The prostate is the small, walnut-sized gland located between the bladder and the penis that makes most of the fluid in semen. Prostate cancer is the most common cancer in men — more than 200,000 cases are diagnosed in the U.S. each year. The disease is rare under age 50, and most common in African-Americans. Fortunately, 85 percent of prostate cancers are detected at the earliest, most treatable stages, and nearly all prostate cancers grow very slowly.
➤ Take this health quiz to help determine your risk for prostate cancer
Prostate Cancer Diagnosis
Prostate cancer often presents no symptoms, so testing is extremely important. Prostate cancer tests include:
- Digital rectal examination (DRE) — A doctor inserts a lubricated, gloved finger into the rectum and feels the prostate to check for enlargement, lumps, nodules or tenderness.
- Prostate-specific antigen (PSA) — A protein called PSA is measured by a blood test. If PSA is high, prostate cancer is more likely, but an enlarged prostate can also cause a high PSA.
- Prostate ultrasound (transrectal ultrasound) — An ultrasound probe is inserted into the rectum, close to the prostate. Ultrasound is often done with a biopsy to test for prostate cancer.
- Prostate biopsy — A needle is inserted into the prostate to take tissue out to check for prostate cancer.
- CT scan — More detailed than X-rays, CT scans produce cross-sectional images of the body and are useful for detecting abnormalities including prostate cancer.
- MRI — Magnets, radio frequencies and a computer produce detailed images of organs and structures in the body.
- Bone scans — A radioactive agent is injected into the body and followed on a camera. This test can determine if prostate cancer has spread to other areas in the body.
- Multiparametric MRI — This is a specialized MRI scan to identify areas of the prostate that might be cancerous. Emerson has a partnership with Shields Imaging to detect the precise location of cancer, which is critical to effectively treat the cancer, without affecting other areas of the prostate, and improve outcome.
Options to Manage and Treat Prostate Cancer
Based on your age, genetics, medical history and stage of cancer, treatment options may include:
- Active Surveillance — Depending on age and the severity of the illness, sometimes physicians recommend a ‘wait and see’ approach since most prostate cancer grows very slowly. We treat the cancer only when there are signs of aggressive growth.
- Radical Prostatectomy — This is when the whole prostate is surgically removed through an incision in the lower abdomen.
- Radiation — Prostate cancer cells are targeted using high doses of radiation, aiming to destroy the cancer and disrupt its ability to spread.
- Focal Cryoablation Therapy — This revolutionary procedure treats only the cancer lesions, without needing to remove the whole prostate. Emerson’s Louis Liou, MD, PhD, is the only doctor in New England who is specially trained to do this procedure. While the patient is sedated, a special MRI guides tiny probes into the prostate. The probes use special gas to freeze and kill prostate cancer cells. This is a minimally-invasive procedure that does not require major surgery. Patients usually go home the same day and recover in a few days with minimal side effects.
Emerson’s experienced medical oncologists specialize in the medical treatment of prostate cancer. They help guide the diagnosis, treatment plan and overall care for patients. Medical oncologists prescribe chemotherapy and/or biotherapy for patients who require it. The medical oncologists at the Mass General Cancer Center at Emerson Hospital – Bethke have close working relationships with colleagues at Mass General Cancer Center in Boston. Emerson patients have access to the latest treatments available through cancer clinical trials.
Surgeons work closely with Emerson’s expert anesthesiologists, who provide clinical anesthesia services for patients. Available at the hospital 24 hours a day, anesthesiologists also consult on pain management for those with chronic pain.
Chemotherapy and Infusion Services
Chemotherapy is an important part of many cancer treatment plans. Advances in chemotherapy treatment are making this therapy more precise and targeted. The Cancer Center’s outpatient chemotherapy infusion suite offers the most advanced therapy in a new, state-of-the-art facility staffed by medical oncologists and specially trained oncology nurses. In addition, patients admitted to Emerson Hospital now have access to the Naka Infusion Center, which provides a suite dedicated to infusion therapies designed with patient safety, comfort and privacy in mind. Family members or friends are welcome to accompany patients during treatment.
Radiation therapy is an invaluable cancer-fighting therapy and is usually given once a day over many weeks, so convenience and ease-of-access to the treatment facility is critical. The Massachusetts General Hospital Department of Radiation Oncology at Emerson Hospital provides all of this. The joint program includes the most up-to-date and highly accurate treatment and planning technologies available at the major downtown hospitals in one convenient location — at the Cancer Center in Concord, Mass. Recent advances in radiation treatment which are available to Emerson patients include:
- 3-D Conformal Radiation Therapy: CT-scan guided treatment planning, which enables the physicians to pinpoint the precise tumor location using an on-site CT scan.
- Intensity-Modulated Radiotherapy (IMRT) so the physicians and physicists can “sculpt” radiation beams around the tumor — thus avoiding unnecessary radiation to normal tissues and structures.
- Image-Guided Radiation Therapy: Imaging tools within the linear accelerator (treatment machine) that enable precise re-positioning of the patient from one treatment session to the next.
