Symptoms: 

Early-stage prostate cancer rarely causes symptoms. The following symptoms may occur as the disease progresses: 

• Trouble urinating. 

• Weak urine flow or interrupted flow. 

• Blood in the urine. 

• Blood in the semen. 

• Bone pain. 

• Losing weight without trying. 

• Erectile dysfunction and painful ejaculation. 

Risk factors: 

Factors that can increase your risk of prostate cancer include: 

• Age. Your risk increases as you get older. You’re more likely to get diagnosed if you’re over 50. About 60% of prostate cancers occur in people older than 65. 

• Race and ethnicity. You’re at greater risk if you’re Black or of African ancestry. You’re more likely to develop prostate cancers that are more likely to spread. You’re also at greater risk of prostate cancer forming before age 50. 

• Family history of prostate cancer. You’re two to three times more likely to get prostate cancer if a close family member has it. 

• Genetics. You’re at greater risk if you have  Lynch syndrome or if you inherited mutated (changed) genes associated with increased  breast cancer risk (BRCA1 and BRCA2). 

• Smoking. 

• Prostatitis. 

• Having a BMI > 30 (having obesity). 

• Sexually transmitted infections (STIs). 

Diagnosis:  

Screenings can help catch prostate cancer early. If you’re average risk, you’ll probably have your first screening test at age 55. You may need earlier screenings if you’re in a high-risk group.  

Screening tests for prostate cancer 

Screening tests can show whether you have signs of prostate cancer that require more testing: 

• Digital rectal exam: Your provider inserts a gloved, lubricated finger into your rectum and feels your prostate gland. Bumps or hard areas may mean cancer. 

• Prostate-specific antigen (PSA) blood test: The prostate gland makes a protein called protein-specific antigen (PSA). High PSA levels may indicate cancer.  

Diagnostic procedures for prostate cancer 

• Imaging: An  MRI or a transrectal  ultrasound can show images of your prostate gland, including suspicious areas that may be cancer. Imaging results can help your provider decide whether to perform a biopsy. 

• Biopsy:  A  transrectal biopsy is used to diagnose prostate cancer. A transrectal biopsy is the removal of tissue from the prostate by inserting a thin needle through the rectum and into the prostate. This procedure may be done using transrectal ultrasound or transrectal MRI to help guide where samples of tissue are taken from. A  pathologist views the tissue under a  microscope to look for cancer  cells. If cancer is found, the pathologist will give the cancer a  grade. The grade of the cancer describes how  abnormal the cancer cells look under a microscope and how quickly the cancer is likely to grow and spread. The grade of the cancer is called the  Gleason score. 

Once a prostate cancer diagnosis has been made, your doctor works to determine the extent (stage) of the cancer. If your doctor suspects your cancer may have spread beyond your prostate, one or more of the following imaging tests may be recommended: 

• Bone scan. 

• Computerized tomography (CT) scan. 

• Magnetic resonance imaging (MRI). 

• Positron emission tomography (PET) scan. 
• PSMA PET scan: An  imaging procedure that is used to help find prostate cancer  cells that have spread outside of the prostate, into bone,  lymph nodes, or other  organs. 

Not every person should have every test. Your doctor will help determine which tests are best for your individual situation.  

Treatment: 

Your prostate cancer treatment options depend on several factors, such as how fast your cancer is growing, whether it has spread and your overall health, as well as the potential benefits or side effects of the treatment. 

Surgery: 

Surgery for prostate cancer involves removing the prostate gland (radical prostatectomy), some surrounding tissue and a few lymph nodes. 

Surgery is an option for treating cancer that's confined to the prostate. It's sometimes used to treat advanced prostate cancer in combination with other treatments. 

Radiation therapy: 

You may receive  radiation therapy as a standalone treatment for prostate cancer or in combination with other treatments. Radiation can also provide symptom relief. 

• Brachytherapy: A form of internal radiation therapy,  brachytherapy involves placing radioactive seeds inside your prostate. This approach kills cancer cells while preserving surrounding healthy tissue. 

• External beam radiation therapy: With  external beam radiation therapy (EBRT), a machine delivers strong X-ray beams directly to the tumor. Specialized forms of EBRT, like  IMRT, can direct high doses of radiation toward the tumor while sparing healthy tissue. 

Systemic therapies: 

Your provider may recommend systemic therapies if cancer has spread outside your prostate gland. Systemic therapies send substances throughout your body to destroy cancer cells or prevent their growth. 

• Hormone therapy: The hormone  testosterone boosts cancer cell growth.  Hormone therapy uses medications to combat testosterone’s role in fueling cancer cell growth. The medicines work by preventing testosterone from reaching cancer cells or by reducing your testosterone levels. Alternatively, your provider may recommend surgery to remove your testicles ( orchiectomy) so they can no longer make testosterone. This surgery is an option for people who don’t want to take medications. 

• Chemotherapy: Chemotherapy uses medicines to destroy cancer cells. You may receive chemotherapy alone or with hormone therapy if your cancer has spread beyond your prostate. 

• Immunotherapy: Immunotherapy strengthens your immune system so it’s better able to identify and fight cancer cells. Your healthcare provider may recommend immunotherapy to treat advanced cancer or recurrent cancer (cancer that goes away but then returns). 

• Targeted therapy: Targeted therapy zeroes in on the genetic changes (mutations) that turn healthy cells into cancer cells to prevent them from growing and multiplying. Targeted therapies that treat prostate cancer destroy cancer cells with BRCA gene mutations. 

Prostate cancer care at Shefa-El Orman Hospital: 

At Shefa-El Orman, a multidisciplinary team of experts works together to care for people with prostate cancer. Benefits of the team approach include: 

• Physicians are highly skilled not in some aspects of prostate cancer care, but across all specialties involved in care for these patients. 

