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The prostate is a gland, about the size of a walnut, that is responsible for producing the fluid that makes semen. The prostate is located in the deep pelvis just above the rectum. However, the prostate is part of the urinary tract and sits between the bladder and the rest of the urethra. The prostate has a hole in the middle of it (the prostatic urethra) to allow urine and sperm to pass through it. Some people think of it like a donut, where the urine passes through the donut hole.

Prostate cancer is the most common cancer in men (not counting skin cancer) in the U.S. It will affect one in five men over their lifetime. Prostate cancer occurs in older men primarily. Prostate cancer is often found before it has spread to other parts of the body.

Types of Prostate Cancer

Adenocarcinoma
Almost all cases of prostate cancer begin in the gland cells that make the prostate fluid. This type of cancer is called adenocarcinoma. Other kinds of cancer can also start in the prostate. This includes small cell carcinoma, transitional cell carcinoma, and sarcoma. But these types of cancer are rare. Most men with prostate cancer have adenocarcinoma.

Other types of growth that may affect the prostate include:

Benign prostatic hyperplasia (BPH)
As a man ages, the prostate can grow larger. BPH is a common condition. While not prostate cancer, it can cause the prostate to press on the urethra. Pressure on the urethra causes urination issues and can be treated.

Prostatic intraepithelial neoplasia (PIN)
This abnormal non-cancerous prostate growth may be found with a prostate biopsy. PIN can be low-grade or high-grade. Low-grade PIN is more common as men grow older. Men who have high-grade PIN have a chance that cancer is somewhere else in the prostate.

Signs and Symptoms

Localized prostate cancer typically causes no symptoms. Urinary frequency (daytime or nighttime), weak flow of stream, and urinary hesitancy are common symptoms among aging men. These symptoms are often not related to prostate cancer, therefore, screening tests, such as PSA or DRE, are crucial in obtaining a diagnosis early in the disease process.

Symptoms of metastatic prostate cancer can include:

Bone Pain
Unintentional Weight Loss

Learn more about prostate cancer screening at Sylvester.

Why Choose Sylvester Comprehensive Cancer Center?

Sylvester is an NCI-designated cancer center. The National Cancer Institute has reaffirmed us as South Florida’s only NCI-designated cancer center. We have been recognized for our scientific leadership, our commitment to training the next generation of cancer researchers and providers, as well as our engagement with the communities that we serve. For patients, this designation translates into greater access to leading-edge treatment options, including clinical trials that prioritize your specific cancer.

Sylvester is a top cancer center. U.S. News and World Report has ranked Sylvester among the nation’s top 50 for cancer care. Sylvester is also rated as high performing in colon cancer surgery. A hospital's prostate cancer surgery score is based on multiple data categories, including patient survival, prevention of prolonged hospitalizations, cancer center designation, volume, among other criteria. Hospitals that earned a high performing rating were significantly better than the national average.

Advanced radiation oncology tools. Our RapidArc® radiotherapy system delivers intensity modulated external radiation therapy (IMRT). These tools lead to more efficient and effective treatments, shorter treatment times, pinpoint accuracy in tumor targeting, and less damage to surrounding healthy tissue.

More cancer clinical trials than any other South Florida hospital. If appropriate for your cancer and stage, our clinical trials provide you with easy access to the very newest ways to treat and potentially cure your cancer.

Access to innovative minimally invasive cancer surgery. Our flagship hospital, UHealth Towers, performs one of the highest volumes of robotic surgeries in the southeast region, providing patients access to innovative, cutting-edge surgery by the most experienced providers.

Thought leaders in the field of active surveillance. We provide NCI-funded clinical trials for men who are considering observing their prostate cancer and access to the latest technology in imaging, biomarkers and AI to detect progression.

A multi-disciplinary advanced prostate program within the only NCI designated cancer center in South Florida. We provide access to the most effective therapies, technologies and clinical trials to battle advanced prostate cancer.

Imaging expertise using the most advanced technology available. Our providers’ expertise allows them to distinguish between normal and abnormal findings and work with you to develop a personalized treatment plan for the right diagnosis.

Non-invasive, radiation-free high intensity focused ultrasound (HIFU). This highly effective alternative to surgery is less painful with low side effect occurrence, reduced recovery time, no blood loss, reduced risk for incontinence and impotence, and can be repeated, if necessary.

Nationally-recognized treatment for prostate cancer. You can rely on our prostate cancer program for advanced, expert care. We are ranked among the top 10 programs in the United States. In addition, our Active Surveillance program, which helps men access safe, conservative cancer care, is the top program in Florida and among the top five programs in the United States. We were also the first hospital in the nation to become fully certified in using Ablatherm robotic high-intensity-focused ultrasound (HIFU) to treat prostate cancer.

Breakthroughs in prostate cancer diagnosis. Our urologists use the latest tools to diagnose prostate cancer and design personalized treatment plans. We were the first medical center in South Florida to use MRI Fusion Biopsy — advanced technology that allows us to identify your cancer using genetics and imaging. We are also the first medical center to offer the 4K score — an advanced blood test that screens for prostate cancer and helps guide treatment decisions.

