Prostate Cancer
What is prostate cancer?
The prostate is part of the male reproductive system. It is a small organ below the bladder that makes fluid for semen. The prostate surrounds the urethra, the tube that carries urine from the bladder out of the body through the penis. Prostate cancer is the abnormal growth of cells in the prostate gland. Prostate cancer cells can spread within the prostate, to nearby lymph nodes and other tissues, and to other parts of the body.
When the cancer hasn't spread outside the prostate, it is called localized prostate cancer. With localized prostate cancer, your options depend on how likely it is that your cancer will grow. Test results, including the Gleason score from your prostate biopsy, will show if your cancer is likely to grow.
- Low-risk cancer isn't likely to grow right away. If your cancer is low-risk, you can choose active surveillance. This means your cancer will be watched closely by your doctor with regular checkups and tests to see if the cancer grows. This choice allows you to delay having surgery or radiation, often for many years. If the cancer grows very slowly, you may never need treatment.
- Medium-risk cancer is more likely to grow. Some people with this type of cancer may be able to choose active surveillance. Others may need to choose surgery or radiation.
- High-risk cancer is most likely to grow. If you have high-risk cancer, you will likely need to choose surgery or radiation.
If your cancer has already spread outside the prostate or to other parts of the body, then you may have other treatments, like chemotherapy or hormone therapy.
If you are older or have other serious health problems, like heart disease, you may choose not to have treatments to cure your cancer. Instead, you can just have treatments to manage your symptoms. This is called watchful waiting.
Our Approach
Patients in our Multidisciplinary Urologic Oncology Program have their cases reviewed weekly by nationally recognized experts in urologic oncology -- urologists, medical oncologists, radiation oncologists and pathologists -- who are supported by a specially trained nursing and physician-assistant staff with specific expertise in urologic oncology. Together, this team recommends personalized, patient specific treatment plans.
When a patient has been diagnosed with localized prostate cancer, there are multiple treatment options for them, including surgery, radiation therapy, and active surveillance. A focused survivorship program targeting the main side effects of these treatments is part of the patients care. These patients are seen at our Weiser Center for Prostate Cancer.
Appointment Information
If you've been diagnosed with prostate cancer, or suspect you may have it, please call 734-647-8902.
If you're referring a patient, please contact M-Line 800-962-3555.
For people with questions, please call our Cancer AnswerLine at 800-865-1125.
What are the symptoms of prostate cancer?
Prostate cancer usually doesn't cause symptoms in its early stages. Most people don't know they have it until it is found during a regular medical exam.
When there are symptoms of prostate cancer, they often include urinary problems, such as:
- Not being able to urinate at all.
- Having a hard time starting or stopping the flow of urine.
- Having to urinate often, especially at night.
- Feeling pain or burning during urination.
Less common symptoms may include:
- Difficulty having an erection.
- Blood in your urine or semen.
- Deep and frequent pain in your lower back, belly, hip, or pelvis.
How is prostate cancer diagnosed?
Early prostate cancer generally has no symptoms. That’s why discussing with your doctor when to begin and how often to have a digital rectal exam and a prostate-specific antigen (PSA) blood test is so important. By the time symptoms are noticeable, like blood in the urine, pain, problems passing urine or even loss of bladder or bowel control, the cancer is in an advanced stage making treatment outcomes less doubtful.
Evaluation and Diagnostic Testing
The most common way to check for prostate cancer is to have a digital rectal exam and a PSA blood test. Prostate-specific antigen is a protein produced by cells of the prostate gland. A higher level of PSA could mean that you have prostate cancer. If your PSA is high, or if your doctor finds anything during the rectal exam, he or she may do a biopsy to figure out the cause. A biopsy means your doctor takes a sample of tissue from your prostate gland and sends it to a lab for testing.
Men who are concerned about their risk should see a urologist who may elect to evaluate for prostate cancer using these tools:
- Digital Rectal Examination and PSA
Prostate biopsy prompted by abnormal findings on a digital rectal exam (DRE), such as nodularity or induration of the prostate leads to a diagnosis of prostate cancer in only 15%-25% of cases. However, an abnormal DRE is associated with a five-fold increased risk of cancer present at time of screening.
PSA is a serine protease produced by the prostatic epithelium and secreted in the seminal fluid in large quantities. The level of PSA is increased in the blood by inflammation of the prostate, urinary retention, prostatic infection, benign prostatic hyperplasia, prostate cancer, and prostatic manipulation.