• Shefa-El Orman doctors will work with you to review all of your treatment options and choose the treatment that best suits your needs and goals. The range of treatments offered for prostate cancer includes active surveillance, radiation therapy, hormone therapy, chemotherapy and surgery, including endoscopic prostatectomy. 

• Our radiation oncologists are experts in planning radiation treatment that targets prostate cancer cells and spares as much nearby healthy tissue as possible. Mayo Clinic offers the latest in prostate cancer radiation options, including brachytherapy.  

•  Each year, more than 17,000 people with prostate cancer receive care at Shefa-El Orman. This experience means your care team is prepared with knowledge and resources to provide you with exactly the care you need.

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1. Diagnostics:

The program includes:

• Initial presentation in the clinic
• clinical history taking
• physical examination
• urological examination (digital rectal examination)
• anesthesia assessment 
• laboratory tests:
• complete blood count
• clinical urine test
• inflammation indicators
• tumor markers (PSA)
• kidney function test
• indicators of blood coagulation
• pelvic ultrasound, CT scan, MRI scan and trans rectal ultrasound (if indicated clinically)
• cystoscopy and biopsy (if indicated clinically)
• histological examination for biopsy and immunohistochemistry (if indicated clinically).
• nursing services
• consultation of all leading experts
• development of individual treatment plan

Required documents

• Medical records
• MRI/CT scan (not older than 3 months)
• Biopsy results (if available)

Price from: On request

Type of program: Outpatient

Expected duration of the program: 3 days

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1. Surgery: 

the program includes:

• Initial presentation in the clinic
• history taking
• general clinical examination
• laboratory tests:
• complete blood count
• general urine analysis
• biochemical analysis of blood
• inflammation indicators (CRP, ESR)
• indicators blood coagulation
• tumor marker, PSA
• ultrasound of the urogenital system
• CT/MRI scanners
• preoperative care
• operations:
• nerve-sparing radical prostatectomy with or without lymphadenectomy 
• bilateral orchiectomy 
• transurethral resection of the prostate.
• histologically and immunohistochemically examination of the excised tissues
• symptomatic treatment
• cost of essential medicines
• control examinations
• nursing services
• stay in the hospital with full board
• elaboration of individual treatment plan

Required documents

• Medical records
• MRI/CT scan (not older than 3 months)
• Biopsy results (if available)

Price from: on request

Type of program: Inpatient

Expected duration of the program: 9 days

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1. Radiotherapy (external beam and /or brachytherapy):

Treating prostate cancer with different modalities according to treatment plane that will be explained by the treating physician that may include:

• IMRT     
• 3D 
• Brachytherapy   

The program includes:

• Initial presentation in the clinic
• clinical history taking
• review of medical records
• physical examination
• urological examination
• CT /MRI or ultrasound pelvic, Bone scan and PET CT (if indicated clinically)
• Anesthesia assessment 
• laboratory tests:
• complete blood count
• general urine analysis
• biochemical analysis of blood
• inflammation indicators (CRP, ESR)
• indicators blood coagulation
• tumor marker (PSA)
• CT planning of radiation therapy
• Physics calculation 
• A full course of intensity-modulated radiation therapy (IMRT) or 3D radiotherapy or brachytherapy and treatment plan will be explained by your treating physician.
• symptomatic treatment
• the cost of essential medicines and materials (needed for fixation during radiotherapy)
• nursing services
• control examinations
• consultation of related specialists

Required documents

• Medical records
• MRI/CT scan (not older than 3 months)
• Biopsy results (if available)

Price from: on request

Type of program: Outpatient

Expected duration of the program: 39 days and 10-15 days for brachytherapy 

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4- chemotherapy and or androgen deprivation therapy:

The program includes:

• Initial presentation in the hospital
• Clinical history taking
• Review of medical records
• Physical examination
• Laboratory tests:
• complete blood count
• biochemical analysis of blood
• tumor markers (PSA) 
• indicators of inflammation
• coagulation tests
• Ultrasound scan of the abdomen and pelvic, CT, MRI, and PET CT, Bone scan (if indicated clinically) 
• Differential diagnosis with other diseases
• Chemotherapy (1 cycle)
• Cost of essential medicines
• Nursing services
• Consultation of related specialists (tumor board)
• Treatment by chief physician and all leading experts
• Elaboration of further recommendations

How program is carried out

During the first visit, the doctor will conduct a clinical examination and go through the results of previous laboratory tests and instrumental examinations. After that, you will undergo an additional examination, including laboratory assessment of liver and kidney function, ultrasound scan. Based on the received results, the doctor will elaborate the chemotherapy regimen. If necessary, related medical specialists will be involved in the elaboration of a treatment regimen (tumor board).

Chemotherapy is carried out as outpatient hospital procedure, without mandatory admission to the hospital. After the placement of a venous catheter, you will stay in a comfortable ward. An infusion system will be connected to the catheter, through which the required drug or a drug combination will be administered. All drugs are administered by intravenous drip, slowly, so the total duration of the infusion can be up to several hours. All this time, doctors and nurses will monitor your health condition closely.

After the course of chemotherapy, you will stay under medical supervision in the ward for a few more hours. If your general condition is good, your doctor will allow you to leave the hospital. You will receive the medical report with detailed recommendations regarding further treatment. In the future, you will be able to have a distant consultation with your attending physician and schedule the next course of chemotherapy, if necessary.

Required documents

• Medical records
• MRI/CT scan (not older than 3 months)
• Biopsy results (if available)

Price from: on request regarding treatment protocol

Type of program: Outpatient

Expected duration of the program: 5 days