Prostate Cancer Treatment in Charlotte and the Carolinas

Outside of skin cancer, prostate cancer is the most common cancer diagnosis among men, affecting more than 3 million US men every year. Prostate cancer affects the prostate, a small gland that produces seminal fluid in males. Most prostate cancers do not spread beyond this gland.

A prostate cancer diagnosis, as with any cancer diagnosis, can seem daunting. However, because many prostate cancers are confined to the prostate gland, they are often treated successfully. Some aggressive prostate cancers do spread quickly, so early detection offers the greatest opportunity for recovery.

If you, a family member, or a friend was recently diagnosed with prostate cancer, it may feel difficult to decide on your next steps. Understanding prostate cancer, its symptoms, and treatment options can help you move forward.

Prostate cancer occurs when cells in the prostate begin to grow out of control. Only men have a prostate gland, and therefore prostate cancer only occurs in men.

Most prostate cancers are adenocarcinomas, meaning they grow from the gland cells that produce seminal fluid. There are other rare types of prostate cancer, including:

• Small cell carcinomas
• Transitional cell carcinomas
• Neuroendocrine tumors
• Sarcomas

Most prostate cancers grow slowly and do not spread outside the prostate gland. Some men even have undiagnosed prostate cancer without any symptoms or side effects.

However, there are exceptions, and some prostate cancers do grow quickly. If you experience any prostate cancer symptoms, you should schedule an appointment to see your doctor.

Fortunately, a large percentage of prostate cancer is found in the early stages, when it is very curable with local treatments like surgery or radiation therapy. Patients are generally seen by a surgeon and radiation oncologist to help determine the best treatment for their cancer.

When in its early stages, prostate cancer does not usually exhibit any symptoms. More advanced prostate cancer may result in noticeable symptoms, such as:

• Difficulty urinating, including
  • Frequent urination
  • Weak or uncontrollable urination
  • Painful urination
• Erectile dysfunction
• Blood in urine or semen
• Pressure in rectum
• Painful ejaculation
• Bone pain, especially in the hips, spine, or ribs
• Weight loss
• Weakness or numbness in the legs or feet

It’s important to recognize the symptoms of prostate cancer and to act quickly if you exhibit any of these symptoms. Be sure to consult a doctor if you experience any prostate cancer symptoms.

Despite its commonality, the causes of prostate cancer are still unknown. Doctors only know that prostate cancer occurs when prostate cells’ DNA changes, leading to uncontrolled growth.

There are, however, risk factors that increase the likelihood of a prostate cancer diagnosis. These risk factors include:

• Age: Prostate cancer is more likely in males over 50.
• African-American descent: Prostate cancer is most common in males of African American descent. These men are also more likely to experience aggressive types of prostate cancer.
• Family history: If a blood relative experienced prostate cancer, you are more likely to develop it as well. There is also a connection between a family history of breast cancer and prostate cancer.
• Obesity: Some studies show that those who are obese are more likely to develop prostate cancer.
• Poor diet: Some studies have shown connections between a poor diet and a higher likelihood of developing prostate cancer.
• Smoking: Many studies have shown that smoking increases your risk of developing prostate cancer.

Since prostate cancer may not show symptoms in its early stages, prostate cancer screening is recommended. Using screening tests, your doctor will look for signs of prostate cancer. If your doctor identifies any signs of prostate cancer, he or she may order further tests.

Prostate cancer screenings and tests may include:

• Prostate-specific antigen (PSA) blood test: This blood test measures the level of a protein produced in the prostate gland. Higher levels may be indicative of prostate cancer.
• Digital rectal exam (DRE): During this exam, your doctor inserts a gloved finger into the rectum to check for bumps or hard areas on the prostate, which might indicate prostate cancer.
• Imaging test: If symptoms or other tests indicate a possibility of prostate cancer, your doctor may order an imaging test, like an MRI or transrectal ultrasound (TRUS).

Prostate Cancer Diagnosis

The only way to confirm and diagnose prostate cancer is with a biopsy. During this procedure, a doctor gathers a small sample of the prostate. This is then studied under a microscope.

A biopsy will not only confirm the presence of cancer, it will diagnose the stage of the cancer and whether it will spread.

Once any cancer is diagnosed, it is assigned a stage. A stage indicates the extent of the cancer and how far it has spread. The stages vary from 1 (the cancer has not spread at all beyond the site of origin) to 4 (the cancer has spread to other organs). This system of staging is applied to prostate cancer.

Cancers are also assigned a tumor category (T), lymph node category (N), and a category based on whether the cancer has spread, or metastasized (M). Your diagnosis will also include your PSA level at the time of diagnosis and a Grade Group, which indicates how quickly your cancer will likely spread.

Prostate Cancer Risk Assessment

Doctors will use the above stages and categories to determine the risk level of your prostate cancer. The risk levels are as follow:

• Very low
• Low
• Intermediate
• High
• Very high

Your doctor may also consider the results of genomic and proteomic tests to determine your risk level.

Radiation therapy is a type of treatment used for many patients with prostate cancer. It uses high-energy radiation beams, usually x-rays, that are powerful enough to kill cancer cells. Radiation may stop cancer cells from growing or slow their spread elsewhere in the body.

There are two main types of radiation therapy for prostate cancer treatment, external beam radiation and internal radiation.

If the cancer is detected in its early stages, radiation therapy is sometimes the only treatment recommended for prostate cancer. As a minimally invasive procedure with lesser side effects, it is often preferred to more invasive procedures like chemotherapy or surgery. It may also be used in combination with other treatments. Some doctors also recommend radiation therapy after surgery to prevent or treat cancer that may return post-operatively.

