Frequently Asked Questions

What is the prostate?
The prostate is a gland that is located in front of the rectum and just below the bladder. It wraps around the urethra (the tube that carries urine from the bladder out through the penis). The main function of the prostate is to supply the fluid which protects and enriches sperm during ejaculation. The size of the prostate varies with age. In younger men, it is the size of a walnut, but it can be much bigger in older men.

What is cancer?
Cancer is a disease characterized by the uncontrolled growth and potential spread of abnormal (malignant) cells. Cancer cell growth is different from normal cell growth. Instead of dying, cancer cells continue to grow and form new, abnormal cells. Cancer cells can also invade (grow into) other tissues, something that normal cells cannot do. Growing out of control and invading other tissues are what makes a cell a cancer cell. Consequently, cancer cells accumulate to form growths.

What is prostate cancer?
Several types of cells are found in the prostate, but almost all prostate cancers develop from the gland cells. Gland cells make the prostate fluid that is added to the semen. The medical term for a cancer that starts in gland cells is adenocarcinoma. Adenocarinoma is the most common type of prostate cancer.

Some prostate cancers can grow and spread quickly, but most of them grow slowly. When cancer affects the prostate, cancerous cells usually start in the outer part of the gland. The tumor may then spread to the tissue adjacent to the gland through the prostate capsule. If the cancer remains within the gland or the areas surrounding the prostate, it is considered “localized.” If it spreads outside of this area, it is called “metastasized” cancer.

What is metastatic prostate cancer?
Sometimes, cancer cells may break away from the malignant tumor in the prostate and enter the bloodstream or the lymphatic system and travel to other organs in the body. When cancer spreads from its original location in the prostate to another part of the body such as the bone, it is called metastatic prostate cancer. Doctors sometimes call this “distant” disease. Most generally, metastatic prostate cancer remains treatable, but not curable.

How do I know if I have prostate cancer?
Symptoms of prostate cancer do not appear in everyone, and there are usually few if any symptoms of prostate cancer when it is in its early stage. However, some men will encounter changes in urinary or sexual function, which may indicate the presence of prostate cancer.

Symptoms may include the following:

  • A need to urinate frequently, especially at night
  • Difficulty starting or stopping urine flow
  • Weak or interrupted flow of urine
  • Painful or burning urination
  • Difficulty in having an erection
  • Painful ejaculation
  • Blood in urine or semen
  • Frequent pain or stiffness in the lower back, hips, or upper thighs

You should consult with your doctor if you experience any of the symptoms above. If these symptoms are present, a doctor will typically begin with a digital rectal examination (DRE) of the prostate to check for firmness, nodules, and/or asymmetry of the prostate gland. Because these symptoms can also indicate the presence of other benign diseases or disorders, such as BPH or prostatitis, men will undergo a thorough work-up to determine the underlying cause.

What is the PSA test?
The next step may be a blood test to check the PSA level. The prostate produces an enzyme called PSA or prostate specific antigen. The levels of PSA change naturally with age but in men with prostate cancer the amount of PSA can increase noticeably. Generally speaking, the higher the level of PSA the more severe the cancer, although in some cases the PSA level has been extremely low even in the presence of malignant cells. These tests are useful but not completely dependable in the diagnosis of cancer. The PSA test is also used to follow effectiveness of treatment for some patients with prostate cancer.The only way to confirm the presence of cancer is with a biopsy to examine tissue under a microscope, which involves taking a cell sample by inserting a needle through the rectum to the prostate. If cancer cells are present the pathologist (physician who reviews the sample) assigns a Gleason Score.

What is a Gleason Score?
Almost all pathologists grade prostate cancers according to the Gleason system. The Gleason grading system accounts for distinct patterns that prostate tumor cells tend to go through as they change from normal cells to tumor cells. The terms “low-grade” and “well-differentiated” look most similar to normal non-cancerous, prostate cells. The terms “high-grade” or “poorly differentiated” describe cancer cells which bare the least resemblance to normal prostate tissue. “intermediate grade” falls between these two extremes.

