If so, it is important to have access to comprehensive, in-depth information about your disease and all the treatment options available. In this section, we will give you an overview of what you or a family member should know, to help you feel well-prepared for when you speak with your doctor. Knowing your options may help you approach decisions with peace of mind.
Many men that have prostate cancer have no symptoms. Therefore, prostate cancer typically develops unnoticed in the early stages; there are usually no complaints from the patient. Signs and symptoms only occur at later stages.
Doctors use various diagnostic procedures to determine whether a patient has prostate cancer. The most common tests are listed below.
The multiple diagnostic procedures aim to find out how aggressive the cancer is, how large it is, whether it has spread into the surrounding tissue, and to assess the patient’s overall condition. Various examinations may need to be carried out several times to get the most detailed picture possible.
Prostate Specific Antigen (PSA) is a protein made by prostate tissue. The amount of PSA measured in your blood normally increases with age and prostate size, but abnormally high levels may indicate the need for additional testing1.
The Digital Rectal Exam (DRE) test is performed by the Urologist who will use their gloved index finger to feel your prostate through the rectal wall to assess the size, shape and stiffness of your prostate1.
The Magnetic Resonance Imaging device will use magnets to generate an image of your prostate and surroundings. From this image, the doctor may be able to find regions suspicious for cancer1.
Under imaging guidance (typically ultrasound), a small needle is used to collect a small amount of tissue from the prostate for further examination1.
Prostate cancer is described as a change in the tissue. The prognosis depends on how far the cancer has spread at the time of diagnosis. It can be characterized by ‘more’ or ‘less’ aggressive growth. Doctors use a method of classification called ‘staging’ to summarize the local extent and evidence of the spread of cancer.
The majority of prostate cancers are diagnosed at an early stage, where the cancer is limited to the prostate, meaning it is growing locally within the prostate. Therefore, it’s referred to as localized cancer. In later stages, it can extend outside the prostate, which is referred to as locally advanced cancer, or even metastasize to other organs. It can spread beyond the prostate by:
To recommend an appropriate treatment, doctors assign a stage to each patient’s prostate cancer. Staging is based on the extent of the cancer, whether lymph nodes are affected, and whether the cancer has already spread to other organs².
A healthy prostate.
The cancer cannot be felt in a digital rectal examination, and cannot be seen using imaging techniques2.
The cancer is limited to the prostate — localized prostate cancer2.
The cancer has broken through the capsule — locally advanced prostate cancer2.
The cancer is growing in surrounding organs2.
Choosing the right treatment for you is not always an easy decision.
Understanding the values and risks associated with available options is essential to helping you make the best decision possible.
The following are some of the most commonly used treatments.
For more information, always speak to your doctor about your diagnosis and what is best for your health and lifestyle.
Many men with prostate cancer do not need to be treated right away because their cancer is slow-growing, and there is a low risk of spreading².
Instead, these men are offered active surveillance, which involves close monitoring of their cancer with repeat PSA, DRE and biopsy tests. Treatment is recommended when there are signs that the cancer has progressed4.
The TULSA Procedure is a less invasive option. It is a customizable, predictable, incision-free and radiation-free ablation of a surgeon defined region of the prostate. It is performed in combination with real-time MR Imaging, transurethral thermal ultrasound and a closed-loop temperature feedback control.
Radical prostatectomy is a surgical procedure (performed robotically or not) that removes the entire prostate gland. If the cancer has spread to surrounding lymph nodes, they too are removed.
Common side effects faced by patients after undergoing prostatectomy include erectile dysfunction and urinary incontinence4.
External beam radiation therapy (EBRT) uses high-energy x-ray beams from outside of the body to ablate cancer cells. Brachytherapy (internal radiation therapy) involves placing radioactive material inside or beside the cancer to ablate cancer cells⁵. Although both healthy and cancerous cells are damaged by radiation therapy, the goal is to destroy as few healthy cells as possible.
Common side effects faced by patients after undergoing radiation therapy include erectile dysfunction and gastrointestinal toxicity4.
1. National Cancer Institute. (2011, August). Understanding Prostate Changes. Retrieved: http://www.cancer.gov/types/prostate/understanding-prostate-changes/prostate-booklet.pdf
2. American Cancer Society. (2015, March 12). Prostate Cancer. Atlanta, GA: American Cancer Society. Retrieved: http://www.cancer.org/acs/groups/cid/documents/webcontent/003134-pdf.pdf.