Today, cancer treatment is tailored to each patient’s tumor. Pathologists play an important role in diagnosing cancer and identifying attributes about each tumor that help oncologists design the most effective treatment plan. Emerson’s pathologists have access to the most cutting-edge molecular tests available to aid in accurate diagnosis.
Genetic Testing and Counseling
Several types of cancer are known to have a genetic component. Emerson provides genetic screening and counseling for patients who want to know their cancer risks.
The ability to perform genetic testing to determine if a patient carries a known cancer gene is a significant breakthrough in cancer management. Patients at genetic risk for cancer can take steps to prevent cancers from occurring, or increase screenings to make sure they are found at the earliest, most treatable stages. Understanding the genetic causes of cancer is also leading to the development of customized, targeted cancer therapies. As more cancer genes are identified, more patients will benefit. Genetic testing also makes it possible to analyze a tumor’s DNA in order to determine whether or not a patient is at high or low risk for recurrence. Patients at low risk for recurrence may not require chemotherapy.
The goal of cancer genetics counseling is to assist patients who wish to understand the role genetics plays in their cancer diagnosis, as well as the potential risk for family members. For more information, please call 978-287-3436.
Over the past 15 years, clinical trials have been an important part of the comprehensive cancer program at the Cancer Center. The decision to take part in a clinical trial is very personal. You should talk to your physician and consider the risks and benefits of a study before agreeing to participate.
Integrative therapies, also known as complementary therapies, can be very effective in addressing nausea, pain and fatigue and in bolstering the immune system. Emerson patients who are interested in combining acupuncture, yoga, Reiki, herbs or other integrative therapies with their cancer treatment are encouraged to speak with their physician, who can make a referral, including to a certified, on-site acupuncturist.
Support Services and Groups
The Clough Family Center for Rehabilitative and Sports Therapies helps patients with physical, occupational and speech therapy needs during and after treatment. An enterostomal nurse specialist is available as needed. Emerson’s home care department has specialists who assist with support services that may be needed in the home, and care coordination if a hospice referral is desired. Emerson’s social work department provide specialists who help to coordinate and integrate support services at any time from initial diagnosis, through treatment and after. Practitioners from all of the support services work collaboratively with our medical oncology teams to provide the best of care. The Cancer Center is dedicated to its patients and continues to provide care and support after completion of active treatment through survivorship programs.
Emerson Hospital offers support groups through an affiliation with the Virginia Thurston Healing Garden in Harvard, Mass. Please call 978-456-3532 for more information. A twice-a-month caregiver support group meets at Emerson Hospital and is open to loved ones of those with a diagnosis of cancer. For more information, please contact the MGH Cancer Center at Emerson Hospital – Bethke social worker at 978-287-3428. In addition, an eight-week grief support group meets quarterly at Emerson Hospital. For more information and registration, please contact Care Dimensions at 855-774-5100.
Emerson also offers a wide range of community health and wellness programs and classes that can help participants learn about cancer prevention and early diagnosis strategies or help those with cancer, their caregivers or family manage the stress associated with the illness. A variety of stress reduction programs use approaches including mindfulness training, yoga and meditation, tai chi, Reiki and Qigong. Another program teaches those who have completed cancer treatment nutrition strategies for preventing cancer recurrence.
Emerson’s Lund Community Health Library offers information that can help individuals understand and cope with the diagnosis of a medical condition and learn about the latest treatment methods.
About the Cancer Center
The Mass General Cancer Center at Emerson Hospital – Bethke was created to bring outstanding cancer specialists and facilities to the residents served by Emerson Hospital. Staffed by expert oncologists with Mass General Hospital, the Cancer Center provides advanced, quality treatment and technology with compassion and care. The staff is committed to answer questions and discuss treatment options openly and honestly; and to provide support services. Treatment is based on a multidisciplinary approach to cancer care that emphasizes the coordination of many disciplines and services to form an organized team of professionals and support staff that works closely with individual patients and families to provide optimal care and the best outcomes.
Prostate Cancer Prevention
Although research is still underway, evidence is mounting that men can take steps to lower their risks of developing prostate cancer. Steps that help lower the risk of developing the disease include:
- A low-fat diet that consists primarily of vegetables, fruits and grains and limiting high-fat foods from animal sources. Antioxidants in fruits and vegetables are believed to prevent damage to the DNA of the body’s cells. Lycopenes — antioxidants found in tomatoes, spinach, artichoke hearts, beans, berries, grapefruit and oranges — are most closely associated with a reduced risk of prostate cancer.
- Vitamin supplements may help lower prostate cancer risk. Some studies show that vitamin E and selenium supplements may provide protection from prostate cancer. Though the evidence is not conclusive, speak with your physician to determine if supplements might be helpful for you.
- Early detection of prostate cancer is important. If it is found at the earliest, most treatable stages, less treatment is usually required and therapeutic options are more extensive. There is not universal agreement on guidelines for routine testing (screening) for prostate cancer, but general recommendations are:
- Annual digital rectal exams (DRE) beginning at age 40
- Prostate-specific antigen (PSA) testing beginning at age 50 followed by testing every other year
- Annual digital rectal exams and PSA testing beginning at age 40 for African-American men and those with a family history of prostate cancer.