What is Prostate Cancer?
Prostate cancer is a type of cancer that occurs in the prostate gland, a small walnut-sized gland in men that produces semen. Since 2014, the incidence rate of prostate cancer has increased by 3% each year in the U.S. In 2024, about 299,010 new patients have confirmed the unpleasant diagnosis.
What is the Function of Prostate Gland?
The prostate is a part of the male reproductive system. It is located beneath the bladder and in front of the rectum. It surrounds the urethra, the tube that carries urine out of the body.
The seminal vesicles are two minor glands attached to the back of the prostate. Both the prostate and seminal vesicles produce fluid that mixes with sperm to create semen. During ejaculation, this semen travels through the urethra and exits the penis.
(source - Columbia University Irving Medical Center)
Who is in the Risk Group of Developing Prostate Cancer?
Prostate cancer is very common in men over 65 years old. The studies show that about 1 in 8 men will get diagnosed with prostate cancer during their lifetime. The severeness of the disease and symptoms depend on several factors:
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👨🏻🦳 Age. Prostate cancer doesn't happen much in men under 40. The chance of early-stage prostate cancer increases after 50 years old. About 6 in 10 prostate cancers are found in men who are 65 years or older.
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👨🏾🦱 Ethnicity. Prostate cancer is more common in African American men and Caribbean men of African descent. In these groups, it often happens at a younger age. On the contrary, prostate cancer occurs less frequently in Asian American, Hispanic, and Latino men. The reasons for these racial and ethnic differences remain unclear.
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🫂 Family history. Having a father or brother with prostate cancer more than doubles a man's risk of developing the disease. The chances increase significantly if multiple relatives have had prostate cancer, especially if they were diagnosed at a younger age.
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🧬 Gene mutations. In a small number of cases, specific gene mutations are among the risk factors. For example, variants of the BRCA1 or BRCA2 genes, which are associated with higher risks of breast, ovarian, and other cancers in some families, can also elevate prostate cancer risk in men, particularly mutations in BRCA2.
What are Prostate Cancer PSA Levels?
PSA stands for "Prostate Specific Antigen". It is a protein produced by normal and cancer cells in the prostate gland. Higher blood levels of PSA can be the first signs of prostate cancer.
There's no specific data on what level of PSA is normal. However, the practitioners consider PSA levels of 4.0 ng/mL and lower acceptable. Men with a PSA level between 4 and 10 (often called the “borderline range”) have about a 1 in 4 chance of having prostate cancer.
Besides the growing cancer cells, PSA and prostate cancer risks depend on:
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Age;
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Prostate gland size;
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Level of inflammation;
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Ejaculation;
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Vigorous exercises (such as cycling) 2 days before the exam;
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Drugs, such as finasteride and dutasteride, are prescribed for treating benign prostatic hyperplasia (BPH).
PSA screening is mandatory for all men over 50 to prevent prostate cancer. The doctors often use it together with the Digital Rectum Exam (DRE) for patients reporting prostate symptoms. However, the PSA test is not a "golden standard" for diagnosing prostate cancer. It indicates several benign (not cancerous) conditions:
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Prostatitis (prostate inflammation);
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Benign prostatic hyperplasia (prostate enlargement).
What is the Gleason Score for Evaluating Prostate Cancer?
When prostate cancer is detected in biopsy samples, a pathologist assesses how aggressive it might be by giving it a grade. One of the most popular evaluation tools is the Gleason system. It measures how quickly the cancer cells are likely to grow and spread.
The Gleason system, which has been used for many years, grades prostate cancer from 1 to 5 based on how closely it resembles normal tissue. A grade of 1 means the cancer looks a lot like the prostate gland, while a grade of 5 indicates that the tissue appears very abnormal. Grades 2 through 4 represent a range between these two extremes.
The Gleason score for prostate cancer combines the two most common grades in the biopsy samples. The first number represents the tumor. For example, if the score is 3+4=7, it means most of the cancer is grade 3, with some grade 4, and these numbers are added together to get a total score of 7.
That's why men with a Gleason score of 3+4=7 cancer tend to do better than those with 4+3=7 prostate cancer.