The Pathologist viewing each prostate biopsy sample determines if cancer is present or not. If cancer is detected, then a number between 1 and 5 is assigned to each cancerous area based on the pattern of cancerous cells growth. The Gleason score represents the patterns read by the pathologist. The most prevalent pattern is listed first, followed by the second most prevalent (or highest number) second.

The most commonly encountered grades and Gleason scores are:
Cancers with Gleason scores of 3 + 3 = 6 or less are called low-grade or well-differentiatedCancers with Gleason scores of 3 + 4 =7 or 4 +3 = 7 are moderately-differentiated or intermediate-grade.Cancers with Gleason scores, 4 + 5= 9 or 5+ 4 = 9 or higher are called poorly-differentiated or high-grade.

What are the stages of prostate cancer?
The stage (extent) of a cancer is one of the most important factors in choosing treatment options and predicting a patient’s outlook. If your prostate biopsy confirms that you have cancer, more tests may be done to find out how far it has spread within the prostate, to surrounding areas, or to other parts of the body. This process is called staging and may include CT scans, bone scans, and/or MRI.

Assessments of the tumor in the prostate (T), lymph nodes near the prostate (N), and distant metastatic deposits (M) are used to assign stage in the TNM staging system. Most commonly, prostate cancer is confined to the prostate gland (T2) and/or not palpable on exam (T1c). Less commonly, lymph nodes near the prostate are involved with cancer (N1) or distant metastatic sites are identified (M1). Modern staging systems incorporate assessments of PSA and Gleason scores as well.

  • Stage I: Early prostate cancer confined to the prostate. These cancers are frequently identified by a change in the PSA level in blood.
  • Stage II: Cancer is still confined to the prostate, but can be felt (due to its unusual firmness or presence of nodules) during a digital rectal exam. PSA levels are often elevated.
  • Stage III: The tumor has spread outside the prostate (T3 or T4) but has not spread to other organs.
  • Stage IV: The cancer has spread (metastasized) to lymph nodes surrounding the prostate (N1), or to a distant organ or other tissue (M1).

What treatment options are available for prostate cancer?
There is no standard treatment for prostate cancer. It is important to research the options available and consult with a knowledgeable physician regarding the available courses of treatment. Depending on the stage of the prostate cancer and how aggressive it is deemed, there can be a variety of options for course of treatment. Some of these include:

  • Active surveillance
  • Surgery
  • Radiation
  • Hormone therapy or,
  • Chemotherapy

There are so many different specialties of physicians. How do I know what type of doctor to see and when in the treatment of my prostate cancer?
Cancer is a complicated disease, and is usually treated by an entire team of health care professionals. Specifically involved with the treatment of prostate cancer are urologists, medical oncologists, radiation oncologists, radiologists, and pathologists.

Urologist – By definition a urologist is a physician who has specialized knowledge and skill regarding problems of the male and female urinary tract and the male reproductive organs. A urologist generally determines if a prostate biopsy should be performed and will be the clinician who actually performs this procedure. A urologist is the surgeon who performs a prostatectomy (removal of the prostate), if required. In addition, a urologist is the doctor who usually manages any urinary or sexual dysfunction that may arise during the course of treatment.

Medical Oncologist – A medical oncologist specializes in diagnosing and treating cancer using chemotherapy, hormonal therapy, biological therapy, and targeted therapy. Often this is the main health care provider for someone who has cancer. A medical oncologist also gives supportive care and may coordinate treatment given by other specialists. Many patients chose to consult with a medical oncologist after being diagnosed with prostate cancer. The medical oncologist will assist with forming a plan for treatment and work closely with the urologist and any other medical professionals to coordinate the best care for the patient. Both Dr. David Agus and Dr. Mitchell Gross are medical oncologists.

Radiation Oncologist – A radiation oncologist is the physician who develops a radiation treatment plan depending on the biology of the cancer and the patient’s anatomy and administers radiation to a patient with cancer. In most cases where radiation is the treatment of choice, the urologist or medical oncologist will refer the patient to consult with a recommended radiation oncologist.

