.webp)
Key takeaways:
- Prostate cancer is one of the most common cancers to affect American men. High-risk prostate cancer is an aggressive type of cancer that makes up around 20 percent of all prostate cancer cases.
- Symptoms of this disease include sexual and urinary problems.
- Physical exams, lab tests, and imaging tests, like multiparametric MRI, are often used to screen, grade, and stage prostate cancer.
- Treatment options for high-risk prostate cancer include surgery, radiation therapy, and medication.
Prostate cancer originates in the prostate, a small walnut-shaped gland situated just below the bladder in men. According to the American Cancer Society, 1 in 8 men may be diagnosed with prostate cancer during their lifetime, with over 300,000 new cases in the US every year1. The risk of developing prostate cancer increases with age – the average age of diagnosis is 67. Approximately 1 in 44 men with prostate cancer will die from it, making it the second-highest cause of death from cancer in men in the US1.
While prostate cancer may be a serious disease, the majority of men do not die from it. Early detection of prostate cancer, while the cancer is still confined to the prostate gland, increases the chances of a successful outcome.
What Is High-Risk Prostate Cancer?
The most common type of prostate cancer is adenocarcinomas – cancer developing from the glandular cells (cells that produce glandular secretion; in this case, some seminal fluid) – making up 95 percent of all cases2. The majority of prostate cancers grow very slowly and do not grow beyond the gland. Aggressive prostate cancers make up approximately 20 percent of cases3. These cancers grow rapidly and are more likely to spread outside of the prostate gland. When detected at stages 1-3, prostate cancer has a high 5-year survival rate of close to 100 percent. However, when detected at stage 4, the average 5-year survival rate is only 28 percent4.
Prostate Cancer Staging
The clinical staging of prostate cancer is based on the following parameters:
- Digital rectal examination (DRE) – a physical examination to feel for lumps in the prostate carried out by an experienced healthcare practitioner5.
- Prostate-specific antigen (PSA) blood test – PSA is a protein produced by the prostate gland; it is elevated when there are issues with the prostate gland, such as cancer6.
- Gleason Score – biopsy samples are graded on this 1 to 5 scale developed by Dr Donald Gleason. The most predominant cancer cell type will be given a Gleason grade, as will the second most predominant cell type; the final Gleason score is calculated by the addition of these grades7.
Using these parameters, the cancer can be categorized into various levels of clinical risk. Most healthcare professionals in the U.S. use the National Comprehensive Cancer Network (NCCN) risk stratification system. This system helps inform many American medical associations’ guidelines about treating clinically localized prostate cancer.
The NCCN system categorizes high-risk prostate cancer as8:
- The tumor has spread beyond the prostate (a cT3a tumor)
- Gleason score of 8-10
- PSA level higher than 20 ng/mL
Signs and Symptoms of Prostate Cancer
At its earliest stages, prostate cancer is often asymptomatic – demonstrating the importance of early screening tests. In the later, more advanced clinical stages, some symptoms can be observed, including9:
- Problems with urination (weak or slow stream and the frequent urge to urinate, especially during the night)
- Erectile dysfunction
- Blood in semen or urine
- Bladder or bowel incontinence
- Weakness in legs and/or feet
- Pain in areas where cancer has spread to the bones (e.g. hips, back, or chest)
These symptoms are not exclusive to prostate cancer and may be due to other underlying medical conditions. For example, urinary incontinence may also be due to benign hyperplasia (non-cancerous enlargement) of the prostate. Always consult your medical practitioner if you experience any of these symptoms.
Diagnosing High-Risk Prostate Cancer
Most prostate cancers are usually detected during a screening for a different medical problem or during a regular screening as part of an individual’s healthcare routine.
Screening Tests for Prostate Cancer
Medical practitioners may order a PSA test during a routine blood test for men aged 50 years and above due to their increasing risk of developing prostate cancer. Medical history and symptoms of prostate cancer, such as urinary or sexual issues, will also be taken into account.
If the test returns elevated PSA levels, further examination may be done.
1. Digital Rectal Exam (DRE)
In this test, the medical practitioner will insert a lubricated, gloved finger into your rectum and feel the size of your prostate gland5.
2. Advanced PSA Tests
Advanced tests like the Prostate Health Index (PHI) and the 4Kscore test combine the results of different PSA tests to arrive at an overall score that is a more accurate indicator of whether a man has prostate cancer10,11.
3. Imaging Tests
Imaging tests like the multiparametric MRI or transrectal ultrasound (TRUS) are usually used to screen for prostate cancer12. The American Joint Committee on Cancer Staging recommends the use of multiparametric MRIs for the staging of prostate cancer.
The Ezra Full Body Plus uses a multiparametric MRI and scans up to 14 organs, including a prostate MRI for those who qualify.
An MRI scan can also help to determine whether the cancer has spread. It can visualize the presence of cancer outside the gland and whether the adjoining seminal vesicles have been invaded or the pelvic node is involved.
