Skip Navigation
Prostate Cancer
Back to Prostate Cancer

Get Care

913-588-1227

After Diagnosis for Prostate Cancer

If you have been diagnosed with prostate cancer and need answers or a second opinion, have an elevated PSA or are concerned about your risk of prostate cancer, we are here and ready to support you and your loved ones in this process.

As the region’s only National Cancer Institute-designated comprehensive cancer center, we tailor prostate cancer treatment to the individual as part of our comprehensive approach to care.

We do not take a 1-size-fits-all approach to treatment because not all prostate cancer is the same. Our precision cancer therapies integrate your specific tumor data into all treatment decisions. Ensuring you receive personalized treatment means better treatment, better outcomes, a better experience and better survivorship.

You will receive care from a team of nationally recognized prostate cancer experts in urologic oncology, radiation oncology, medical oncology and supporting specialties. Together, these specialists will design an effective personalized treatment plan for you based on your specific cancer features, overall lifestyle and other critical influences.

Prostate cancer

Most prostate cancers are adenocarcinomas, a particular type of cancer. Adenocarcinomas develop in the glands that line your organs. Common forms of adenocarcinoma include breast, stomach, prostate, lung, pancreatic and colorectal cancers.

Once we diagnose you as having prostate cancer, we consider multiple factors to determine the most appropriate treatment options for you, including:

Your PSA (prostate-specific antigen) level before diagnosis

  • Your PSA level before diagnosis is important in understanding the extent of cancer that may be present. We generally think about PSA in 2 ways:
  • PSA thresholds: <10, 10-20 and >20
  • PSA density: PSA is influenced by the size of the prostate. A normal PSA density is <0.1-0.15ng/ml/cc. We determine this by dividing your PSA by the volume (from either an MRI or a prostate ultrasound) of your prostate.

Cancer grade, which is how we classify cancer cells based on their appearance and behavior under a microscope

  • We grade prostate cancer in 1 of 2 ways:
    • Gleason score: Gleason is a scoring system based on reporting the 2 highest identified grades of cancer (individual grades are 3-5) and are summed together to give a score that can range from 3+3=6 to 5+5=10. There is no Gleason score less than 6.
      • Grade group: Grade group is a system based on the Gleason score and is reported as a number between 1 and 5.
      • Grade group 1 = Gleason 3+3=6
      • Grade group 2 = Gleason 3+4=7
      • Grade group 3 = Gleason 4+3=7
      • Grade group 4 = Gleason 8 (3+5, 4+4, 5+3)
      • Grade group 5 = Gleason 9 and 10 (4+5, 5+4, 5+5)

Prostate biopsy, which involves collecting 10-12 core samples from different areas of the prostate

  • Prostate biopsies involve taking 12 or more samples from the prostate. These biopsies are then examined by our prostate cancer-focused pathologists, who are board-certified and focus solely on diseases and conditions found only in the prostate. We can estimate the extent of cancer in the prostate by assessing the number of samples that show the presence of prostate cancer. If more than 50% of the samples show prostate cancer, we consider that a predictive finding.

Local cancer staging, which is a process we use to determine if the cancer has spread and how far

  • Cancers are staged using the TNM system, which stands for tumor, node and metastasis. Tumor staging in prostate cancer is:
    • T1a/b – diagnosed from a procedure for prostate enlargement
    • T1c – diagnosed because of an elevated PSA (normal digital rectal examination)
    • T2 – diagnosed with a nodule on exam
    • T3 – diagnosed with suspicion of extension outside of the prostate on exam
    • T4 – diagnosed with suspicion of invasion of nearby organs on exam
  • Nodal staging:
    • N0 – no evidence of lymph node involvement
    • N1 – evidence of regional (pelvic) lymph node involvement
  • Metastatic staging:
    • M0 – no evidence of distant metastasis
    • M1a – spread to distant lymph nodes
    • M1b – spread to bones
    • M1c – spread to organs (liver, lung or brain)

Your prostate biopsy may include additional findings that we use to develop your treatment plan, such as:

  • Perineural invasion
  • Intraductal prostate cancer
  • High-grade intraepithelial neoplasia
  • Atypical small acinar proliferation

Other, rarer types of prostate cancer include:

  • Ductal prostate cancer
  • Small cell prostate cancer
  • Neuroendocrine prostate cancer
  • Sarcoma of the prostate

