of tissue to look for cancer cells and is the only sure way to diagnose prostate cancer. The doctor inserts needles through the rectum into the prostate. The doctor removes small tissue samples (called cores) from many areas of the prostate. Transrectal ultrasound is usually used to guide the insertion of the needles. A pathologist checks the tissue samples for cancer cells.

The Gleason Score and Prostate Cancer Grading

If the biopsy shows that prostate cancer is present, it will be given a Gleason score and a grade.

The Gleason Score

During the biopsy, several cell samples are taken from throughout the prostate. The two most dominant cell patterns found will be given a score. Cells that look more like healthy cells get a lower score, and the more abnormal the cells look under the microscope, the higher the score.

Those scores are added together to get a Gleason Score. The most predominant cell pattern is first in the equation. For example, if the predominant cell sample receives a score of 3 and the secondary sample receives a 5, together, the score would be 8.

Gleason 6 or lower: The cells look similar to healthy cells (called well-differentiated), and treatment is not likely needed right away.
Gleason 7: for this score, there is a difference between 3+4=7 and 4+3=7. When the three is first, the predominant cell pattern is slightly more normal than when the predominant pattern is a 4. The doctor may choose to monitor you closely for signs of cancer growth, or treatments may begin.
Gleason 8, 9, or 10: The cells look very different from healthy cells (called poorly differentiated or undifferentiated), and treatment is likely to start soon.

Prostate Cancer Grades

Another way of determining the likelihood of prostate cancer growing quickly is through a grading system. The higher the grade (and the higher the Gleason score), the more aggressive the cancer is likely to be.

There are five grades for prostate cancer, and they're related to the Gleason score.

Grade 1: Gleason score of 6 or less

Grade 2: Gleason score of 3+4=7

Grade 3: Gleason score of 4+3=7

Grade 4: Gleason score of 8

Grade 5: Gleason score of 9 or 10

The Gleason score and prostate cancer grade are related to how prostate cancer is staged.

Stages of Prostate Cancer

Staging is the process used to find out if cancer has spread within the prostate or to other parts of the body. It is important to know the stage in order to plan treatment. In prostate cancer, staging tests may not be done unless you have symptoms or signs that the cancer has spread, such as bone pain, a high PSA level, or a high Gleason score.

When prostate cancer spreads, it’s often found in nearby lymph nodes. If cancer has reached these nodes, it also may have spread to other lymph nodes, the bones, or other organs.

There are two types of staging methods for prostate cancer:

Clinical staging. This is based on the results of DRE, PSA testing, and the Gleason score. These test results will help determine whether x-rays, bone scans, CT scans, or MRIs are also needed.

Pathologic staging. This is based on information found during surgery, plus the laboratory results of the prostate tissue removed during surgery also called pathology. The surgery often includes the removal of the entire prostate and some lymph nodes.

One tool used in the staging process is the TNM system developed by the American Joint Committee on Cancer. The results from diagnostic tests and scans are used to answer the following questions:

Tumor (T): How large is the primary tumor? Where is it located?
Node (N): Has the tumor spread to the lymph nodes? If so, where and how many?
Metastasis (M): Has the cancer spread to other parts of the body? If so, where and how much?

The results are combined to determine the stage of cancer for each person. There are 5 stages: stage 0 (zero) and stages I through IV (1 through 4).

Stage I

The cancer can’t be felt during a digital rectal exam and can’t be seen on a sonogram. It’s found by chance when surgery is done for another reason, usually for BPH. The cancer is only in the prostate. The grade is G1, or the Gleason score is no higher than 4.

Stage II

The tumor is more advanced or a higher grade than Stage I, but the tumor doesn’t extend beyond the prostate. It may be felt during a digital rectal exam, or it may be seen on a sonogram.

