Prostate Cancer

We treat men from around the country, in all stages of this type of cancer

Prostate cancer is the most frequently diagnosed cancer in men and second-leading cause of cancer death in men. You can often successfully treat prostate cancer.

Through annual prostate exams, physicals, and screenings, you can increase your chance of surviving prostate cancer.

As the home of Indiana's largest network of geographically diverse cancer specialists with expertise in medical, radiation and surgical oncology, we treat men from around the country, in all stages of this type of cancer.

The prostate is a small, walnut-sized structure in the male reproductive system. It sits just under the bladder, surrounding the urethra.

Like other cancers, prostate cancer begins when damaged cells begin to grow out of control. An enlarged prostate can be benign (noncancerous) or malignant (cancerous). Many prostate cancers grow slowly, while some grow fast and cause serious health problems or death.

Watch: David's Prostate Cancer Journey

Understanding Prostate Cancer

The prostate is a small, walnut-sized structure in the male reproductive system. It sits just under the bladder, surrounding the urethra.

Like other cancers, prostate cancer begins when damaged cells begin to grow out of control. An enlarged prostate can be benign (noncancerous) or malignant (cancerous). Many prostate cancers grow slowly, while some grow fast and cause serious health problems or death.

Watch: David's Prostate Cancer Journey

PSA Screening

PSA is a protein measured by a simple 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 one 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, and a repeat screen may be needed 2 weeks later. A PSA elevation could be from infection, biking or intercourse.

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.

How is Prostate Cancer Screened?

PSA Screening

PSA is a protein measured by a simple 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 one 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, and a repeat screen may be needed 2 weeks later. A PSA elevation could be from infection, biking or intercourse.

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.
Prostate Cancer Detection & Treatment Advancements

Biopsy

The biopsy is a clinical procedure that must be scheduled with your urologist. A numbing injection will be given to the patient so there will be minimal 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 2 to 3 days.

MRI Fusion Biopsy

A MRI fusion biopsy is the standard of care at IU Health to ensure that we are catching all of the cancer is in the prostate and not missing any cancerous tissue. Multiple points are placed in the prostate for biopsy to ensure that we are seeing exactly where the cancer is located and where there is healthy tissue.

These biopsy results and a patient's MRI image 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. Using this, physicians are able to see the high risk areas that were visualized on the MRI, on the ultrasound image.

Due to this technology, physicians are able to determine which type of treatment is best for the patient based on these scans. The PET MRI has a faster detection and diagnosis for prostate cancer patients. It captures metabolic activity and anatomy simultaneously, so it can offer physicians more accurate assessment of the disease.

This can allow for better detection, characterization, staging and ultimately management of prostate cancer. By using this technology, it combines the PET and MRI scanners into one machine allowing 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 that is not available to any other type of imaging.

How is Prostate Cancer Diagnosed?

We will ensure you have all of the answers you need after 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 by a grade 1. These 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 are checking in with you every six months and getting 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. For these types of cancers we will need to treat with surgery, radiation, hormone therapy and chemotherapy.

Biopsy & Diagnosis

Biopsy

The biopsy is a clinical procedure that must be scheduled with your urologist. A numbing injection will be given to the patient so there will be minimal 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 2 to 3 days.

MRI Fusion Biopsy

A MRI fusion biopsy is the standard of care at IU Health to ensure that we are catching all of the cancer is in the prostate and not missing any cancerous tissue. Multiple points are placed in the prostate for biopsy to ensure that we are seeing exactly where the cancer is located and where there is healthy tissue.

These biopsy results and a patient's MRI image 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. Using this, physicians are able to see the high risk areas that were visualized on the MRI, on the ultrasound image.

Due to this technology, physicians are able to determine which type of treatment is best for the patient based on these scans. The PET MRI has a faster detection and diagnosis for prostate cancer patients. It captures metabolic activity and anatomy simultaneously, so it can offer physicians more accurate assessment of the disease.

This can allow for better detection, characterization, staging and ultimately management of prostate cancer. By using this technology, it combines the PET and MRI scanners into one machine allowing 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 that is not available to any other type of imaging.

How is Prostate Cancer Diagnosed?

We will ensure you have all of the answers you need after 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 by a grade 1. These 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 are checking in with you every six months and getting 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. For these types of cancers we will need to treat with surgery, radiation, hormone therapy and chemotherapy.

What to Expect: Prostate Cancer

To help you better understand your diagnosis, watch these videos that outline what you should expect with a low-risk or high-risk prostate cancer diagnosis and how your expert team at IU Health will treat this cancer.