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Treatments

Many different factors help decide prostate cancer treatment options: age, overall health, medical history, the extent of the disease, and more. Treatment may include active surveillance, surgery, radiation therapy, hormonal therapy, chemotherapy, or some combination of therapies. Active surveillance may be recommended for some men who have early-stage prostate cancer that appears to be slow growing, as well as for older men or men with other serious medical problems.

Surgery

For all stages of penile cancer, surgery is the most common treatment. Sylvester Comprehensive Cancer Center offers the following types of surgery, based on your exact diagnosis.
- Total Prostatectomy: The doctor removes the entire prostate and, when necessary, nearby lymph nodes through a small incision in the lower abdomen. In some cases, the doctor can use nerve-sparing surgery that may save the nerves that control erection.
- Laparoscopic Prostatectomy: This technique uses smaller incisions and specialized instruments to remove the prostate. Robotic technology further enhances the advantages of laparoscopic surgery.
- Transurethral Resection of the Prostate (TURP): This surgery is performed through the urethra with a tube called a resectoscope to remove prostate tissue. Usually done for BPH, this surgery can also be performed to reduce symptoms caused by a tumor before another treatment is provided.
- High Intensity Focused Ultrasound (HIFU): This non-invasive, radiation-free outpatient procedure for the treatment of prostate cancer relies on high-intensity ultrasound waves to treat only the diseased part of the prostate with precision and without damaging surrounding tissue. Sylvester is among the first medical centers in the United States to offer the HIFU prostate ablation tool.
Radiation Therapy
- External beam radiation: Most prostate radiation treatment at Sylvester is external beam from outside the body. Advanced technology tools working for you include RapidArc®, an advanced technology used with a linear accelerator to deliver intensity modulated external radiation therapy (IMRT). This shortens treatment times to one-half to one-eighth that of conventional radiation therapy, resulting in better tumor targeting, allowing higher doses to the tumor and less damage to surrounding healthy tissue.
- Brachytherapy: An alternative to external radiation therapy is brachytherapy. Also called radioactive seed implantation, radiation oncologists insert small "seeds" with radioactive material in them throughout the prostate using an ultrasound guiding them. This technique, called low dose rate (LDR) brachytherapy, discharges radiation for a few weeks and then remains permanently and harmlessly in place. Another brachytherapy technique, called high dose rate (HDR) brachytherapy, relies on temporarily placing a radioactive source in the prostate gland.

Chemotherapy

Chemotherapy may be administered intravenously or in oral (pill) form. It is usually a combination of cancer-fighting drugs. Chemotherapy is used with other therapies for cancer that has spread outside the prostate gland.

If you require intravenous (infusion) chemotherapy, you can receive it at the Comprehensive Treatment Unit (CTU) at Sylvester's main location in Miami. It's a 12,000-square-foot unit that includes 33 recliners and 11 private rooms. However, if you prefer, you can have your infusion treatments at the Kendall, Plantation, Hollywood, Coral Springs, and Deerfield Beach locations.

Hormonal Therapy

Prostate cancer cells need male hormones to develop. Hormonal therapy keeps cancer cells from receiving such hormones. Hormone therapy may be offered in conjunction with surgery, drugs, or other substances. It is typically used to treat cancer that has already spread.
Support Services

Psychologists and palliative care specialists are available to help you fit cancer treatment into their lives. This can ease both the burden and stress of treatment. Ask your oncologist or nurse for details. Fertility preservation services and counseling also are available to help in your decisions prior to undergoing treatments such as chemotherapy or radiation therapy.

Tests

In addition to a complete medical history and physical examination, procedures for diagnosing prostate cancer may include the following:

Digital Rectal Exam

The medical provider inserts a gloved finger into the rectum to look for an enlarged prostate, lumps or other abnormalities.

Prostate Specific Antigen (PSA) Test

This antigen can be seen in increased amounts in the blood of men with prostate cancer. This test measures the level of the antigen. It is also possible for PSA levels to be high among men with an infection or inflammation of the prostate or BPH.

Transrectal Ultrasound

During this test, a probe similar in size to a finger is inserted into the rectum to examine the prostate. The probe then bounces high-energy sound ultrasound waves off the internal structures, which creates a picture. This technique can also guide a biopsy.

Magnetic Resonance Imaging MRI

MRI helps the urologist identify which part of the prostate to biopsy. It also lets us see if cancer has spread outside the prostate.

Transrectal Biopsy

A thin needle is inserted up through the rectum and into the prostate. Cells are then removed and examined.

Gleason Score

After a biopsy, the pathologist can do a Gleason score to predict how aggressive the cancer is. They do this by examining the cells under a microscope and rating them from 2-10.

Multigene Tests

Because no tumor has a single mutation, genomic profiling allows the pathologist to identify groups of mutations in your tumor tissue sample and create a tumor profile. That profile can help determine if you would benefit from chemotherapy before surgery, what type of treatment would be the most effective, and how long you should have treatments like chemotherapy. Your profile may also help predict whether cancer is likely to spread to other parts of the body or recur and guide treatment accordingly.

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