Key risk factors that may increase once risk include age, family history, and race.  Genetics also play a role, with certain mutations increasing risk and genetic testing for men with strong family history of prostate, breast cancer or ovarian cancers is warranted.  Lifestyle factors and dietary influences are under study for their impacts on prostate cancer risk.

Many men diagnosed with prostate cancer may not exhibit symptoms and are often diagnosed through routine screenings like and elevated or rising PSA blood test or a digital rectal exam (DRE) performed during routine annual physicals. Symptoms that do occur can include changes in urination patterns or the presence of blood in urine, but these can also be signs of less severe conditions like BPH.

When a man has an elevated or rising PSA, abnormal DRE, or other sign or symptom that is concerning for the presence of prostate cancer, he is usually referred to a urologist who may repeat the PSA and DRE, or order certain testing such as a multi-parametric MRI which is state of the art for evaluating the prostate.  Ultimately, if there remains a high index of suspicion for prostate cancer, a biopsy is performed.  In order to assess the entire prostate, up to 12 sections or cores may be taken from random but sectioned regions of the right and left prostate lobes.  Additionally, an MRI-fusion biopsy might be performed which then further biopsies regions of concern noted on the pre-biopsy MRI to improve the yield of evaluating the prostate tissue.

The diagnosis of prostate cancer is made by the pathologist who reads the slides created from the tissue removed during the biopsy and determines a Gleason Score for each or any area of cancer which describes the level of aggressiveness, or lack thereof, of the cancer, as well as other microscopic pathologic factors that are meaningful toward prognosis such as perineural invasion, cribriform pattern, extracapsular extension or intraductal carcinoma. Your urologist may order other tests to help further determine the cancer stage, including advanced imaging such as a PSMA PET scan, or molecular testing to further understand the cancer’s underlying characteristics.

A referral to a urologist specializing in robotic-assisted surgery and a radiation oncologist to discuss radiation options is then made, and often a medical oncologist to further discuss treatment options.

Treatment options vary based on the cancer’s stage and may include surgery, radiation therapy, or hormone therapy, among others. Decisions are personalized, considering the extent of the disease and the patient’s overall health. Surgery is sometimes an option in the form of a robot-assisted radical prostatectomy (RALP) which involves the removal of the prostate and some surrounding tissue. An invasive procedure, RALP techniques have improved. Side effects or risks can include urinary incontinence and erectile dysfunction.

Radiation is often a more acceptable form of curative therapy as it typically has less long-term risks of urinary incontinence and erectile dysfunction compared to surgery. Radiation can also be done on patients who have surgery but have residual or recurrent disease found in the prostate bed or fossa.

Radiation therapy is a primary treatment for newly diagnosed prostate cancer, and it can be used in men who undergo surgery and have residual or recurrent disease. As an affiliate of Solaris Health – the largest urologic medical platform in the US – the physicians and staff have a unique commitment to the cure and advanced treatment of prostate cancer, using precise radiation delivery methods, like IGRT and RapidArc, to minimize side effects by protecting surrounding healthy tissues. Below are some of the state-of-the-art technologies pioneered and used by ARC radiation oncologists

The fight against prostate cancer leverages several advanced radiation therapies, each designed for precision and minimal impact on the patient’s quality of life. Radiation can be delivered to the prostate via external beam radiation technologies (EBRT), where a linear accelerator delivers beams of radiation in a specialized fashion – or via brachytherapy, where radioactive seeds are implanted into the prostate (or sometimes, a combination of these). Here is an overview of some of the key technologies used at ARC:

• IGRT (with fiducial tracking): Image-Guided Radiation Therapy (IGRT) is a targeting technology that utilizes detailed imaging, often with implanted fiducial markers, to deliver radiation with pinpoint accuracy.  IGRT (as the “scope”) is typically paired with a delivery technology (as the “rifle”) matching the most precise targeting accuracy with the most efficient radiation delivery modality to preserve surrounding healthy tissue and optimize dose to tissues at risk.
• Radiation Delivery – IMRT/VMAT:   Intensity-Modulated Radiation Therapy (IMRT) and Volumetric Modulated Arc Therapy (VMAT) are delivery technologies and techniques that adjust the radiation dose’s intensity and shape in real time, optimizing the distribution to conform to the tumor’s dimensions. VMAT in particular delivers a highly conformal and efficient dose delivery within minutes, as a rotational modulated inversed planned treatment course.  For most prostate cancers, treatment with VMAT is performed over a 28 or 45-48 daily treatment course, where each treatment is only 90 seconds. This slower methodology is often safer, as less radiation is needed with each treatment allowing for a more “gentle” treatment delivery.
• Radiation Delivery – SBRT: Stereotactic Body Radiation Therapy (SBRT) delivers very highly focused radiation doses to the prostate in fewer sessions, offering a shorter treatment course with precise targeting. Sometimes referred to as “Cyberknife”, or “ultra-hypofractionation”, ARC uses SBRT to deliver your entire curative course of radiation in only 5 sessions, albeit delivering higher doses in each session.  SBRT in certain cases has been shown in numerous studies to provide equivalent outcomes to more conventional treatment deliveries. Your radiation oncologist can discuss whether SBRT is an appropriate treatment for your situation.
• Adaptive Radiotherapy: Physicians at ARC are studying this innovative and evolving technology which adjusts the treatment plan in real time, accounting for changes in the tumor’s size or position, or daily fluctuations in normal tissues, ensuring optimal effectiveness and safety.
• Seed Implantation: Also known as brachytherapy, this method involves placing radioactive seeds directly into the prostate, delivering radiation from the inside out to target cancer cells while sparing surrounding healthy tissue.