What are the Stages of Tumor Growth?
The Tumor, Nodes, and Metastasis (TNM) system determines how far prostate cancer has spread in the body. It helps doctors understand the stage of the tumor.
Prostate cancer that is confined to the prostate is generally easier to treat successfully. However, if the cancer has spread (metastasized) outside the prostate, it usually requires treatments that affect the whole body, such as drug-based therapies.
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🩻 T (Tumor) score indicates the size and extent of the original tumor in the prostate;
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🩻 N (Nodes) score shows whether the cancer has spread to nearby lymph nodes;
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🩻 M (Metastasis) score reveals if the cancer has spread to other body parts.
Prostate cancer has four main stages:
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🟢 Early-stage | Stages I-II. The so-called "localized" cancer because the tumor doesn't spread beyond the prostate. The doctors can't see the cancer during the first stages with imaging tests.
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🟡 Locally advanced | Stage III. Cancer cells spread outside the prostate but only to nearby tissues. The doctors detect tumors during DRE or transrectal ultrasound;
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🔴 Advanced | Stage IV. The cancer spreads to lymph nodes, bones, liver, or lungs.
Some stages of prostate cancer split further (for example, IIA, IIB, IIC, etc.). Within each stage, an earlier letter signifies a lower stage. Although every individual's cancer experience is unique, cancers with similar stages often have a similar outlook and are typically treated in a similar way.
What is the Grading for Prostate Cancer?
The doctors divide prostate cancer patients into 5 groups, according to the Cambridge Prognostic Group (CPG). The risk group indicates how likely cancer cells will grow and spread.
The Cambridge Prognostic Group (CPG) is a system doctors use to predict the aggressiveness of prostate cancer. It classifies cancer into one of five groups (CPG 1 to CPG 5) based on such factors:
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PSA levels;
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Gleason score;
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Metastasis.
CPG 1 indicates a lower likelihood of rapid growth or spread, while CPG 5 signifies a more aggressive cancer with a higher chance of spreading. This classification helps doctors develop the most effective prostate cancer treatment.
| Group | CPG 1 | CPG 2 | CPG 3 | CPG 4 | CPG 5 |
| PSA result | ≤ 10 ng/ml | 10-20 ng/ml | 10-20 ng/ml | ≥ 20 ng/ml | ≥ 20 ng/ml |
| Gleason score | 6 | 3+4=7 | 4+3=7 | 8 | 9-10 |
| Tumor stage | 1 or 2 | 1 or 2 | 1 or 2 | 3 | 3 |
What are the “Red Flag” Symptoms?
Early-stage prostate cancer doesn't show many symptoms. However, as the cancer cells grow, the following signs may appear:
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Frequent urination, especially at night;
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Difficulty starting or stopping urination;
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Weak or interrupted urine flow;
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Pain or discomfort in the lower back, hips, or pelvic area;
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Blood in the urine or semen;
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Erectile dysfunction;
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Unexplained weight loss or fatigue;
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Loss of appetite;
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Bone pain.
Other diseases can cause these symptoms as well. However, as prostate cancer remains the second most common cancer in men, its early detection can make a big difference in successful treatment outcomes.
What are the Screening Methods for Prostate Cancer?
Besides the PSA test, there's a whole range of exams to treat prostate cancer successfully.
Digital Rectal Exam
During a digital rectal exam (DRE), the doctor inserts a gloved, lubricated finger into the rectum to check the prostate for any unusual bumps or problematic areas that could be signs of cancer.
Because the gland is in front of the rectum, the doctor can feel bumps or solid areas in the back in case of prostate cancer.
(source - American Cancer Society)
The procedure might feel uncomfortable, especially if there are swollen veins, but it typically isn’t painful and only takes a few moments.
MRI or Transrectal Ultrasound (TRUS)
Also called a prostate sonogram or endorectal ultrasound, this test is often combined with a prostate biopsy. It allows to visualize the prostate gland and surrounding tissues. The TRUS-guided prostate biopsy has shown positive results in 14-27% of men who had negative biopsy tests before.
Prostate Biopsy
A core needle biopsy is one of the main diagnostic tools for prostate cancer. It is the choice for patients who have confirmed their prostate cancer with PSA and DRE tests.
