Hoag Prostate Cancer Program

For more than two decades, Hoag Family Cancer Institute has been the highest volume provider for prostate cancer patients. With a multidisciplinary approach that includes early detection, active surveillance, the use of leading-edge technology and therapies, participation in laboratory and clinical research, and extensive complementary care, the team at Hoag Family Cancer Institute provides prostate cancer patients with every diagnostic and therapeutic advantage. We invite you to take a moment to explore the content below to learn more about the program.

If you have any questions, or wish to receive a second opinion on your prostate cancer diagnosis, please call 949-7-CANCER (722-6237).

DO I HAVE PROSTATE CANCER?

What is prostate cancer?

Prostate cancer is the uncontrollable growth of cells in the prostate gland. If untreated, these cells can spread into and destroy surrounding and distant tissues/organs.

What are the symptoms?

Symptoms of prostate cancer can include urinary symptoms such as difficulty urinating, blood in the urine, and back or skeletal pain. It should be emphasized that currently, it is uncommon for men diagnosed with prostate cancer to have symptoms. This is because prostate cancer is typically diagnosed at early stages before symptoms have started to precipitate.

What causes prostate cancer?

The exact cause(s) of prostate cancer have not been fully established at this point. However, known risk factors for development of prostate cancer include: family history of prostate cancer, smoking, “western” diet (diet high in fat, red meats) and obesity. In addition, certain ethnicities are at increased risk such as African-American men and men of African ancestry.

If it runs in my family, am I more likely to get it?

Prostate cancer does appear to run in certain families. If a man’s father had prostate cancer, his risk for developing prostate cancer is doubled. This risk is tripled if his brother had the disease.

Hoag Family Cancer Institute offers a Hereditary Cancer Program to assess a person's family history and any associated risk for cancer. Learn more by calling 949-764-5764.

Should I be screened for prostate cancer?

It has been recommended that men have a discussion about the pros and cons of prostate cancer screening with their physicians so that a personal, informed decision on this testing can be made.

Prostate cancer screening is carried out with the PSA blood test and an examination of the prostate, also called the digital rectal exam (DRE). Both of these tests are required for screening. Newer prostate cancer biomarkers such as the 4K and Prostate Health Index (PHI) are available at Hoag to improve the accuracy/precision of screening.

It should be noted that since prostate cancer screening with the PSA test was started in the early 1990’s, there has been a significant reduction in mortality related to prostate cancer. This is because the PSA test, in many cases, allowed detection of prostate cancer at early and potentially more curable stages. All men should seriously consider PSA screening and this is especially important for men at increased risk (men with a family history of prostate cancer or of African ethnicity).

How is prostate cancer diagnosed?

Prostate cancer is diagnosed with prostate biopsy. This is a procedure where a small amount of prostate tissue is sampled with a needle. A pathologist then microscopically evaluates this tissue for the presence of cancerous cellular changes. A prostate biopsy is recommended when a man’s PSA profile or DRE is considered suspicious.

There are two ways that prostate biopsy can be performed: trans-rectal ultrasound (TRUS) prostate biopsy and MRI-ultrasound fusion prostate biopsy (fusion biopsy).

TRUS biopsy involves the use of ultrasound only to guide the biopsy procedure. During this approach, an ultrasound probe is placed within the rectum and sonography is used to evaluate the prostate and guide the needle biopsy placement.

“Fusion” biopsy applies leading-edge targeting technology. This advanced diagnostic tool fuses pre-biopsy MRI images of the prostate with the real-time ultrasound guided images for potential superior biopsy accuracy. A man should discuss these options with his physician to determine which approach would be most appropriate.

What type of imaging is available?

Hoag’s state-of-the-art diagnostic services give patients convenient access to a full spectrum of technologies that enable doctors to pinpoint the nature and extent of the disease - and the best treatment plan for each individual patient.

Hoag’s sophisticated imaging technology and expert radiologists provide an essential component of service. Detailed images of the tumor site, contours and dimensions help physicians determine an accurate diagnosis and develop an effective treatment plan.

Some of the advanced imaging techniques at Hoag include:

  • MRI/Ultrasound fusion-guided biopsy
  • Endorectal ultrasound and endorectal ultrasound guided prostate biopsy
  • Technetium bone scans
  • Multi-parametric prostate magnetic resonance imaging (MRI)
  • PET Scanning (Positron Emission Tomography) with both MRI and CT
    • Sodium Fluoride PET CT bone scanning
    • 18F fluciclovine (Axumin) PET scanning
  • Computerized tomographic (CT) scanning, including spiral CT

NEWLY DIAGNOSED WITH PROSTATE CANCER?

How aggressive is my cancer?

Prostate cancer actually describes a spectrum of cancers, from slow growing to very aggressive. The pathologist will determine this grade or level of aggressiveness by using the Gleason scoring system, which assigns a numerical grade to the cancer based on its microscopic appearance. Gleason grade scores typically range from 6 to 10. Gleason 6 cancers are thought to be the least aggressive and Gleason 10 the most lethal.

