Prostate Cancer

What is prostate cancer? 

Prostate cancer is cancer that occurs in the prostate, the small, walnut-sized gland in a man’s pelvic region that produces seminal fluid, a component of semen. It’s the most common type of cancer in males. According to the American Cancer Society, one-in-eight men will be diagnosed with prostate cancer during their lifetime.

What are the symptoms of prostate cancer?

In its early stages, prostate cancer can often present no symptoms. Other symptoms of prostate cancer may include:

• Frequent daytime and nighttime urination
• Difficulty urinating, or not being able to urinate with force
• Pressure in the rectum
• Erectile dysfunction
• Blood in the urine
• Blood in ejaculate
• Unexpected weight loss

What are the risk factors for prostate cancer?

There are a number of factors that are believed to increase your risk of developing prostate cancer. These include: 

• Smoking
• Age, as most patients with prostate cancer are older than age 50
• A family history of prostate cancer, particularly in a father or brother
  • Hoag Family Cancer Institute offers a Hereditary Cancer Program to assess a person’s family history and any associated risk for cancer. Learn more by calling 949-764-5764
• Your race, as black and Hispanic men have a significantly higher chance of developing prostate cancer, and a greater chance of more aggressive cancer.
• Sedentary lifestyle

How can I reduce my risk of developing prostate cancer? 

Ways to reduce your risk of developing prostate cancer may include:

• Avoid being overweight by eating a healthy diet and getting regular exercise to avoid being overweight. Here at Hoag, we offer help with weight management to help reduce this risk and others that come with being overweight.
• Don’t smoke
• Get regular prostate cancer screenings, especially if you are at a higher risk due to your race, age or family history

How is prostate cancer diagnosed?

All men over 55 should be screened for prostate cancer by a doctor every year. Men who are at higher risk due to their race, age or family history should consider being regularly screened earlier, after age 40. Prostate cancer screening includes the following:

• A digital rectal exam, in which the doctor painlessly inserts a lubed finger into rectum to directly examine the prostate for abnormalities
• Blood testing, especially for levels of Prostate-Specific Antigen (PSA) a chemical that can be elevated in people with prostate cancer.

If those tests are positive, your doctor may refer you for other tests or procedures, that may include:

• Transrectal ultrasound, which uses sound to make an image of your prostate
• Prostate MRI
• Molecular urine tests
• Prostate biopsy
• PSMA imaging

Types of prostate biopsies
Prostate biopsies are used to diagnose prostate cancer. Generally, there are two main types of prostate biopsies:

• Transrectal method, this is the most common form of prostate biopsy, in which an ultrasound probe is placed into the rectum to guide a biopsy needle. Samples are directly taken from the prostate.
• Transperineal method — Hoag will soon offer transperineal prostate biopsies, which offer less chance of sepsis than the transrectal method. With the transperineal method, physicians use images produced through ultrasound to guide a needle inserted painlessly through the area between the anus and testicles and into the prostate. By utilizing transperineal biopsy, the risk of life-threatening infection is greatly reduced, and physicians are provided a much better ability to take tissue samples from areas of the prostate that might be difficult to sample using the transrectal method.

I’ve been diagnosed with prostate cancer. Now what do I do?

After diagnosis, your case will be evaluated and given what’s called a “Gleason Score,” which assigns a grade to your prostate cancer cells from 6 (not at all aggressive) to 10 (fast-spreading and very aggressive). Your doctor will talk to you about your current symptoms, discuss treatment options and potentially refer you to a specialist for more tests or surgery. Remember that prostate cancer is one of the most treatable of all cancers, with over 96 percent of those diagnosed surviving at least 5 years past diagnosis. 

Trust Hoag for your urologic cancer care. The Hoag Family Cancer Institute offers world-class programs for urologic cancer of all types, with multidisciplinary teams, state-of-the-art facilities and technology and the latest in cancer therapies. For the sixth consecutive year, U.S. News & World Report’s 2022-2023 Best Hospitals Rankings named Hoag Memorial Hospital Presbyterian in Newport Beach the highest-ranked hospital in Orange County, Calif. 

U.S. News also named Hoag as a High-Performing Hospital — their highest ranking — for Prostate Cancer Surgery, with Patient Experience and Prevention of Prolonged Hospitalizations both ranked “Excellent”. 

Find more information about urologic cancer care at Hoag at this link.  Meet Hoag’s Urologic Cancer Team.

What are the treatment options for prostate cancer?