To diagnose prostate cancer, doctors take tissue samples either through the wall of the rectum (a transrectal biopsy) or through the skin between the scrotum and anus (a transperineal biopsy). The urologists take a few tissue samples to examine them through a microscope.
Although the procedure might seem painful, it causes only a short period of discomfort. This is because a special tool quickly inserts and removes the needle. Most specialists will use a local numbing medication before starting the biopsy to make the area less sensitive.
The prostate biopsy takes about 10 minutes and is often performed in the doctor’s office. The doctors often recommend taking antibiotics a few days before the procedure to prevent infection.
What are the Main Treatment Options?
Treatment for prostate cancer depends on several factors, including how fast the tumor is growing, whether it has spread, and the patient's overall health.
For a man diagnosed with localized or locally advanced prostate cancer, there are three main treatment options:
🔬 Active Surveillance
This method implies monitoring prostate cancer closely, without radical solutions. It includes regular doctor visits with revised PSA and DRE exams. The specialist might suggest other treatment options if the cancer changes its dynamic. This approach is best when the prostate cancer doesn't cause any visible changes or symptoms, such as trouble urination, and is expected to grow slowly;
👩🏻⚕️ Surgery
The primary surgery for prostate cancer is called prostatectomy. It involves removing the prostate gland, surrounding tissue, and a few lymph nodes.
There are a few ways to access the prostate gland:
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Open, or a radical, prostatectomy;
Surgery is an option for treating cancer that’s confined to the prostate and may be used to treat advanced prostate cancer in combination with other treatments.
⚡️Radiation Therapy
Radiation therapy uses high-powered energy to kill cancer cells. Prostate cancer radiation therapy treatments may involve external beam radiation therapy or
brachytherapy (internal radiation), which uses a machine to direct high-powered energy to prostate cancer.
Radiation therapy might be considered for treating prostate cancer, depending on its stage and other factors:
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As the first treatment for prostate cancer that is still within the prostate gland, especially if it's in a lower-risk category. In these cases, the success rates are similar to those of men who undergo radical prostatectomy (92.4% for radiation therapy compared to 96.1% for surgery);
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As part of the initial treatment, combined with hormone therapy, for cancers that are still in the prostate but are higher-risk or for cancers that have spread to nearby tissues;
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If surgery doesn’t altogether remove the prostate cancer or if the cancer returns in the area of the prostate after surgery;
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If the cancer is advanced, such as spreading to the bones, help control it for as long as possible and relieve symptoms.
💊 Hormone Therapy
Prostate cancer cells rely on testosterone to help them grow, and cutting off the supply of testosterone may kill cancer cells or reduce their growth.
Hormone therapy for prostate cancer works by blocking the sex hormones called androgens (mainly testosterone), which cancer needs to grow. This can be done in a few different ways:
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Reducing the production of androgens by the testicles;
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Blocking the effects of androgens throughout the body;
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Stopping the body from making androgens altogether.
(source - National Cancer Institute)
🩸 Chemotherapy
Chemotherapy is not a standard treatment for prostate cancer patients. Chemotherapy-exposed men have shown higher survival rates (76.3%) compared to chemotherapy-naive men who didn't receive treatment (survival rate 70.5%).
Chemotherapy can be used with hormone therapy or by itself. It is an option for advanced cases, mainly when the cancer has spread extensively beyond the prostate gland.
🩺 Immunotherapy
Immunotherapy helps the body’s immune system kill prostate cancer cells. One type of immunotherapy approved by the FDA is a vaccine called sipuleucel-T (Provenge). It increases the 36-month survival probability to 31.7% from 23.0%.
Sipuleucel-T is different from traditional vaccines, which are designed to prevent infections. Instead, this vaccine boosts the immune system to help it target and attack prostate cancer cells.
This vaccine works for advanced prostate cancer that no longer responds to hormone therapy and is causing few or no symptoms.
The doctors prescribe Sipuleucel-T individually. The medical personnel extracts white blood cells from the patient's blood to produce a vaccine.