- Mi-Prostate Score
For men with an elevated PSA, the University of Michigan has begun offering a new urine test called Mi-Prostate Score to better assess the risk of cancer being present. The test developed from a discovery by U-M researchers of a genetic anomaly that occurs in about half of all prostate cancers, an instance of two genes changing places and fusing together.
This gene fusion, T2:ERG, is believed to cause prostate cancer. Studies in prostate tissues show that the gene fusion almost always indicates cancer.
The new urine test looks for the T2:ERG fusion as well as another marker, PCA3. This is combined with the PSA measure to produce a risk assessment for prostate cancer. The test also predicts risk for having an aggressive tumor, helping doctors and patients make decisions about whether to wait and monitor test levels or pursue immediate biopsy.
Biopsy
If your PSA or Mi-Prostate Score are high, or if your doctor finds something concerning during the rectal exam, he or she may do a biopsy to figure out the cause. A biopsy means your doctor takes a sample of tissue from your prostate gland and sends it to a lab for testing. Prostate biopsies are usually performed as an office procedure. The procedure is done without the need for anesthesia and carries a risk of significant infection of only 1 in 200. Some blood in the urine or in bowel movements can be common for two or three days following the biopsy. Blood in the semen may last for up to several weeks.If the biopsy is negative, these men are typically followed by checking PSA and rectal exam annually. Repeat biopsy may be needed if PSA levels rise at abnormal rates (less than 0.8 ng/dL/year) or if rectal exam shows new nodularity or induration.
When the biopsy is positive and the cancer is staged, you and your interdisciplinary team will devise a personalized treatment plan that may include medical management and/or surgery.
Men in whom high-grade prostatic intraepithelial neoplasia (an abnormality thought to precede prostate cancer) is found on biopsy may undergo repeat biopsy, since about one-third will be found to have prostate cancer.
How is prostate cancer treated?
Medical management and treatment options
You and your doctor may decide to treat your cancer with surgery, radiation, hormone therapy, or a combination. As part of your treatment in the Multidisciplinary Urologic Oncology Clinic, patients have their cases reviewed weekly by nationally recognized experts in urologic oncology -- urologists, medical oncologists, radiation oncologists and pathologists -- who are supported by a specially trained nursing and physician-assistant staff with specific expertise in urologic oncology. Together, this team recommends personalized, patient specific treatment plans.
There are many variables that are taken into consideration when your treatment plan is devised and discussed in the weekly conference such as other health risks, the level of your disease and past health history. Main treatment options may include one or more of the following:
- Active surveillance with regular medical checkups
- Chemotherapy
- Clinical trials
- Cryotherapy
This procedure freezes the cancerous tissue and is used when other therapies have failed. - Focal Therapy
- Hormone therapy
Chemical or surgical castration to remove the source of hormones fueling the cancer. Though not curative, hormone therapy can keep the cancer at bay for an extended time. - Radical prostatectomy (surgery)
- Radiation therapy with the intent to cure
Treatment plans can include intensity modulated radiation therapy, proton therapy and brachytherapy (seeds). - Pluvicto
Locations
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Urologic Oncology Clinic | Rogel Cancer Center 1500 E Medical Center Dr
Floor B1 Reception E
Ann Arbor, MI 48109-5913Get Directions -
Urologic Oncology Clinic | West Ann Arbor Health Center-Parkland Plaza 380 Parkland Plaza Ste 210
Floor 2
Ann Arbor, MI 48103-6201Get Directions
Doctors
Joshi James Alumkal, MD
Professor
Medical Oncology
Tudor Borza, MD
Assistant Professor
Urology
Megan Elizabeth Veresh Caram, MD
Clinical Associate Professor
Medical Oncology, Hematology, Internal Medicine
Robert Timothy Dess, MD
Clinical Associate Professor
Radiation Oncology
Robert Timothy Dess, MD
Clinical Associate Professor
Radiation Oncology
Jason Warren David Hearn, MD
Clinical Associate Professor
Radiation Oncology
William Carl Jackson, MD
Clinical Assistant Professor
Radiation Oncology
David Christopher Miller, MD
Professor
Urology
Jeffrey Scott Montgomery, MD
Clinical Professor
Urology
Todd Matthew Morgan, MD
Professor
Urology
News & Stories
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