Low-Risk Prostate Cancer
High-Risk Prostate Cancer

When treated for prostate cancer at IU Health, you receive the full focus of a team of physicians, oncologists, surgeons and other specialists. Your physicians will work to heal you as a whole person—emotionally, spiritually and physically.

Your physicians will customize the treatment plan to every unique patient using the tools at our disposal. These tools include standard pathology from dedicated genitourinary pathologists, genetic tissue testing when appropriate, and state-of-the-art imaging.

Active Surveillance

Our physicians have the commitment 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 low-risk grade 1 prostate cancers. The goal of active surveillance is to avoid overtreatment.

Surgery

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.

High-Frequency Ultrasound (HIFU)

Surgeons at IU Health assisted in the development of a new technique utilizing high-frequency ultrasound (HIFU) to treat prostate cancer. This technique uses high-intensity sound waves to destroy prostate tissue.

HIFU provides reliable cancer destruction in the targeted area without radiation or incisions. The treatment has limited side effects. It has low risk of incontinence and erectile dysfunction. This treatment is an outpatient surgery procedure (2 to 4 hours) with a short recovery.

HIFU treats cancer within the gland. It cannot treat cancer that has spread beyond the gland or into lymph nodes. In some cases, the surgical removal of the prostate and lymph nodes can remove prostate cancer that has spread beyond the prostate.

First trialed at IU Health, the Food and Drug Administration approved it in October 2015. IU Health is the first healthcare facility in the Midwest to perform the surgery.

The PSA test is checked a few times after treatment with HIFU or prostate removal. After HIFU, it should decrease significantly and remain stable with only slow rises over the rest of your life. We'll do a repeat biopsy six months after HIFU to look for persistent cancer. After removal of the prostate, the PSA should be undetectable.

Prostate cancer that has spread outside the prostate is typically slow-moving. It requires many years to cause symptoms and death. Due to this, if your life expectancy is less than 10 years, you might receive more harm than benefit from treatment.

Cryotherapy

Relatively new and minimally invasive, cryotherapy destroys the prostate gland and prostate cancer. Your physician exposes your prostate to very cold gases that cause the cells to freeze and die. It does not affect the healthy tissues surrounding your prostate.

Cryotherapy provides a less invasive treatment with less bleeding, less pain and a quick recovery. However, side effects after cryotherapy may include trouble urinating or impotence.

Chemotherapy

Chemotherapy uses specialized drugs either to kill cancer cells or to help manage side effects of cancer. Sometimes more than one of these drugs is combined to treat cancer. You might hear such combinations referred to as a “drug cocktail” or regimen.

Radiation Therapy

When Does Radiation Oncology Come Into the Prostate Cancer Patient Journey?

The use of high-powered X-rays, placement of radioactive materials into the body or injection of radioactive substances into the bloodstream may help you avoid surgery, reduce the size of tumors before surgery or prevent cancer from recurring. At IU Health, we offer a variety of radiation techniques, including computed tomography (CT) simulation, four-dimensional CT simulation and image guided radiation therapy (IGRT), to precisely target the tumor while sparing normal adjacent tissues.

Brachytherapy

Also called implant therapy, brachytherapy places tiny radioactive pellets, or "seeds," each about the size of a grain of rice directly into your prostate. This delivers highly targeted radiation to the prostate. The seeds let out high doses of radiation to a very small area. The seeds remain permanently implanted, but they will no longer emit radiation after one to two weeks.

External Beam Radiotherapy

This type of radiation uses precisely aimed beams of radiation to destroy cancer cells. Before you undergo this therapy, you may have several imaging procedures, such as magnetic resonance imaging (MRI) or CT scans, so your physician can pinpoint exactly where your tumor is located.

Your physician uses these images to direct the beam of radiation at your tumor and minimize the damage to healthy cells in your prostate. Your physician may also create special 3D molds for you to lie in during your treatment to ensure the radiation hits the same area each time. The procedure may take 15-20 minutes to set up, but the actual radiation occurs for fewer than ten minutes. It is a painless procedure.

Prostate Cancer  Urology  Brand 2018 13

What are Treatment Options for Prostate Cancer?

When treated for prostate cancer at IU Health, you receive the full focus of a team of physicians, oncologists, surgeons and other specialists. Your physicians will work to heal you as a whole person—emotionally, spiritually and physically.