Radiologist – The radiologist is the physician who uses various imaging technologies (CT scans, MRI, Ultrasound, etc) to obtain images of areas inside the body. This doctor will read the images and create a report of their findings. These reports are then used by the medical oncologist, radiation oncologist and urologist to assist with developing the best plan for treatment.

Pathologist – Once a biopsy has been done, the sample is placed on slides and then is read under a microscope by the pathologist. This is the physician who determines whether a tissue sample contains cancer cells and with prostate cancer will assign the Gleason Score.

What insurances are accepted for Keck Medical Center?
Keck Medical Center of USC accepts most PPO private insurance plans as well as Medicare. However, we do recommend verifying with your insurance company that Keck Medical Center of USC is within your network. To obtain this information, call the member services number on your insurance card. You will want to verify both the USC Care Network as well as the specific doctor you’ll be seeing.

How do I become a patient at the USC Norris Westside Cancer Center?
Patients being seen in our office have been diagnosed with prostate cancer. If you have not been, diagnosed it is best to consult with a urologist first and have a biopsy of the prostate performed. Once prostate cancer is confirmed, it is then appropriate to consult with a medical oncologist.

In order to have the most meaningful consultation with our physicians, it is essential to have your pertinent medical records compiled. Obtaining this information prior to contacting our office will speed the process of scheduling your initial visit. When you phone our office to set up an appointment we will first go through a telephone intake in which we will request both demographic information and information regarding the state of your present illness. Once we complete the questionnaire, the next step will be to forward us your pertinent medical records. Included in those records we will need current laboratory results (including PSA value), physician reports, radiology reports (e.g. CT scans, x-rays, bone scans), and biopsy/pathology reports. If you have received any prior treatments for your prostate cancer, such as radiation, hormone therapy or chemotherapy, we will also need to the physician notes relating to those treatments. All of these records can be faxed to our office either by the patient or the other physician’s offices. Our fax number is 310-272-7656.

After the telephone intake is complete and we have received all the required medical records, this information is given to the physician for review. When this review has been completed, you will receive a phone call from our office to set up the time for your appointment.

What forms will I need to fill out prior to my first appointment?
There are a few forms that need to be completed prior to your first appointment. Included in these forms are a patient self history packet, a USC registration form and patient contact sheet. We request that these forms be completed and returned to us before your appointment date so that we can register you and to allow the doctor and nurses to have time to review all of your information before meeting with you.

What questions should I ask at my appointment?

      a) What is the exact stage of my disease?
      b) What treatment options are available to me?
      c) Is there a certain diet I should adhere to?
      d) Can I take dietary supplements, herbs or vitamins?
      e) Is there a clinical trial that is appropriate for me?

What are clinical trials and why are they important?
Clinical trials are health-related research studies that follow a predefined protocol. Clinical trials may be classified as interventional or observational studies. Interventional trials encompass controlled treatments of new medications in a group of patients that share similar characteristics. In some interventional trials, all patients receive a new therapy or medication. In other cases, a new treatment is compared with an existing therapy. Observational trials include the study individuals and outcomes for participants without specifically directed any particular course of therapy. The goal of studies in our center is generally to discover new approaches and improved therapies for patients with prostate cancer. Men who enroll in clinical trials are helping future generations who may one day develop prostate cancer.

How can I participate in a clinical trial?
The first step in the process of determining whether participation may be appropriate for any one patient is to have a consultation with one of our medical oncologists. In some cases, standard therapies and other approaches are most appropriate for particular clinical situations such that participation in a clinical trial may not be recommended or medically advisable. However, if the clinician determines that participation in a clinical may be appropriate, the patient will be presented with details regarding the trial in both oral and written form. If there is continued interest in participation from the individual, he will be asked to review and then sign an informed consent document to begin the formal process of screening for that particular clinical trial.

Information collected during the screening process (such as medical history, physical exams, and the results of laboratory and/or radiologic testing) will be used to determine the final suitability and appropriateness for inclusion into any clinical trial.