Stage IIA: The tumor cannot be felt and involves half of 1 side of the prostate or even less than that. PSA levels are medium, and the cancer cells are well differentiated. This stage also includes larger tumors found only in the prostate, as long as the cancer cells are still well differentiated.
Stage IIB: The tumor may be large enough to be felt during DRE. The PSA level is medium. The cancer cells are moderately differentiated.
Stage IIC: The tumor may be large enough to be felt during DRE. The PSA level is medium. The cancer cells may be moderately or poorly differentiated.

Stage III

The tumor extends beyond the prostate. The tumor may have invaded the seminal vesicles, but cancer cells haven’t spread to the lymph nodes.

Stage IIIA: The cancer has spread beyond the outer layer of the prostate into nearby tissues. It may also have spread to the seminal vesicles. The PSA level is high.
Stage IIIB: The tumor has grown outside of the prostate gland and may have invaded nearby structures, such as the bladder or rectum.
Stage IIIC: The cancer cells across the tumor are poorly differentiated, meaning they look very different from healthy cells.

Stage IV

The cancer has spread beyond the prostate.

Stage IVA: The cancer has spread to the regional lymph nodes.
Stage IVB: The cancer has spread to distant lymph nodes, other parts of the body, or to the bones.

Prostate Cancer Treatment Options

Prostate cancer is often diagnosed by a urologist. While they can offer some treatment options, it’s a good idea to visit with an oncologist who specializes in prostate cancer. They work with you to see if there are options that will leave you with the least impact on your day-to-day life after treatment.

A prostate cancer treatment plan is suggested by the cancer care team based upon factors such as your age, the grade of the tumor (the Gleason score), the number of biopsy tissue samples that contain cancer cells, the stage of the cancer, your symptoms, and your general health. Your oncologist can describe your treatment choices, the expected results of each, and the possible side effects. Together, you will develop a treatment plan that meets your medical and personal needs.

Active Surveillance (Watchful Waiting)

Your doctor may suggest active surveillance if you’re diagnosed with early-stage prostate cancer that seems to be slowly growing. Your doctor may also offer this option if you are older or have other serious health problems.

Active surveillance is closely following your condition without giving any treatment unless there are changes in test results. It is used to find early signs that the condition is getting worse. During this time, you will be checked regularly to see if the cancer is growing. When the cancer begins to grow, treatment is given.

Radiation Therapy for Prostate Cancer

Radiation therapy is an option for men with any stage of prostate cancer. It’s often a good option to use before resorting to prostate removal surgery.

Men with early-stage prostate cancer may choose radiation therapy instead of surgery. It also may be used after surgery to destroy any cancer cells that remain in the area. In later stages of prostate cancer, radiation treatment may be used to help relieve pain.

Radiation therapy (also called radiotherapy) uses high-energy rays to kill cancer cells. It affects cells only in the treated area.

Doctors use two types of radiation therapy to treat prostate cancer. Some men receive both types:

Internal radiation (implant radiation or brachytherapy)

The radiation comes from radioactive material usually contained in very small implants called seeds. Dozens of seeds are placed inside needles, and the needles are inserted into the prostate. The needles are removed, leaving the seeds behind. The seeds give off radiation for months. They don’t need to be removed once the radiation is gone.

External radiation

The radiation comes from a large machine outside the body. You will go to a hospital or clinic for treatment. Treatments are usually 5 days a week for several weeks. Many men receive 3-dimensional conformal radiation therapy (3-D CRT) or intensity-modulated radiation therapy (IMRT). These types of treatment use computers to more closely target the cancer to lessen the damage to healthy tissue near the prostate.

Both internal and external radiation can cause impotence. You can talk with your doctor about ways to help cope with this side effect of radiation therapy for prostate cancer treatment.

Medical Oncology Therapies for Prostate Cancer Treatment

A cancer treatment that affects the whole body is called systemic therapy. Systemic therapies include hormone therapy, chemotherapy, targeted therapy, and immunotherapy — treatments that involve the use of medications to kill cancer. Each works differently to shrink the tumor and prevent recurrence.

