A urologist is a key member of your health care team. He or she can give you information about different treatment options and help you decide what’s right for you.
Watchful waiting and active surveillance are terms that describe not giving you immediate treatment to cure the prostate cancer unless there’s a change in your test results.
Diagnosis
When a man has a potential prostate cancer diagnosis, his urologist uses the results from screening and symptoms to decide if diagnostic testing is needed. Screening involves a blood test that measures PSA levels, which can go up when prostate cells start to grow and spread.
A urologist can also use digital rectal exam (DRE) to feel for changes in the prostate, or do a biopsy to take a small sample of tissue from the prostate with a needle. A pathologist then examines the tissue under a microscope to look for signs of cancer. If cancer is found, a doctor gives it a Gleason score, with lower scores indicating more closely packed cancer cells and higher scores indicating more spread-out cancer cells.
Tumor staging describes how far the cancer has spread in the prostate and in the nearby lymph nodes, which is used to determine treatment options. Staging may include a procedure called transrectal ultrasound, where a health care provider inserts a probe with a camera into the rectum. A urologist can use this tool to help guide where to take a biopsy.
A urologist may also order other tests, including bone scans, computed tomography (CT) scans or magnetic resonance imaging (MRI), to find out if the cancer has spread. These tests can help the urologist determine the best course of treatment to get rid of the cancer.
Treatment
Melbourne urologist help determine if prostate cancer screening is the right move for patients, make a diagnosis and then walk them through their options of treatment for prostate cancer. Depending on the stage, treatment can include surgery to remove the prostate (prostatectomy) or radiation therapy or both.
When a biopsy confirms the presence of cancer, a pathologist will examine the tissue and assign a “grade.” A Gleason score is a number that indicates how abnormal the tumor cells are compared to normal prostate cells. A lower score means a less aggressive tumour that may be more likely to stay in the prostate and not spread.
In some cases, the urologist will recommend watchful waiting rather than immediate treatment. This involves routine PSA tests and biopsies to track the progression of the cancer over time. It is an option for men who are older and whose cancer has not progressed enough to warrant immediate treatment or if the side effects of treatment outweigh the benefits.
For more advanced stages of prostate cancer, a urologist can use radiation to shrink the tumour and ease symptoms. This can be done through external radiation, called IMRT or conformal radiation or internal radiation, known as brachytherapy. With brachytherapy, the urologist places a small capsule of radioactive seeds near the tumour. These seeds emit a dose of radiation over several weeks.
Prevention
Men with a family history of prostate cancer have twice the risk of developing it themselves. Scientists have also identified several inherited genes that seem to increase the risk. A urologist can help a man with suspected genetic risk determine whether or not to pursue screening for prostate cancer.
A urologist can use an ultrasound exam or magnetic resonance imaging (MRI) screening to find the location of tumors in the prostate. A sample of tissue from the prostate, called a biopsy, can then be removed and examined under a microscope to see if cancer cells are present. In some cases, a urologist may perform a biopsy during a transurethral resection of the prostate (TURP) to treat benign prostatic hyperplasia.
Some urologists use MRI fusion biopsies, which merge the images and data from an ultrasound exam or MRI screening to offer a more detailed picture of the size, severity, and location of a prostate tumor. This allows urologists to more precisely remove only the tumor and spare the surrounding normal prostate tissue.
When a patient is diagnosed with metastatic or hormone-refractory prostate cancer, the urologist can recommend chemotherapy to help extend life and improve quality of life. A urologist who offers these treatments must be familiar with the various chemotherapy regimens available and have access to them. About half of the urologists surveyed do not employ a medical oncologist in their practice or group. Those in multi-specialty groups and academia are more likely to employ a medical oncologist than those in solo practices or single-specialty groups.
Monitoring
Men with lower-risk prostate cancer who don’t have symptoms may consider a treatment option called active surveillance. This involves closely monitoring the cancer and delaying treatment until there are signs that it is progressing. It’s also known as watchful waiting. Men on active surveillance are monitored with PSA tests and digital rectal examinations, as well as a magnetic resonance imaging (MRI) scan. The MRI uses radio waves and strong magnets to produce high-resolution images of the prostate and nearby tissue. A contrast dye is sometimes injected to enhance the image.
When a biopsy sample of the prostate shows cancer cells, a pathologist assigns a Gleason score. This measures how quickly the cancer is likely to grow and spread, based on how tightly the cells are packed together.
If the Gleason score of a patient’s cancer starts to increase, doctors generally recommend immediate treatment. This is because if the cancer progresses, it can cause urinary, bowel and sexual problems.
Many patients on active surveillance eventually receive definitive treatment through surgery or radiation, though this varies widely by physician. To ensure the best care, doctors use a technique called Tumor Board, which is a weekly meeting of urologists and oncologists who discuss each case. The team also uses the latest advances in imaging and diagnostic capabilities, including MRI fusion biopsy. This combines the results of an ultrasound and MRI screening to give urologists a more accurate, precise view of the prostate and its surrounding tissue.