Prostate Cancer

Urologists screen for prostate cancer using the PSA test. PSA is a protein measured by a blood draw. At IU Health, we recommend annual PSA screening between 50 and 70 years of age.

PSA was introduced in the 1990s and the rate of death and metastasis from prostate cancer has reduced dramatically since then. PSA became controversial because it can lead to overtreatment of slow growing tumors. At IU Health, our goal is to avoid overtreatment and use PSA to find aggressive cancer in time for a cure.

PSA screening finds cancer 10 years prior to symptoms, but is not recommended if life expectancy is less than ten years. The PSA screening finds cancers that need to be treated, but also many low grade cancers that do not need treatment. Over half of men will have a low Grade 1 cancer and never know it. One PSA value can be misleading. PSA elevation could be elevated from infection, biking, or intercourse. Therefore, a repeat screen may be needed two weeks later.

There are several technologies available at IU Health to prevent overtreatment:

• 4K Score, which is a blood draw giving percent risk of prostate cancer
• MRI-guided fusion biopsy, which enables us to better see where the cancer is
• Genomic testing, which helps predict if a tumor will become more aggressive
• PSMA/PET Imaging, which is a tracer that makes prostate cancer glow when looking at it on the scan.

The biopsy is a clinical procedure that must be scheduled with your urologist.

A numbing injection will be given to minimize discomfort. The procedure takes ten minutes with an ultrasound-guided biopsy, and twenty minutes for an MRI-guided fusion biopsy. The risks associated with a prostate cancer biopsy is that one in 200 patients will have an infection, and there will also be blood in the urine for two to three days.

MRI Fusion Biopsy

A MRI fusion biopsy is the standard of care at IU Health to ensure that we catch all of the cancer in the prostate and do not miss any.

Multiple points are placed in the prostate for biopsy to ensure that we see the exact location of the cancer and where there is healthy tissue.

These biopsy and MRI results are fused together, so that our physicians have a clear picture of where the cancerous prostate tissue is located.

PET/MRI

IU Health is one of the few centers in the United States that has the ability to combine a PET scan with an MRI.

This technology uses a computer to fuse the images from the MRI with the images from the ultrasound into a single image. Physicians can then see the high risk areas shown on the MRI, on the ultrasound image.

Thanks to this technology, physicians are able to determine which type of treatment is best for the patient, and do so faster. The PET MRI captures metabolic activity and anatomy simultaneously, so it can offer physicians more accurate assessment of the cancer. The procedure also allows for less radiation than patients would be exposed to from traditional PET/CT scans.

PSMA-Pet Tracers

The PSMA scanning technology is able to find where the prostate cancer has spread. This is done by using a PET scan either in combination with an MRI or a CT Scan. It is very helpful to physicians as the PSMA’s compound binds to prostate tissue.

This technology allows physicians to see areas of spread inside of the pelvis and around the prostate to a degree of resolution not available with any other type of imaging.

We will answer all your questions after a diagnosis. Cancer grade, or Gleason score, is determined from the prostate biopsy. Gleason scores are grouped into the following three risk levels:

Low-Risk Prostate Cancer

At IU Health, we determine the least aggressive or low risk cancers based on grade. Grade 1 cancers do not need to be treated by systemic treatment, surgery, or radiation. Instead, we use active surveillance for the low-risk prostate cancers, where physicians check in with you every six months. You will get PSA checks as well.

Intermediate-Risk Cancer

Intermediate-risk prostate cancers have a grade 2. For these cancers we can use as a single treatment with prostatectomy, HIFU (focal therapy) or radiation.

High-Risk Prostate Cancer

High risk prostate cancers are graded 3 to 5. We will need to treat these cancers with surgery, radiation, hormone therapy, and chemotherapy.

Our physicians believe that the treatment or cure should never be worse than the disease. Because prostate cancer grows slowly, your physician may suggest periodic prostate biopsies or prostate-specific antigen (PSA) tests.

Your physician will frequently utilize multiparametric MRI and/or genetic testing to confirm the degree of risk for disease progression. Many older men or men with other health issues may never need prostate cancer treatment based upon other health factors. Active surveillance allows you to avoid possible side effects of cancer treatment.

Active surveillance is only used for Grade 1 prostate cancers. The goal of active surveillance is to avoid overtreatment.

We offer three approaches for a prostatectomy—a procedure to remove all or part of your prostate:

• Radical prostatectomy
• Robotic assisted prostatectomy
• Open radical prostatectomy

Your physician will help you decide which might be best for you.

The term “female prostate cancer” actually refers to the extremely rare cancer of a gland in the female body called the Skene gland. Women and people assigned female at birth do not have a prostate gland.