The prostate gland is a part of the genitourinary system. In men, this includes the reproductive system (prostate, penis, and testicles) and the urinary system (kidneys, ureters, and bladder). 

The prostate makes some of the fluid in semen and helps push semen out during ejaculation. It sits below your bladder and in front of your rectum.

In younger men, the prostate gland is the size of a walnut. As you get older, it may grow. When this happens, it can cause urinary problems and affect how your prostate gland works.

These growths are typically noncancerous or precancerous. That means the prostate cells have changed but haven't spread to other parts of the gland. 

• Benign prostatic hyperplasia: This is not cancer. It’s when you have an enlarged prostate. It can also cause problems with urination. 
• Prostatic intraepithelial neoplasia: The prostate cells don’t look normal. But they aren’t spreading like cancer cells do. 
• Proliferative inflammatory atrophy: When the prostate cells are smaller than normal, and the area is inflamed. 

Sometimes, these overgrown cells turn into cancer. Often, there are no symptoms at all, especially if we find prostate cancer early through a screening test. 

If we suspect prostate cancer, our experts may take a sample of your prostate. We use images from an MRI scan and ultrasound to produce a 3-D image of your prostate. The image helps guide the biopsy needle accurately. This is an MRI-ultrasound fusion-guided biopsy.

At Carilion, your prostate cancer plan may be as simple as a set of regular follow-ups or as advanced as a clinical trial. Finding the best plan for you is the heart of what we do. 

Active surveillance and watchful waiting

You may not need treatment for an enlarged prostate or prostate cancer right away or at all if:

• Your cancer is slow-growing
• You're older
• You have other serious health problems

With active surveillance, we monitor your cancer closely. We do regular blood tests, physical exams, and prostate biopsies. If your cancer starts to grow more quickly, we can begin treatment. 

With watchful waiting, we don’t do this intensive follow-up. We wait until your symptoms change before we do these tests or start treatment.

Cancer surgery

Surgery can be an option for prostate cancer that hasn’t spread. One common approach is a radical prostatectomy, where your prostate gland, some surrounding tissue, and nearby lymph nodes are removed. This can be done using minimally invasive or open surgery, depending on your needs.

Radiation therapy

Radiation therapy is another common way we treat prostate cancer. We use high-energy rays to target and kill cancer cells. 

For prostate cancer, the 3 types of radiation therapy we use are:

• External beam radiation: A machine outside your body delivers radiation focused on your tumor and nearby lymph nodes. 
• Internal radiation therapy: Also called brachytherapy. We place a radioactive source inside your prostate that emits small doses of local radiation to destroy cancer cells.
• Radioactive medicine: When prostate cancer has spread, we inject radioactive drugs into a vein to reach these cancer cells.

Cancer medicines

Cancer medicines can access the entire body and kill cancer cells that have moved to other areas. 

How long you need to take medicine is tailored to your cancer type and stage. For prostate cancer, there's sometimes an option to take your drugs on an on-again/off-again (intermittent) basis. Your urologist and oncologist can talk to you about your options.

• Hormone therapy: The hormone testosterone often helps prostate cancer grow, but it also plays a vital role in male health. Hormone therapies block testosterone’s effects in the body and on tumor growth. Intermittent hormone therapy can slow tumor growth and promote sexuality, strength, and bone and heart health.
• Non-targeted therapy: Medicines like chemotherapy kill rapidly growing cells, which includes cancer cells and some healthy cells. Most men with prostate cancer don’t need chemo. But we may use it for advanced prostate cancer.
• Targeted therapy: Some cancer cells have a target that we can use to kill the cancer cells. These treatments leave healthy cells relatively untouched. 

Clinical trials

Some medicines are so new they're only offered in a clinical trial. Trials usually compare a new medicine or protocol to the current best therapy. Your care team may ask you to consider a trial when studying a new way to treat your cancer.

These studies are voluntary; you'll talk to your care team before enrolling. A trial can be a first treatment option or an option if your treatment stops working.