Goals of Radiation Therapy

Radiation therapy is considered a standard treatment for prostate cancer and has several specific goals. Radiation therapy is so effective that it may be considered a cure for some early stage prostate cancers. Even if radiation therapy can’t completely destroy all prostate cancer cells, it can still shrink the tumors.

Depending on the stage of your prostate cancer, the goals may vary:

• Kill or slow the growth of prostate cancer cells while preserving surrounding healthy tissue.
• Alleviate symptoms of advanced prostate cancer, such as pain, if curing the cancer isn’t possible.

External Beam Radiation

External beam radiation therapy (EBRT) is used for prostate cancer treatment with a machine called a linear accelerator. This machine is located outside the body, and it directs focused beams of radiation at the prostate. EBRT is often used to cure early stages of prostate cancer. It can also be used to alleviate symptoms in more advanced prostate cancer.

This treatment consists of an eight to eight and a half week course of therapy, with treatments delivered Monday through Friday. The experience is similar to receiving an x-ray. The radiation is simply much stronger than that delivered via a typical x-ray.

Brachytherapy

Internal radiation, also called brachytherapy, uses implantable “prostate seeds” or pellets that emit specific doses of radiation to the prostate from inside the body. Your doctor will surgically place radioactive sources inside of your prostate gland. While inside your prostate, these seeds will emit radiation, killing the prostate cancer cells.

High-dose brachytherapy is temporary, and the sources are only in the prostate for a few minutes. With low-dose brachytherapy, the radioactive seeds are planted permanently, they release radiation over the course of a few months.

This treatment is sometimes preferred because it has minimal effect on surrounding tissues. It is ideal for those with cancer that has not, and is not expected to, spread beyond the prostate.

SERO physicians in Charlotte and the surrounding area have been performing prostate seed implants for nearly 30 years. We continue to manage a robust prostate seed implant program at most of our centers and have over 10 physicians trained in this technique. Since the inception of the prostate seed implant program at SERO, thousands of patients have enjoyed the promising results of brachytherapy.

The results of radiation implants for patients with prostate cancer have been promising, with a cure rate of 90 percent. It is sometimes combined with external beam radiation for even greater rates of effectiveness.

Image-Guided Radiation Therapy

Image-Guided Radiation Therapy (IGRT) uses imaging, like CT scanning, to visualize the tumor. This allows your doctor to more precisely deliver radiation. Your doctor will use the images to exactly align the radiation treatment every time. By comparing IGRT images, your doctor can also track the progress of the treatment and its effect on the tumor.

Intensity Modulated Radiotherapy

A special type of radiation planning and targeting called intensity modulated radiotherapy (IMRT) is utilized at all of our facilities. This treatment minimizes radiation in areas surrounding the prostate.

Because of the ability to tailor the dose closely to the prostate, patients often receive the therapy with little or no side effects. A small number of patients may experience irritation while urinating, fatigue, or loose stool by the end of their treatment course. Fortunately, these symptoms are usually easily treated with medications.

Stereotactic Body Radiosurgery

According to some studies, select prostate cancer patients may benefit from a very short course of radiotherapy, or stereotactic body radiosurgery (SBRT). SBRT uses precisely focused radiation beams to treat the tumor. This procedure consists of a total of five treatments given over two to three weeks. The extraordinary accuracy of SBRT allows for minimal effect on surrounding tissues.

SERO has several years of experience using this technology at one of our facilities with a special linear accelerator called the CyberKnife. We are excited to offer this as a cutting-edge method of treatment for prostate cancer patients.

Focal Radiation Beam Therapy

Radiation is also a viable treatment for patients with advanced prostate cancer that has spread to other sites in the body. If prostate cancer spreads or is advanced at diagnosis, the cancer tends to travel to the patient’s bones. Like other forms of radiation, focal radiation beam therapy delivers precise beams of radiation to the tumor, but in this case the doses are much higher. Focal radiation beam therapy is particularly effective at reducing or eliminating pain.

Injectable Intravenous Radium-223

Advanced patients may also benefit from a new treatment, injectable intravenous Radium-223. This has been used to treat sites where cancer has spread to the bone. Through an injection, this treatment travels by the bloodstream to the areas of disease in the bones.

Injectable intravenous Radium-223 is a very targeted therapy that has a minimal effect on blood counts. One of the radiation therapy facilities staffed by SERO is at the forefront of injectable intravenous Radium-223 use.

The side effects of radiation for prostate cancer include:

• Urinary leakage or incontinence
• Frequent, difficult, and/or painful urination
• Bloody urine
• Diarrhea
• Stomach cramps
• Bleeding or leaking from the rectum
• Painful bowel movements
• Fatigue
• Skin reactions that may look like a sunburn
• Lymphedema, or swollen lymph nodes, especially in the groin area
• Sexual dysfunction, such as decreased semen volume or erectile dysfunction

Most side effects of radiation for prostate cancer are mild. Using more advanced radiation technologies that can deliver a high, targeted dose of radiation to prostate cancer cells while sparing surrounding healthy tissues may help reduce the severity and duration of radiation side effects.

A prostate cancer diagnosis can feel alarming, but with efficient, expert care, a full recovery is likely for most patients. SERO’s 30 experienced and board-certified physicians have treated and cured thousands of prostate cancer patients. With locations at 20 hospitals and cancer treatment centers around the Charlotte Metro area, our groundbreaking care is accessible to prostate cancer patients across the region.

When you choose SERO, you’re choosing best-in-class prostate cancer treatment. But you’re also choosing a cancer care team that will stand by your side every step of the way.

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