While challenges may arise in result interpretation due to magnet strength and other factors, such as variability arising from different levels of expertise of the reader, Ezra addresses these challenges by using state-of-the-art MRI equipment with 3T magnet strength. We also address the problems of reader variability by having your MRI scans reviewed by board-certified and experienced radiologists.
4. Prostate Biopsy
If the above test results suggest that you may have prostate cancer, your medical practitioner will most likely order a prostate biopsy.
A core needle biopsy will be performed by a urologist to remove small cylinders of prostate tissue13. The biopsy samples will then be viewed to determine if the cells are cancerous and also to calculate the Gleason Score. Due to the risks that biopsies can carry, it is often recommended to first carry out a prostate MRI.
Treatment Options for High-Risk Prostate Cancer
While active surveillance and watchful waiting are used in early phase, or low-risk prostate cancer, high-risk disease requires a more proactive treatment approach.
Currently, different treatment modalities are used, usually in combination, to provide optimal treatment and the best possible prognosis.
For patients with localized high-risk prostate cancer, the treatment options include radiotherapy or radical prostatectomy along with pelvic lymph node dissection and androgen deprivation therapy. The multimodal approach is guided by the individual’s case and the input of a team of medical experts14.
1. Surgery
The surgical removal of the prostate gland follows the first principle of treatment of high-risk localized (in which the cancer is within the prostate gland or localized within the surrounding area) prostate cancer, which is to treat the primary tumor15.
In radical prostatectomy, the entire prostate gland and the seminal vesicles (in some cases, also the pelvic lymph nodes) are removed.
The major side effect of surgery may be loss of sexual function. Other side effects may include urinary incontinence and difficulty controlling bowels14.
2. Hormone Therapy
The male hormone (androgen) testosterone enhances prostate cancer growth. Hormone therapy tries to reduce the levels of androgen to control cancer growth. This is also called androgen deprivation therapy (ADT) or androgen suppression therapy16.
3. Radiation Therapy
External beam radiation therapy (EBRT) is a well-established treatment modality for prostate cancer. In this therapy, a machine focuses a beam of X-rays on the area where the cancer is located17.
Another type of radiation therapy, called brachytherapy, uses radioactive material that is inserted into the prostate, where it continually gives off radiation. These radioactive “seeds” may be low-dose (often left permanently in the prostate) or high-dose (only left inside the prostate short-term). When treating high-risk prostate cancer, brachytherapy must be used alongside other methods17.
Radiation therapy causes some side effects during treatment. They include problems with urinary function, bowel function (including diarrhea), sexual functions, rectal bleeding, and tiredness.
4. Chemotherapy
Chemotherapy is not part of regular prostate cancer treatment but may occasionally be used to treat advanced prostate cancers – particularly if the cancer has spread beyond the prostate gland18.
Survival Rate of High-Risk Prostate Cancer
Cancer survival rates are not absolute numbers but are derived from previous outcomes of a large population.
Generally, the earlier a cancer is detected, the better the prognosis because of the likelihood of successful treatment.
The 5-year survival rate of prostate cancer is the highest of all cancers and is usually close to 100 percent if the cancer is localized (confined within the prostate gland or in the immediate surroundings)7.
For high-risk patients, however, the survival rates depend upon the treatment modalities used. In a study that observed the patterns of biochemical recurrence (BCR) of cancer in patients who had undergone radical prostatectomy alone, for instance, the 5-year BCR-free survival rate was slightly over 55 percent19.
To better understand your prognosis, talk to your team of medical experts.
Effect of High-Risk Prostate Cancer on the Quality of Life
Any type of cancer negatively affects the quality of life.
Apart from the disease itself, which may harm the body in multiple ways, the current treatment modalities also have side effects that reduce the quality of life.
In high-risk prostate cancer patients, symptoms may impact one’s sex life. Due to incontinence, people with this disease may also feel uncomfortable in social situations. Treatment procedures, such as radiation therapy, also have a negative impact on the social, emotional, and financial aspects of a patient’s life.
While planning treatment strategies for a patient for any kind of cancer, the medical team has to consider the risk-benefit ratio, which differs for different patients.
Early Detection: Key to Better Clinical Outcomes
Early detection of any type of cancer is often related to a better prognosis.
The Ezra Scan is specially designed to screen for potential abnormalities.
If incorporated into regular health check-ups, it may help with early screening of prostate cancer, so you can take control of your health by planning a treatment regimen and decreasing the chances of disease progression that leads to better treatment outcomes20.
The Ezra Full Body
The Ezra Full Body is an MRI-based scan service that screens for potential abnormalities in the head, neck, abdomen, and pelvis.
It is priced at $2395 and includes the screening of the following organs:
- Brain
- Spine
- Thyroid
- Liver
- Gallbladder
- Pancreas
- Spleen
- Kidney
- Adrenal glands
- Bladder
- Ovaries
- Uterus
- Prostate
The Ezra Full Body Plus
The Ezra Full Body Plus is our most advanced service that scans up to 14 organs and is priced at $2695. It also includes a 5-minute low-dose chest CT for those who medically qualify.
Be proactive with your screenings and stay a step ahead of cancer. Take our 5-minute quiz to calculate your estimated risk, or book your scan today.