What are the Specific Prostate Cancer Treatment Options?
| Method of treatment | Brachytherapy (Radiation Seed Implants) | Proton Therapy for prostate cancer | HIFU (prostate ultrasound) | Leuprolide injection | Cryotherapy |
| Who’s it for? | Men with early-stage prostate cancer who are in a lower-risk group. | When the cancer has spread to the lymph nodes. | If the cancer comes back after radiation therapy. Sometimes for early-stage prostate cancers. | For treating advanced prostate cancer. | If the cancer comes back after radiation therapy. Also an option for men with low risk who can’t have surgery. |
| Survival rates | 99.3% | 94.4% | 90.1% | 87% | 93.9% |
| Main advantages | Shorter treatment time (10-20 minutes per session for high-dose therapy). | Lower radiation dose to surrounding tissues. | Cancer destruction in the targeted area without radiation or incisions. | Relieves painful/difficult urination. | Less blood loss, shorter hospital stay (usually one night), and recovery period. |
| Main disadvantages | It can cause incontinence or pain during urination. | The method is more niche and expensive. | Narrowing of the prostatic urethra (stenosis). | Increased risk of heart attack and stroke. | Erectile dysfunction is more common in contrast to radical prostatectomy. |
What Are the Best Centers to Treat Prostate Cancer?
Finding a reputable hospital with experienced specialists is essential for effective prostate cancer treatment. The table below highlights the best cancer centers worldwide based on their ratings and the number of patient reviews.
|
Hospital |
Rating |
Number of reviews |
|
4.7 |
398 |
|
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4.6 |
469 |
|
|
4.6 |
138 |
|
|
4.5 |
59 |
|
|
4.5 |
121 |
|
|
4.5 |
61 |
|
|
4.4 |
138 |
*To get a comprehensive consultation and find the best hospital for prostate cancer treatment, contact Bookimed. Our coordinators will choose an appropriate solution for every case.
What is the Cost of Prostate Cancer Treatment?
Bookimed has picked the top 5 countries for prostate cancer treatment based on our smart ranking system. The prices and other cost information have three independent sources:
- Hospital representatives, who provide info about the clinic;
- Bookimed coordinators, who check the price relevance and calculate saving rates;
- Official websites and organizations provide facts and figures.
Here's an overview of the cost of proton therapy for prostate cancer alongside other methods.
| Izrael | Turkey | Spain | Germany | Czech Republic | |
| Brachytherapy | From $4,012 | From $2,500 | From $3,871 | From $2,796 | From $4,800 |
| Proton therapy | From $24221 | From $24,382 | From $24,382 | From $24,382 | From $22,166 |
| HIFU | From $13,000 | From $8,500 | From $13,000 | From $13,000 | From $8,500 |
| Cryotherapy | From $8,000 | From $8,000 | From $8,000 | From $8,000 | From $7,000 |
*The prices may vary, depending on the center's policy, exchange rates, etc. The Bookimed MD will suggest the total cost after reviewing each individual case.
How to Pick the Best Hospitals for Prostate Cancer Treatment?
The right hospital and well-qualified doctors are the main factors for successful treatment outcomes. Here’s a quick guide on finding the best prostate cancer treatment centers.
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Research Hospital Reputation. Hospitals known for excellence in prostate cancer care should be a top priority. Global rankings and reviews can give some valuable insights;
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Check Accreditations. The accreditations from international health organizations ensure quality diagnostics and treatment;
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Doctor's Expertise. The clinics with experienced prostate cancer specialists, especially those engaged in prostate cancer research, count;
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Treatment Options. The ideal options should have access to the latest technologies (such as robotic surgery, HIFU, and brachytherapy) and personalized care plans;
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Patient Reviews. Testimonials from patients with high prostate cancer levels are insightful to assess the care quality.
Is it better to have the prostate removed or treated?
Both treatments are effective, and the risk of cancer spreading is low with either option.
However, each prostate cancer treatment comes with side effects, including potential issues with the bladder, bowel, and erections. Radiation therapy is more likely to cause bowel problems. 10-20% of men report having diarrhea a few times each week after the procedure.