Treatment options for prostate cancer depend on many factors, including how advanced the cancer is when detected, your age and any other health issues you may have. In the case of very slow-growing prostate cancer, your doctor may advise only close monitoring. Other treatments for prostate cancer vary from patient to patient, but may include:

Surgery and advanced treatments at Hoag

Facing surgery can be a frightening prospect, but it is a vital component in the successful treatment of many urologic cancers. The Hoag Family Cancer Institute’s medical team includes experienced, fellowship-trained urologic oncologists who utilize the latest techniques and technology in the surgical management of many different urologic cancers, including prostate cancer.

• Non-Invasive Robotic Focal HIFU (High Intensity Focused Ultrasound) enhances precision tissue ablation, thereby, reducing debilitating side effects. For patients with localized prostate cancer. Focal One is today’s most advanced technology for precisely targeted ablation of diseased prostate tissue.

  Focal One combines real-time ultrasound image guidance with magnetic resonance imaging (MRI) and biopsy data presented in 3D. Using a transrectal probe, the doctor navigates to the tumor in real time, directs high speed ultrasound energy at the target area and ablates only the diseased portion of the prostate. No incisions are made.

  The fusion of these technologies enables urologists to establish more precise contours around the cancerous tumor than was possible in the past. Critically, they can then ablate a smaller portion of the prostate, which lessens the damage to surrounding healthy tissue and minimizes the risk of side effects of urinary incontinence and erectile dysfunction for patients, commonly associated with radical prostatectomy and radiation.

• Less-invasive surgical removal of the cancerous prostate, also known as “radical prostatectomy”. To help patients recover faster and return to normal activities sooner, Hoag surgeons utilize the da Vinci® Surgical System to perform robot-assisted minimally invasive surgeries in some cases. Utilizing the da Vinci® Surgical System to perform robot-assisted minimally invasive radical prostatectomy, surgeons at Hoag offer expert skills paired with technological advantages, which include a high-definition optical magnification system and endo-wrist capability, affording a post-operative recovery during which patients experience less pain, less blood loss and quicker return to normal activities. Other potential benefits may include a faster return of urinary continence and sexual function. Hoag has both the multi-port (Xi) and single port (SP) DaVinci platforms to offer the best possible outcomes.
• Non-surgical options
  • Hoag’s non surgical options, including chemotherapy and radiation therapies, are world-class. Hoag was recently named a Radiopharmaceutical Therapy Center of Excellence (RTCoE) by the Society of Nuclear Medicine and Molecular Imaging (SNMMI), a distinction held by only 17 centers in the U.S. including Stanford Health Care, Harvard Medical School and the University of California — San Francisco.
  • Hoag Family Cancer Institute’s Radiation Oncology Program offers personalized services to treat urologic cancers. Explore advanced treatment technologies for urologic cancers available at Hoag.
  • Radiation Therapy, employing either radiation beamed from outside the body, or the implantation of radioactive pellets directly into the cancerous prostate, a procedure called brachytherapy
    • ViewRay MRIdian™ linear accelerator — Hoag is one of only two hospitals in California with the ViewRay MRIdian™ linear accelerator, the most advanced radiation treatment available in the United States for cancers of the abdomen, including prostate cancer. By utilizing MRI imaging with a linear accelerator, Hoag clinicians can obtain real-time, high resolution images of tumors and surrounding soft tissues. This allows for precise application of radiation during treatment, even if the tumor shifts due to breathing or other factors. That level of precision allows Hoag clinicians to deliver a higher, potentially more effective, radiation dose to the tumor with minimal impact on healthy surrounding tissue. Find more information about Hoag’s ViewRay MRIdian™ linear accelerator at this link.
    • Brachytherapy — also known as “internal radiation therapy,” brachytherapy is a radiation treatment in which a small radioactive source is temporarily placed inside the body. With this procedure, the position, timing and placement of radiation sources is precisely controlled, allowing the physician to shape the radiation dose to the target. Because of the high dose rate, brachytherapy treatments are usually delivered on an outpatient basis or with a minimal hospital stay. Explore information about brachytherapy and other advanced treatment options at Hoag.
    • Hoag’s Radiation Oncology Program offers a full spectrum of leading-edge radiation treatment options. Learn more about Radiation Oncology Services at Hoag at this link.
  • Precision Medicine, in which Hoag physicians test the DNA of patients’ tumors, then develop treatments tailored specifically to the mutations that caused the cancer. That allows physicians to treat the cancer very precisely. Hoag is a national leader in the use of precision medicine in several types of cancer, including prostate cancer. Explore precision medicine at Hoag.
  • Immunotherapy, which primes your immune system to fight the cancer
  • Chemotherapy
  • PSMA – Pluvicto Targeted Therapy – A type of precision cancer treatment combining a targeting compound (ligand) with a therapeutic radioisotope (a radioactive particle)1. After administration into the bloodstream, Pluvicto binds to target cells, including prostate cancer cells that express PSMA, a transmembrane protein

