The document discusses prostate cancer, including its stages, diagnosis, and treatment options. It provides information on: - The stages of prostate cancer range from Stage I, where cancer is found only in the prostate, to Stage IV, where cancer has metastasized to other parts of the body. - Prostate cancer can be diagnosed through a digital rectal exam, PSA blood test, ultrasound, and Gleason score from a biopsy. - Treatment options depend on cancer stage, health of the patient, and may include active surveillance, surgery, radiation therapy and more.

1. STAGES OF
PROSTATE CANCER
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2. Prostate Cancer Overview
Possible Signs of Prostate Cancer:
Weak or interrupted flow of urine
Frequent urination
Trouble urinating
Pain or burning during urination
Blood in the urine or semen
Persistent pain in the back, hips, or pelvis
Painful ejaculation
¨ The prostate is a
walnut-sized gland
located in a man’s
lower abdomen that
controls the flow of
urine and semen.
¨ Prostate cancer is a
leading cause of
cancer death among
American men, second
only to lung cancer.
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CA
92025
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739-­‐3835
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3. Diagnosing Prostate Cancer
Prostate Cancer can be diagnosed by:
¨ Digital Rectal Exam (DRE) – examination of
the rectum.
¨ Prostate-specific antigen (PSA) test –
measures the level of PSA in the blood. PSA
may be found in an increased amount in the
blood of men with prostate cancer.
¨ Transrectal Ultrasound – provides a picture of
the prostate for the doctor to analyze.
¨ Gleason Score – determines how likely
prostate cancer is to spread.
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Valley
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Escondido,
CA
92025
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739-­‐3835
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4. The TNM Staging System
A staging system describes how far a cancer has spread.
The most widely used staging system for prostate cancer is
the American Joint Committee on Cancer (AJCC) TNM
system.
The TNM system for prostate cancer is based on 5 key
pieces of information:
¤ The extent of the primary tumor (T category)
¤ Whether the cancer has spread to nearby lymph nodes (N
category)
¤ The absence or presence of distant metastasis (M category)
¤ The PSA level at the time of diagnosis
¤ The Gleason Score, based on the prostate biopsy (or surgery)
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East
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Escondido,
CA
92025
(760)
739-­‐3835
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5. Prostate Cancer - Stage I
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¨ Cancer is found in the prostate only.
¨ Cancer is microscopic and cannot be felt during the
DRE or seen on imaging tests.
¨ Cancer is found in one-half or less of one lobe of
the prostate.
¨ PSA level is lower than 10 ng/mL.
¨ Gleason Score is 6 or lower.

6. Prostate Cancer - Stage IIA
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¨ Cancer is more advanced than
Stage I but has not spread outside
the prostate.
¨ The cells are usually more
abnormal and may tend to grow
more quickly.
¨ Cancer is found in more than half
of one lobe of the prostate.
¨ PSA level is lower than 20 ng/mL.
¨ Gleason Score is 7 or lower.

7. Prostate Cancer - Stage IIB
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¨ Cancer is found in opposite sides of the prostate.
¨ Cancer cannot be felt during a DRE and is not
visible by imaging.
¨ The tumor has not spread outside the prostate.
¨ PSA level is 20 ng/mL or higher.
¨ Gleason Score ranges from 2 to 10.

8. Prostate Cancer - Stage III
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¨ Cancer has spread beyond the
outer layer of the prostate.
¨ Cancer may have spread to
nearby tissues like the seminal
vesicles.
¨ PSA can be any level.
¨ Gleason Score can range from
2 to 10.

9. Prostate Cancer - Stage IV
¨ Cancer has spread
(metastasized) beyond the
seminal vesicles to nearby
tissues or organs such as
the rectum, bladder or
pelvic wall.
¨ Cancer has spread to
distant parts of the body,
which may include other
lymph nodes or bones.
Prostate cancer often
spreads to the bones.
¨ Cancer has spread to
nearby lymph nodes
¨ PSA can be any level.
¨ Gleason score can range
from 2 to 10.
555
East
Valley
Parkway,
Escondido,
CA
92025
(760)
739-­‐3835
www.sdradiosurgery.com

10. Prostate Cancer Treatment
Treatment Options
Active Surveillance
Surgery
External-Beam Radiation Therapy
Brachytherapy
Proton Therapy
Stereotactic Body Radiation Therapy
¨ Treatment options depend on:
¤ The stage of the cancer
¤ The patient’s age and health
¤ The patient’s Gleason Score
¤ Whether the cancer is recently
diagnosed or recurring
¤ The patient’s prostate-specific
antigen (PSA) levels
555
East
Valley
Parkway,
Escondido,
CA
92025
(760)
739-­‐3835
www.sdradiosurgery.com

11. Novalis Tx® Treatment Process
¨ Prior to stereotactic body radiation therapy with Novalis Tx, small tissue
markers known as fiducials are implanted in the prostate to help pinpoint
the tumor location throughout each treatment, so the radiation beams can
be locked on the tumor.
¨ About a week later, patients are fitted with a custom body mold of soft
material that they lie on during treatments. The fitting process is painless.
¨ This treatment process includes
¤ Consultation Appointment
¤ Pretreatment procedures
¤ Novalis Tx treatment
¤ Follow-up
555
East
Valley
Parkway,
Escondido,
CA
92025
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739-­‐3835
www.sdradiosurgery.com

12. Additional Resources
555
East
Valley
Parkway,
Escondido,
CA
92025
(760)
739-­‐3835
www.sdradiosurgery.com

13. Our Center
Under the leadership of Medical Director Dr. Brian Volpp, San Diego
Radiosurgery has offered advanced cancer treatment from some of the
region’s most experienced radiation oncologists and technicians since opening
in 2008. Call us or visit our website to learn more about prostate cancer
treatment with Novalis Tx. San Diego Radiosurgery is a service of Palomar
Health Downtown Campus, a member of Palomar Health.
Medical Director: Dr. Bryan Volpp
Nurse: Cathy Blazek, RN, BSN
Medical Physicist: Mark Young
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