I’ve Been Diagnosed with Prostate Cancer: Now What?

You’ve just been diagnosed with prostate cancer. Now you’re wondering: what happens now?

"The next thing we do is what’s called ‘staging,’” explains Mark Delworth MD, Medical Director of Robotics at Bethesda North Hospital.

Prostate Cancer Staging: How Does it Work?

Staging is a term that is used to determine if a cancer has spread from where it first began. Prostate cancer staging is commonly described as:

• Localized prostate cancer: the cancer is contained within the prostate gland and has not spread to nearby tissues or elsewhere in the body.
• Locally advanced prostate cancer: the cancer has spread outside the prostate gland to surrounding tissue, most often the seminal vesicles.
• Advanced prostate cancer: the cancer has spread to nearby lymph nodes, bones, or elsewhere in the body.

“They determine the grade by looking under a microscope to see how aggressive the cells look, and depending on the psa (prostate-specific antigen) of the grade, they may or may not do additional tests,” Dr. Delworth says. “Those tests are usually either a bone scan or a CT scan – and that’s to determine if there’s any spread.”

• Learn more about prostate cancer staging in our Health Library.

How is Prostate Cancer Treated?

Option #1: Active Surveillance

An option for treating low-grade prostate cancer is active surveillance, also known as watchful waiting, where your doctor closely monitors your prostate cancer for any changes. No medical treatment is provided.

“Or, if the cancer is in older men, where we think treatment is going to be worse than the disease, we do active surveillance, and that usually involves getting a PSA exam every six months and then a repeat biopsy in six months to a year,” Dr. Delworth explains.

From there, if the cancer changes or progresses, your treatment will be adjusted accordingly, and would likely involve radiation or surgery.

Option #2: Surgical Removal

Surgical removal of the prostate – and sometimes lymph nodes – is another option. “The upside with surgery is you can get the cancer out,” Dr. Delworth says. “In about 30 percent of patients, we end up finding more cancer than we originally expected, so when you get it out, you know that, and we can treat it. The other advantage of surgery is that if it were to come back in that area, we can go back and do radiation as a second treatment, with the ability to potentially cure it.”

On the other hand, surgical treatment can impair sexual function or cause temporary urinary leakage. Issues with urinary leakage, however, usually go away within several weeks or a few months of surgery.

Most surgeries are done robotically, which is a less invasive alternative to laparoscopic and open radical prostatectomy. Potential benefits of  robotic-assisted prostatectomy include:

• Less pain and scarring
• Less risk of wound infection
• Less blood loss
• Faster recovery
• Quicker return to normal activities

Treatment #3: Radiation

Treating prostate cancer through radiation comes in two forms:

• Seed implantation, which involves placing radioactive seeds inside the prostate gland (placed permanently)
• External beam radiation, which uses a high-powered x-rays pointed at the prostate gland (treatment is usually daily treatment for seven weeks)

Deciding which radiation treatment option to go with depends on the size of the tumor, your symptoms, and your personal preferences. Sometimes seed implantation and external beam radiation are combined.