Used alongside radiation, hormone therapy blocks the effects of androgens, which can fuel prostate cancer growth. This can shrink the prostate and slow cancer growth, and “weakening” the cancer by sensitizing it and increasing its susceptibility to the effects of radiation, often improving survival rates. Your radiation oncologist would discuss with you whether or not this adjuvant treatment to radiation is warranted.

The first day and even first weeks of radiation are unlikely to produce any noticeable side effects; however, the cumulative effect of radiotherapy can lead to temporary irritative symptoms of the local tissues such as urinary changes including increased frequency at night or day or urgency.  More frequent bowel movements or looser stools can be noticed. Fatigue may also be noticeable, but it is unlikely to warrant any change in daily schedule and patients could work or exercise without restriction. These “acute” irritative symptoms typically resolve 4-6 weeks after treatment completion. Long term risks of therapy will be discussed with you during your consultation, and certain advanced techniques like IG-VMAT, SBRT, placement of a rectal spacing balloon to protect rectal tissues may aid in minimizing these risks. During the course of radiation, weekly visits with the radiation oncologist are set to assess your response to therapy and discuss any possible side effects. 

Radiation treatment demands meticulous preparation by a dedicated team, ensuring precision and patient safety throughout the process.   Each step of the radiation treatment process is designed with precision, safety, and your well-being in mind, ensuring that you receive the most effective and personalized care possible.

Consultation

The initial step involves you and your family meeting with an ARC radiation oncologist to discuss your diagnosis, review your medical history, and consider the most effective radiation treatment options tailored to your specific case.  Expectations of therapy, side effects and treatment alternatives will be discussed.

Simulation

Once a course of radiation is agreed upon a simulation, or treatment planning session is performed over a 45-60 minute period.  During the simulation, the positioning of the body is set, often with a mold or cradle being customized to ensure reproducibility of positioning on a day-to-day basis.  Small “freckle-like” tattoo marks are often used for alignment and an imaging scan is performed to pinpoint the exact location of the cancer or areas at risk relative to the geometric position of the body and treatment room. This step is crucial for designing a treatment plan that maximizes the radiation dose to the cancer while sparing surrounding healthy tissue.

The Planning Process (Behind the Scenes)

For a week or two following the simulation, a multi-disciplinary team composed of the radiation oncologist, medical physicists and dosimetrists, collaborate behind the scenes using advanced software to 3-dimenionally reconstruct the anatomic areas of consideration and map out the precise treatment plan, calculating the optimal radiation dose distribution.  This dosimetry plan is a “blueprint” that will be used to ensure accuracy in the treatment delivery.

Daily Radiation Treatments

Radiation therapy typically involves daily treatments over several weeks using a machine that generates high energy photons called a linear accelerator. You may be asked to drink water prior to each treatment to increase the bladder size and location away from the prostate. The treatment room is large and is not claustrophobic. Each session typically takes place in a 10-15 minute appointment slot, with most of this time used in positioning and alignment, while the actual beams of radiation are on for only a few minutes. The radiation is invisible and not felt. Patients can drive themselves to and from the appointments, continue to work or exercise and maintain their normal daily activities.  Specific restrictions, if any, can be discussed with your radiation oncologist at consultation and during the weekly on-treatment visits.

Weekly On-Treatment Physician Review

Regular meetings with patients undergoing radiation are conducted with the radiation oncologist throughout your treatment course. These check-ins allow the doctor to monitor your progress, briefly exam the area under treatment for any possible side effects, provide any medications or treatment adjustments, and discuss any questions or concerns that may arise during therapy.

Completion of Therapy and Follow-Ups

Upon finishing the radiation treatment course, a final conversation with your radiation oncologist will discuss the next steps, expectations for resolution of side effects, and any further treatment or monitoring needed. Regular follow-up appointments are crucial after completing radiation therapy, and allow the radiation team to monitor your recovery, manage any late side effects, and check for signs of cancer recurrence.