Hoag’s Clinical Nurse Navigator Program
Hoag is a leader in peace of mind for cancer patients through our Clinical Nurse Navigator program. This unique program provides cancer patients and their families with access to nurses who have specialized training in specific cancers. These nurses serve primarily as facilitators and guides. By answering questions, providing support and serving as a trusted source of science-backed information at each phase of treatment, Hoag’s Clinical Nurse Navigators are a critical resource for patients during diagnosis, treatment and recovery. Find more information about Hoag’s Clinical Nurse Navigator program.

Survivorship – before, during and after surgery?

• Pelvic Floor Therapy — One of the biggest concerns for urologic cancer patients is the prospect of long-term incontinence. To help patients restore and retain normal urinary function, Hoag is a national leader in pelvic floor therapy. With over a dozen dedicated pelvic floor therapists, Hoag has the largest pelvic floor program in California, combining this therapy with massage, pilates and other treatments to improve patient outcomes and quality of life. Explore Pelvic Floor Therapy at Hoag.
• Erectile Function – Hoag’s urologists offer a number of treatment options for men with erectile dysfunction including medication regimens (PDE5-Is), low-intensity shock wave treatment, intraurethral suppositories (MUSE), intracavernosal injections (Trimix), and penile implants. Talk to your urologists if you are interested in restoring and rehabilitating erectile function.
• Urinary Symptoms – Many men after prostate cancer treatment may develop bothersome urinary symptoms including urinary leakage (stress incontinence), urinary blockage (urethral strictures or bladder neck contractures), and bladder overactivity. Hoag’s urologists offer treatments and therapies for all types of urinary symptoms to improve patients’ quality of life and restore a sense of normalcy after prostate cancer treatment.
• Prosthetic Surgery – Men with persistent erectile dysfunction or stress urinary incontinence can see significant improvements in their quality of life and confidence after prosthetic surgery. Hoag’s reconstructive urologist Dr. Hanson Zhao offers all types of penile prosthesis (three-piece inflatable, two-piece inflatable, malleable) for men to restore their erectile function and intimacy. Men with bothersome urinary leakage can greatly benefit from an artificial urinary sphincter or sling placement and dramatically reduce the amount of incontinence. Book an appointment today to see if you would be a good candidate for these prosthetics.
• Integrated Cancer Support Services at Hoag – At Hoag Family Cancer Institute, we’re committed to offering the best support services, resources and educational information to our patients and their families at every stage of their cancer journey. Hoag’s Integrated Cancer Support Services are open to everyone regardless of their prognosis, cancer stage or phase of recovery.
  • Resources include: 
    • Classes & Workshops
    • Counseling Services
    • Hoag’sFitter Image Exercise Program
    • Support Groups
    • Hoag Rehabilitation Services
    • Spiritual Care Services
    • Oncology Massage
    • Oncology Dietitians
    • Financial Navigators for cancer-related care
  • Find more information about Integrated Cancer Support Services at Hoag at this link.

Are there any clinical trials for prostate cancer?

Hoag is committed to leading the way in state-of-the-art technologies and advanced treatment options. Part of this commitment includes clinical research with the goal of helping patients live longer, healthier lives. Through carefully-planned clinical trials, researchers evaluate the safety and effectiveness of new ways to diagnose, treat and prevent diseases or conditions. Treatments studied in clinical trials might be new drugs or new combinations of drugs, new surgical procedures or devices, or new ways to use existing treatments. View clinical trials for prostate cancer here.

Hoag was recently named a Radiopharmaceutical Therapy Center of Excellence by the Society of Nuclear Medicine and Molecular Imaging (SNMMI), a distinction held by only 17 centers in the U.S., including Stanford Health Care, Harvard Medical School and the University of California, San Francisco.  

At Hoag, our clinical research team is committed to excellence in research and a continuing commitment to protect the interests and well-being of patients.  Contact us at 949-764-4577 to see if joining a clinical trial for prostate cancer is right for you.