How do you estimate what stage it’s at?

The stage of a man’s cancer describes how far the cancer has traveled from the prostate gland. This is determined initially by combining imaging tools (bone scan, CT or MRI) with clinical variables such as the Gleason grade, PSA level, and DRE findings. Staging can be further delineated if surgery is performed to remove the prostate.

What are my treatment options?

Active Surveillance Management

For men diagnosed with non-aggressive prostate cancer (Gleason 6 or less), active surveillance management should be considered. Active surveillance (AS) is the clinical observation of cancer without treatment, thus avoiding potential side effects associated with radiation or surgery. The cancer is monitored with biomarker testing, imaging and repeated biopsy for signs cancer progression. It is estimated that 80% of men on AS will not require future treatment.

Hoag Family Cancer Institute’s prostate cancer active surveillance program combines state-of-the-art cancer surveillance with improved health and wellness to optimize a man’s oncologic outcome. A man’s lifestyle habits can have a major impact on the status of his prostate cancer. Therefore, men enrolled in the program will have regular comprehensive nutritional assessment and monitoring and will have access to assistance with smoking cessation, weight loss and exercise. Please contact 949-7-CANCER (722-6237) for more information about this program.

Radiation Therapy

Radiation therapy is a standard treatment option for the treatment of low risk to high risk prostate cancer, and can be used in the treatment of regionally advanced prostate cancer, or metastatic prostate cancer.

Hoag Family Cancer Institute’s Radiation Oncology Program is another example of its commitment to excellence in personalized prostate cancer treatment. Hoag offers radiation oncology services in both Newport Beach and Irvine where its highly specialized team of medical experts delivers the latest in state-of-the-art radiation therapy to patients.

The most progressive options are available for prostate cancer patients including image guided IMRT-VMAT, IMRT by Tomotherapy or SBRT (entire treatment in five fractions over approximately two weeks).

SpaceOAR® hydrogel is the first FDA cleared spacing device to protect the rectum in men undergoing radiation therapy for prostate cancer. Hoag is the first hospital in Southern California, and west of Mississippi, to offer this revolutionary product.

Hoag’s Radiation Oncology Program offers a full spectrum of leading-edge radiation treatment options. Visit us for a complete list of radiation oncology services.

Surgery

Surgery is a vital component in the successful treatment of prostate cancer. Hoag Family Cancer Institute medical team includes experienced surgeons and the latest techniques and technology in the surgical management of prostate cancer.

Hoag surgeons utilize the da Vinci® Surgical System to perform robot-assisted minimally invasive radical prostatectomy. Technological advantages, which include a high-definition optical magnification system and endo-wrist capability, afford a post-operative recovery during which patients experience less pain, less blood loss and quicker return to normal activities. Other potential benefits may include a faster return of urinary continence and sexual function.

Jeffrey Yoshida, M.D., Hoag Urologic Cancer Program Director and fellowship-trained urologic surgeon, is an expert in robotic surgery and has performed more than 2,000 robotic prostatectomies.

Hormone therapy

Hormone therapy (also called androgen deprivation therapy) utilizes different medications to lower a man’s androgen levels. This is effective because androgens stimulate the growth of prostate cancer. This type of therapy is commonly used together with radiation therapy or in treatment of advanced stage prostate cancer.

Chemotherapy

Chemotherapy involves the use of anti-cancer medications in treatment of advanced prostate cancer.

What are the survival rates for prostate cancer?

The superior care provided to Hoag prostate cancer patients is most clearly illustrated by having a relative five-year survival rate of 100 percent since the early 1990s.

Hoag was a leader in the use of prostate specific antigen to screen for prostate cancer. This is one of the reasons that more than 90 percent of Hoag prostate cancer patients have only localized disease at the time a diagnosis of prostate cancer is made.

How can I get a second opinion?

Hoag’s expert physicians are available to provide second opinion consultations. For a comprehensive evaluation, please call 949-7-CANCER (722-6237) to schedule an appointment.

ALREADY TREATED, WHAT'S NEXT?

Can I get help with treatment related side effects?

Hoag offers pelvic floor services for men pre- and post-surgery to help strengthen bladder and pelvic floor muscles. Read more about RESTOREHIM.

How do I take part in follow-up studies?

Hoag participates in a number of ongoing research studies. To find out if there are currently any renal cancer-related studies and if you qualify, call 949-764-4430.

What happens after treatment?

Following prostate cancer treatment, you may feel relieved or apprehensive about recurrence. It may take time for your fears to subside. The good news is that many cancer survivors live relatively normal, fulfilling lives after treatment. Hoag offers multiple resources for survivors, including support groups, fitter image exercise classes and many other types of classes and workshops to support patients through this journey.