Imaging

  • CT scans are a form of X-ray imaging that looks at the bones and soft tissues (organs and lymph nodes) inside the body. With prostate cancer, this involves looking at the abdomen and pelvis and includes use of contrast (a medication injected through an IV into the veins to allow better imaging of the body). Approximately 50% of patients referred to us have had unnecessary CT scans, which are limited in detecting prostate cancer. We use a CT scan to identify any enlarged lymph nodes in the pelvis or abdomen.
  • A bone scan is a type of nuclear medicine imaging in which we inject a radioactive element (Technetium 99) into the veins to obtain images of the body. Areas of bone turnover will “light up” and may reflect prostate cancer that has spread to the bone. Approximately 50% of patients referred to us have had unnecessary bone scans, which are limited in detecting prostate cancer. Previously broken bones, arthritis and other trauma can cause a bone scan to light up. Bone scan findings often require additional tests to identify the cause.
  • Magnetic resonance imaging is a nonradiation-based procedure that looks closely at the pelvis. We use MRI to look at tumors in the prostate, spread of cancer outside of the prostate and potential spread to lymph nodes and pelvic bones. MRI involves placing an IV in the vein to inject contrast, which takes about 45 minutes. For the most accurate diagnosis, we rely on an MRI or PET scan, which provides a detailed picture of the prostate and nearby areas.
  • PET/CT imaging combines images from a positron emission tomography scan and a computed tomography scan. The PET and CT scans are done at the same time with the same machine. The combined scans give more detailed pictures of areas inside the body than either scan by itself. PET/CT uses contrast containing a radioactive element that attaches to a molecule that gravitates to prostate cancer cells. The test is useful in looking for prostate cancer that has gone beyond the prostate and into lymph nodes, bones and organs. For the most accurate diagnosis, we rely on a PET scan or an MRI, which provides a detailed picture of the prostate and nearby areas.

Genetic testing

  • Germline genetics are the genes that are passed down from parents. These are the genes that are in all cells in the body. For men with a strong family history of prostate cancer, early onset of prostate cancer (<60), high-risk disease and those with a family history of other cancers (breast, ovarian, colon and pancreatic) genetic testing may uncover a potential genetic cause for their cancer. Understanding if a mutation is present can guide (1) additional cancer screenings that may be needed (2) inform family members (children and siblings) of their potential cancer risk and (3) aid in treatment recommendations.

    With prostate cancer, some men benefit from tumor genomic testing. Genomic testing is different from genetic testing. Genomic testing looks at the genes that are active in the tumor as opposed to the changes in the genes resulting from mutation. Currently, we use prostate cancer genomics to assess how aggressive the cancer may be and to guide treatment decision making.

  • Somatic genetics are changes that develop in specific tissues over time. These acquired changes can give rise to cancer. Like germline genetics, understanding these changes can be useful in guiding treatment. Currently the only indication to consider somatic genetics is in men with metastatic prostate cancer.

Not every patient needs every test. We evaluate you and your disease individually. Each person and each situation is distinct and needs to be appropriately evaluated before starting a treatment plan. Our team is here to ensure that your prostate cancer is treated as uniquely as you are.

Why choose The University of Kansas Cancer Center?

The University of Kansas Cancer Center is part of a nationwide network of select cancer research centers established by the National Cancer Institute, part of the National Institutes of Health. NCI-designated cancer centers achieve patient outcomes that are 25% better than those of other centers.

Our dedicated team of prostate cancer doctors comprises fellowship-trained urologic surgical oncologists, urologic medical oncologists, urologic radiation oncologists and urologic pathologists. We provide the most advanced medical and surgical care for prostate cancer patients, including screening and prevention, active surveillance and survivorship. As the region’s largest cancer center, we have 13 locations throughout Kansas City. Our prostate cancer program has been recognized as 1 of 13 Clinical Centers of Excellence in the nation by Urology Times. Additionally, U.S. News & World Report ranks our urology program among the nation’s top in cancer care. The urologic oncologists at The University of Kansas Cancer Center set the standard for care and treatment in prostate cancer and other urologic specialty areas.

Ours is the only team in the region offering Retzius-sparing radical prostatectomy, a minimally invasive robotic surgery that allows us to remove the prostate in a less invasive way — dramatically reducing recovery time and unwanted side effects. We offer the most advanced treatments in radiation oncology, including brachytherapy, stereotactic body radiation therapy (SBRT) and SpaceOAR™ and opened the first Proton Therapy Center in Kansas City. We also offer many clinical trials for early-stage (I and II), advanced and metastatic (stage III and IV) prostate cancer and are at the forefront of clinical studies with immunotherapy and targeted therapy used to treat prostate cancer.

We are 1 of fewer than 60 NCI-designated comprehensive cancer centers nationwide. NCI-designated cancer centers are the backbone of innovative research and patient care across the country. We treat patients from across the US and around the globe at our multiple locations. Since 2012, we have diagnosed and treated patients from 50 states and 26 countries.

Related links

After Diagnosis for Prostate Cancer
To request an appointment, call 844-323-1227.