What is pT3b Prostate Cancer Prognosis?
pT3b means a locally advanced prostate cancer that has spread into seminal vesicles on both sides. It is a high-risk disease associated with a negative outcome. The overall survival rates for this stage are 59-84% in a 10-year period.
Nevertheless, patients with clinically significant prostate cancer still have treatment options.
These include:
- External beam radiation therapy (EBRT);
- Hormone therapy;
- Radical prostatectomy.
What is the newest and best treatment for prostate cancer?
In 2023, the FDA approved a medication called enzalutamide. It can be used alone or with another drug called leuprolide for men who have a rise in PSA levels (biochemical recurrence) and are at high risk of their cancer spreading.
Do patients need a urinary catheter after prostate removal?
During a radical prostatectomy, the surgeon inserts a catheter into a penis to help drain the bladder. The catheter has to stay in place for 1 to 2 weeks during healing. In a robot-assisted prostatectomy, though, the catheter doesn't stay longer than 2 days. After the catheter is removed, normal urination can resume.
Can a patient ejaculate after prostatectomy?
After surgery, the feeling of orgasm should still be enjoyable, but there won't be any ejaculation of semen—this is known as a "dry" orgasm. This happens because the doctor removes the prostate and seminal vesicles, which produce most of the fluid for semen, and cuts the pathways for sperm.
For some men recovering from prostate cancer, orgasms may feel less intense, and in rare cases, some might experience pain during orgasm.
Does Viagra work after prostate removal?
After surgical prostate cancer treatment, Viagra can help with erectile dysfunction, especially if the procedure did not significantly affect the nerves. However, everyone responds differently, so finding the correct dose might take some time.
Can a man with no prostate get a woman pregnant?
During a radical prostatectomy, the surgeon cuts the vas deferens, which are the pathways that carry sperm from the testicles to the urethra. Although the testicles will still produce sperm, the sperm can no longer leave the body as part of the ejaculate, meaning that natural conception is no longer possible.
Men with prostate cancer are often older, but for those who still wish to have children, it's possible to preserve fertility. Before surgery, they can store sperm in a sperm bank, allowing the option for fatherhood through assisted reproductive methods later on.
How Bookimed Can Help Find Prostate Disease Treatment?
For patients in a hurry looking for the best solution, Bookimed is a sure way to get the best treatment for prostate cancer in its early stages. In a few days, the users can get their personalized treatment plan and recommendations for the best medicine for prostate treatment.
How does it work?
1. Patients submit a request outlining the medical issue;
2. A doctor reviews the case;
3. The medical coordinator selects the best hospital and specialist;
4. Once the treatment plan is ready, Bookimed assists in arranging the trip;
5. The medical coordinator supports patients 24/7 throughout their trip;
6. Bookimed monitors the progress and continues communication after returning home.
By choosing Bookimed, patients can save up to 50% on medical travel. They won't have to calculate expenses, arrange airplane tickets, or sign up for doctor's appointments. They can enjoy a smooth experience and non-stop support.
References
- Bowel Dysfunction After Prostate Cancer Treatment. Johns Hopkins Medicine. URL: https://www.hopkinsmedicine.org/health/treatment-tests-and-therapies/bowel-dysfunction-after-prostate-cancer-treatment (date of access: 03.09.2024).
- Key Statistics for Prostate Cancer | Prostate Cancer Facts. Information and Resources about Cancer: Breast, Colon, Lung, Prostate, Skin | American Cancer Society. URL: https://www.cancer.org/cancer/types/prostate-cancer/about/key-statistics.html (date of access: 03.09.2024).
- Prostate cancer risk groups and the Cambridge Prognostic Group (CPG). Cancer Research UK. URL: https://www.cancerresearchuk.org/about-cancer/prostate-cancer/stages/cambridge-prognostic-group-cpg (date of access: 03.09.2024).
- Prostate cancer statistics | World Cancer Research Fund International. WCRF International. URL: https://www.wcrf.org/cancer-trends/prostate-cancer-statistics/ (date of access: 03.09.2024).
- Prostate-Specific Antigen (PSA) Test. Comprehensive Cancer Information - NCI. URL: https://www.cancer.gov/types/prostate/psa-fact-sheet (date of access: 03.09.2024).