Hormone Therapy

The oncologist may suggest a drug that blocks testosterone, the hormone that fuels prostate cancer growth. Some of these drugs include:

Luteinizing hormone-releasing hormone (LH-RH) agonists: These drugs can prevent the testicles from making testosterone. Examples are leuprolide, goserelin, and triptorelin. The testosterone level falls slowly. Without testosterone, the tumor shrinks, or its growth slows. These drugs are also called gonadotropin-releasing hormone (GnRH) agonists.
Antiandrogens: These drugs can block the action of male hormones. Examples are flutamide, bicalutamide, and nilutamide.
Other drugs: Some drugs can prevent the adrenal gland from making testosterone. Examples are ketoconazole and aminoglutethimide.

Doctors usually treat prostate cancer that has spread to other parts of the body with hormone therapy. For some men, the cancer will be controlled for two or three years, but others will have a much shorter response to hormone therapy. In time, most prostate cancers can grow with very little or no male hormones, and hormone therapy alone is no longer helpful. At that time, your oncologist may suggest chemotherapy or other forms of treatment that are under clinical research.

Targeted Therapy

Targeted therapy is a type of treatment that uses drugs or other substances to identify and attack specific cancer cells. Targeted therapies usually cause less harm to normal cells than chemotherapy or radiation therapy.

PARP inhibitors block an enzyme involved in many cell functions, including the repair of DNA damage. Blocking this enzyme may help keep cancer cells from repairing their damaged DNA, causing them to die. PARP inhibitors are used to treat patients with prostate cancer that has spread to other parts of the body and has mutations in certain genes, such as BRCA1 or BRCA2.

Immunotherapy

Immunotherapy is a treatment that uses the patient’s immune system to fight cancer. Substances made by the body or made in a laboratory are used to boost, direct, or restore the body’s natural defenses against cancer. This cancer treatment is a type of biological therapy.

Drugs called checkpoint inhibitors can be used for people whose prostate cancer cells have tested positive for specific gene changes, such as a high level of microsatellite instability (MSI-H), or changes in one of the mismatch repair (MMR) genes. Changes in MSI or in MMR genes (or both) are often seen in people with Lynch syndrome. An example of an approved checkpoint inhibitor drug is Pembrolizumab (Keytruda).

Sipuleucel-T, a therapeutic cancer vaccine, is a type of immunotherapy used to treat prostate cancer that has metastasized (spread to other parts of the body). The vaccine may be used in men with advanced prostate cancer not responding to hormone therapy. Each vaccine is adapted for the patient.

Chemotherapy

Chemotherapy may be used for prostate cancer that has spread and no longer responds to hormone therapy.

Surgery to Remove the Prostate

Surgery can be used for men with early (Stage I or II) prostate cancer. It’s sometimes an option for men with Stage III or IV prostate cancer. The surgeon may remove the whole prostate or only part of it. While this is often a laparoscopic surgery done with small incisions, the lasting effects of prostate removal can affect your day-to-day life, including the ability to have sex. Talk to your oncology team about whether surgery to remove the prostate is necessary or if other treatment options can be used first.

In some cases, the surgeon can protect the nerves that control erection. But if you have a large tumor or a tumor that’s very close to the nerves, surgery may cause impotence which can be permanent.

Prostate removal will stop the production of semen, resulting in dry orgasms during sex. If you wish to father children, you may consider sperm banking or a sperm retrieval procedure before surgery.

Find Prostate Cancer Care in Northwest Indiana

The medical oncologists and radiation oncologists at Northwest Cancer Centers work with you to ensure you have the most effective prostate cancer treatment plan. We have locations in the northwest Indiana area, including Crown Point, Dyer, Hobart, Michigan City, and Valparaiso, Indiana. We also offer second opinions on diagnosis and treatment plans for prostate cancer. Take the time to evaluate your options and choose the cancer care team you feel most comfortable with.

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