Your physicians will customize the treatment plan to every unique patient using the tools at our disposal. These tools include standard pathology from dedicated genitourinary pathologists, genetic tissue testing when appropriate, and state-of-the-art imaging.

Active Surveillance

Our physicians have the commitment 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 low-risk grade 1 prostate cancers. The goal of active surveillance is to avoid overtreatment.

Surgery

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.

High-Frequency Ultrasound (HIFU)

Surgeons at IU Health assisted in the development of a new technique utilizing high-frequency ultrasound (HIFU) to treat prostate cancer. This technique uses high-intensity sound waves to destroy prostate tissue.

HIFU provides reliable cancer destruction in the targeted area without radiation or incisions. The treatment has limited side effects. It has low risk of incontinence and erectile dysfunction. This treatment is an outpatient surgery procedure (2 to 4 hours) with a short recovery.

HIFU treats cancer within the gland. It cannot treat cancer that has spread beyond the gland or into lymph nodes. In some cases, the surgical removal of the prostate and lymph nodes can remove prostate cancer that has spread beyond the prostate.

First trialed at IU Health, the Food and Drug Administration approved it in October 2015. IU Health is the first healthcare facility in the Midwest to perform the surgery.

The PSA test is checked a few times after treatment with HIFU or prostate removal. After HIFU, it should decrease significantly and remain stable with only slow rises over the rest of your life. We'll do a repeat biopsy six months after HIFU to look for persistent cancer. After removal of the prostate, the PSA should be undetectable.

Prostate cancer that has spread outside the prostate is typically slow-moving. It requires many years to cause symptoms and death. Due to this, if your life expectancy is less than 10 years, you might receive more harm than benefit from treatment.

Cryotherapy

Relatively new and minimally invasive, cryotherapy destroys the prostate gland and prostate cancer. Your physician exposes your prostate to very cold gases that cause the cells to freeze and die. It does not affect the healthy tissues surrounding your prostate.

Cryotherapy provides a less invasive treatment with less bleeding, less pain and a quick recovery. However, side effects after cryotherapy may include trouble urinating or impotence.

Chemotherapy

Chemotherapy uses specialized drugs either to kill cancer cells or to help manage side effects of cancer. Sometimes more than one of these drugs is combined to treat cancer. You might hear such combinations referred to as a “drug cocktail” or regimen.

Radiation Therapy

When Does Radiation Oncology Come Into the Prostate Cancer Patient Journey?

The use of high-powered X-rays, placement of radioactive materials into the body or injection of radioactive substances into the bloodstream may help you avoid surgery, reduce the size of tumors before surgery or prevent cancer from recurring. At IU Health, we offer a variety of radiation techniques, including computed tomography (CT) simulation, four-dimensional CT simulation and image guided radiation therapy (IGRT), to precisely target the tumor while sparing normal adjacent tissues.

Brachytherapy

Also called implant therapy, brachytherapy places tiny radioactive pellets, or "seeds," each about the size of a grain of rice directly into your prostate. This delivers highly targeted radiation to the prostate. The seeds let out high doses of radiation to a very small area. The seeds remain permanently implanted, but they will no longer emit radiation after one to two weeks.

External Beam Radiotherapy

This type of radiation uses precisely aimed beams of radiation to destroy cancer cells. Before you undergo this therapy, you may have several imaging procedures, such as magnetic resonance imaging (MRI) or CT scans, so your physician can pinpoint exactly where your tumor is located.

Your physician uses these images to direct the beam of radiation at your tumor and minimize the damage to healthy cells in your prostate. Your physician may also create special 3D molds for you to lie in during your treatment to ensure the radiation hits the same area each time. The procedure may take 15-20 minutes to set up, but the actual radiation occurs for fewer than ten minutes. It is a painless procedure.

Prostate Cancer  Urology  Brand 2018 13

Prostate Cancer Foundation

The Prostate Cancer Foundation website provides in-depth information about prostate cancer and its treatment. It also has an extensive list of support resources for men with prostate cancer.

Us Too

Us Too, a national advocacy and information organization, dedicates itself to helping men with prostate cancer. Among this website’s resources include links to online and in-person support for men with prostate cancer and their families.

Resources

Prostate Cancer Foundation

The Prostate Cancer Foundation website provides in-depth information about prostate cancer and its treatment. It also has an extensive list of support resources for men with prostate cancer.

Us Too

Us Too, a national advocacy and information organization, dedicates itself to helping men with prostate cancer. Among this website’s resources include links to online and in-person support for men with prostate cancer and their families.