3. Rukstalis, D. B. (2002). Treatment options after failure of radiation therapy—a review. Reviews in urology, 4(Suppl 2), S12. Retrieved: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC1477547/
4. National Cancer Institute. (2019, June 12). Prostate Cancer Treatment. National Cancer Institute. Retrieved: https://www.cancer.gov/types/prostate/patient/prostate-treatment-pdq
5. Radiologyinfo.org (2019, May 01). Brachytherapy. RadiologyInfo.org for Patients.
Retrieved: https://www.radiologyinfo.org/en/info.cfm?pg=brachy
64 years old
“By far, the TULSA Procedure had the lowest risk of any treatment out there. To me, there was no question. If you are a candidate for the TULSA Procedure, please consider it.”
My wife and I hadn’t seen a doctor in many years, so in 2019, we decided to get physicals. I found out that my PSA was elevated. After another PSA test with elevated results, I was referred to a urologist.
In between that time, I came across an article online about a new procedure for prostate cancer called the TULSA Procedure. When I read the article, I didn’t know that I definitely had prostate issues. I always knew it was a possibility, but for some reason, that article stuck with me.
After another PSA test with elevated results, a positive prostate biopsy, and genetic testing confirming a more aggressive type of cancer, my physician recommended treatment and referred me to a surgeon. I started researching what my options were knowing I had to do something.
I decided I had to get more information to determine if the TULSA Procedure was a viable option. I started researching and looked at some of the TULSA Procedure studies. What I was able to determine was that for short term side effects, there really is no comparison between the TULSA Procedure and other treatment options.
I was hesitant about having surgery because anything can happen when you start cutting into the body. My brother also had prostate cancer and ended up getting surgery (twice) and radiation. He experienced issues afterwards and said to avoid surgery if at all possible. I also talked to a few other people I knew that had had prostate cancer, and all of them said to avoid surgery. From a relationship standpoint, my wife just said that she didn’t care what I did, she just wanted me to be around.
After meeting with a surgeon, my wife and I decided that was not the way I wanted to go. For me, surgery was going to be more expensive than other options, and I would have probably needed radiation on top of that. I’m looking at quality of life and surgery is risking your quality of life. I’m only 63. I don’t want to have a bag for the rest of my life. With the TULSA Procedure, it was likely that I would not need radiation, there was less risk of side effects which meant a better quality of life afterwards.
I had to get a new Urologist to proceed in the direction that I wanted. You have to make your own decisions about what you want to do to yourself, and you cannot be afraid to make difficult decisions. After conversations with my Urologist and their surgeon and their lack of knowledge or interest about new developments for the treatment of prostate cancer, my wife and I knew we had to make a change.
It is important to remember that Doctors are not God and they only know what they have learned or been exposed to. If they are not listening to you or you don’t think they are giving you the best advice for your condition, you have to have the courage to make the best decision for yourself.”
I also looked at HIFU, and from my understanding, it works like a pencil eraser, delivering treatment line-by-line so one of the problems is that it could miss some cancerous tissue. I was concerned about getting rectal or bladder damage from the heat. With the TULSA Procedure, the device rotates in a cooling tube and has 10 rotating transducer elements delivering the treatment with direct MRI feedback to ensure the tissue is heated to the proper temperature to kill the cancerous tissue but not too high to damage any non-cancerous tissue. So, to me, there’s no comparison between these two treatments either.
I can’t say enough about Dr. Dora’s team at the Mayo Clinic in Jacksonville. He, his nurses, the technicians, and the other staff were amazing. Because there are three different doctors in the room – the urologist, radiologist, and anesthesiologist, you’re getting three different perspectives on what the treatment should be.
As far as the actual procedure versus an operation, there is no comparison. In general, there is no recovery. I didn’t have any pain. If it wasn’t for the catheter, I would not have known anything was done. If I had had surgery, it would have taken a lot longer to recover with more pain.
You have to make your own decision and be informed. Being informed means that you know the possible treatment options available and you understand their benefits and risks. As a patient going through this procedure, I can say that this was the best decision I could have made to treat this problem. And I did not go into it blindly. I knew there were risks, but I looked at the risks of all potential treatments. By far, the TULSA Procedure had the lowest risk of any treatment out there. To me, there was no question. If you are a candidate for the TULSA Procedure, please consider it.
There are things I talk about now that I never thought I’d be talking about – like urinary issues and ED issues. I know that a lot of men don’t want to talk about prostate issues or the possible side effects of prostate treatment, but it’s important. If you were to ask me two years ago, if I would be talking openly about my prostate issues and experience, I would say no. Now, I won’t stop talking about it.
I hope information about this procedure gets out to Urologists and to their patients. I am glad I had the choice.
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