By Dr. Kim Lockheimer, PhD, DFM – Functional Medicine Practitioner, Molecular Oncology Specialist

Prostate cancer is one of the most common cancers in men—but with today’s diagnostic tools, genomic insights, and personalized treatment options, outcomes are better than ever. Whether you’ve been recently diagnosed, are exploring screening options, or are supporting a loved one, understanding the process reduces fear and empowers informed decision-making.

This guide breaks down everything you need to know—from PSA testing to biopsy types, staging, and modern treatments.

What Is Prostate Cancer?

Prostate cancer begins in the prostate gland, a walnut-sized organ responsible for producing seminal fluid. Most prostate cancers are adenocarcinomas, arising from glandular cells, and many grow slowly. However, others can be aggressive—making early detection critical.

Screening & Early Detection

1. PSA Testing

PSA (Prostate-Specific Antigen) is a blood test that measures a protein produced by prostate cells. High PSA does notalways mean cancer—levels can rise due to:

  • Benign Prostatic Hyperplasia (BPH)

  • Prostatitis

  • Urinary retention

  • Recent ejaculation

  • Even bicycle riding

PSA Velocity (rate of rise), PSA Density, and age-adjusted PSA give deeper insight into whether further testing is needed.

2. Digital Rectal Exam (DRE)

A quick physical exam where the clinician feels for:

  • Firm or nodular areas

  • Asymmetry

  • Enlargement

DRE abnormalities often prompt an MRI or biopsy.

3. Multiparametric MRI (mpMRI)

Today’s gold standard non-invasive tool before biopsy.

MRI identifies suspicious regions and assigns a PI-RADS score (1–5):

  • 1–2: Low suspicion

  • 3: Indeterminate

  • 4–5: High suspicion, usually biopsy recommended

MRI-targeted biopsies increase accuracy and reduce unnecessary sampling.

Prostate Biopsies: What Patients Should Know

Types of Biopsies

1. Transrectal Ultrasound-Guided (TRUS) Biopsy

  • Needle passes through the rectal wall

  • 12–14 core samples

  • Common, quick, but slightly higher infection risk

2. Transperineal Biopsy

  • Needle passes through the skin between scrotum & rectum

  • Lower infection risk

  • Allows better sampling of anterior prostate

  • Increasingly preferred

3. MRI-Targeted (Fusion) Biopsy

Combines real-time ultrasound with MRI images to precisely sample suspicious lesions—higher detection rate of clinically significant cancer.

Understanding Your Biopsy Results

Gleason Score / Grade Group

Pathologists analyze patterns of prostate cells:

  • Grade Group 1 (Gleason 6) – Low risk

  • Grade Group 2–3 (Gleason 7) – Intermediate

  • Grade Group 4–5 (Gleason 8–10) – High risk

The two numbers represent primary + secondary cell patterns (e.g., 3+4 or 4+3).

Other Key Pathology Terms

  • Perineural Invasion (PNI): Cancer involving nerves—may influence treatment

  • Cribriform Pattern: More aggressive subtype

  • Extraprostatic Extension: Cancer growing beyond the gland

Staging: How Doctors Classify the Cancer

TNM System

  • T: Tumor size/extent

  • N: Lymph node involvement

  • M: Metastasis

Risk Stratification

Combines PSA, Gleason, and imaging:

  • Low-risk

  • Favorable intermediate-risk

  • Unfavorable intermediate-risk

  • High-risk

  • Very high-risk

Genomic Testing

Modern assays help predict aggressiveness:

  • Oncotype DX

  • Decipher

  • Prolaris

These guide decisions about active surveillance vs treatment.

Treatment Options

1. Active Surveillance

Ideal for low-risk cancers. Includes:

  • PSA tests every 3–6 months

  • Repeat MRI

  • Periodic biopsies

Goal: Monitor, avoid overtreatment, intervene only if progression occurs.

2. Surgery: Radical Prostatectomy

Removal of the prostate gland, often robot-assisted.

Benefits

  • Curative for many patients

  • Provides full pathology

  • Useful for localized disease

Risks

  • Urinary incontinence

  • Erectile dysfunction

  • Pelvic pain

Nerve-sparing techniques help preserve function.

3. Radiation Therapy

External Beam Radiation (EBRT)

  • Daily treatments over 4–9 weeks

  • Modern techniques minimize damage to surrounding tissue

Brachytherapy

  • Radioactive seeds placed inside the prostate

Proton Therapy

  • More precise beam targeting

  • Growing availability

4. Hormone Therapy (Androgen Deprivation Therapy – ADT)

Prostate cancer relies on testosterone. ADT lowers hormone levels using:

  • LHRH agonists/antagonists (e.g., Lupron®, Degarelix®)

  • Oral agents (e.g., Orgovyx®)

Often combined with radiation for high-risk disease.

Side Effects

Hot flashes, fatigue, bone loss, weight gain
(Functional medicine support—nutrition, exercise, mitochondrial support—can help mitigate these.)

5. Advanced & Metastatic Disease Options

Next-Generation Hormonal Agents

  • Enzalutamide (Xtandi®)

  • Abiraterone (Zytiga®)

  • Apalutamide (Erleada®)

Chemotherapy

  • Docetaxel

  • Cabazitaxel

Immunotherapy

  • Sipuleucel-T (Provenge®) – vaccine-based therapy

  • Pembrolizumab for select MSI-high tumors

Radiopharmaceuticals

  • Lu-177 PSMA Therapy (Pluvicto®) – targeted radiation to PSMA-expressing cells

  • Radium-223 for bone metastases

Clinical Trials

Access to cutting-edge therapies, especially for high-risk or advanced disease.

Functional & Integrative Support for Patients

As a molecular oncology and functional medicine specialist, I emphasize whole-system support:

  • Mitochondrial optimization during treatment

  • Nutrition for inflammation & immune support

  • Botanical therapies (e.g., curcumin, green tea catechins)

  • Testosterone-safe exercise plans

  • Managing side effects of ADT, radiation, and surgery

  • Using biomarkers to track progress and metabolic health

Integrative care does not replace oncology treatment—it enhances resilience and recovery.

When to Seek a Second Opinion

You should always consider another evaluation when:

  • Gleason 7 or higher

  • Rising PSA after treatment (biochemical recurrence)

  • Conflicting recommendations

  • Considering robotics vs radiation vs surveillance

  • MRI findings are unclear

  • You’re unsure of next steps

Cancer is complex—your care team should empower you, not pressure you.

Key Questions to Ask Your Doctor

  • Do I need a biopsy? Why or why not?

  • What is my PI-RADS score?

  • What is my exact Grade Group and risk category?

  • Is my cancer slow-growing or aggressive?

  • What side effects can I expect from each treatment?

  • Do I qualify for active surveillance?

  • Should I get genomic testing?

  • What lifestyle changes can support my recovery?

Final Thoughts

Prostate cancer is often highly treatable—especially when caught early. With advances in imaging, targeted biopsies, genomics, and integrative support, patients today have more options than ever.

If you or a loved one is navigating a prostate cancer diagnosis, you do not have to make these decisions alone. At Mitotics® Biolabs, I provide personalized guidance, biomarker interpretation, second-opinion support, and integrative strategies to help patients move forward with clarity and confidence.