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Prostate Cancer

  • Posted: 09/26/2012

About This Booklet

This National Cancer Institute (NCI) booklet is for you—a man who has just been diagnosed with prostate cancer. In 2013, about 239,000 American men will be diagnosed with prostate cancer.

This booklet tells about medical care for men with prostate cancer. Learning about medical care for prostate cancer can help you take an active part in making choices about your care.

You can read this booklet from front to back. Or, you can read only the sections you need right now.

This booklet has lists of questions that you may want to ask your doctor. Many people find it helpful to take a list of questions to a doctor visit. To help remember what your doctor says, you can take notes. You may also want to have a family member or friend go with you when you talk with the doctor—to take notes, ask questions, or just listen.

The Prostate

The prostate is part of a man's reproductive system. It's located in front of the rectum and under the bladder. The prostate surrounds the urethra, the tube through which urine flows.

A healthy prostate is about the size of a walnut. If the prostate grows too large, it squeezes the urethra. This may slow or stop the normal flow of urine.

The prostate is a gland. It makes part of the seminal fluid. During orgasm, the seminal fluid helps carry sperm out of the man's body as part of semen.

Diagram of the prostate The first picture shows the prostate and nearby organs. The second picture shows how the prostate surrounds the urethra.

Cancer Cells

Cancer begins in cells, the building blocks that make up all tissues and organs of the body, including the prostate.

Normal cells in the prostate and other parts of the body grow and divide to form new cells as they are needed. When normal cells grow old or get damaged, they die, and new cells take their place.

Sometimes, this process goes wrong. New cells form when the body doesn't need them, and old or damaged cells don't die as they should. The buildup of extra cells often forms a mass of tissue called a growth or tumor.

Growths in the prostate can be benign (not cancer) or malignant (cancer):

  • Benign growths (such as benign prostatic hypertrophy):
    • Are rarely a threat to life
    • Don't invade the tissues around them
    • Don't spread to other parts of the body
    • Can be removed and usually don't grow back
  • Malignant growths (prostate cancer):
    • May sometimes be a threat to life
    • Can invade nearby organs and tissues (such as the bladder or rectum)
    • Can spread to other parts of the body
    • Often can be removed but sometimes grow back

Prostate cancer cells can spread by breaking away from a prostate tumor. They can travel through blood vessels or lymph vessels to reach other parts of the body. After spreading, cancer cells may attach to other tissues and grow to form new tumors that may damage those tissues.

When prostate cancer spreads from its original place to another part of the body, the new tumor has the same kind of abnormal cells and the same name as the primary (original) tumor. For example, if prostate cancer spreads to the bones, the cancer cells in the bones are actually prostate cancer cells. The disease is metastatic prostate cancer, not bone cancer. For that reason, it's treated as prostate cancer, not bone cancer.

Stages

Doctors describe the stages of prostate cancer using the Roman numerals I, II, III, and IV. A cancer that is Stage I is early-stage cancer, and a cancer that is Stage IV is advanced cancer that has spread to other parts of the body.

The stage of prostate cancer depends mainly on…

  • Whether the tumor has invaded nearby tissue, such as the bladder or rectum
  • Whether prostate cancer cells have spread to lymph nodes or other parts of the body, such as the bones
  • Grade (Gleason score) of the prostate tumor
  • PSA level

On NCI’s website at http://www.cancer.gov/cancertopics/types/prostate, you can find pictures and more information about the stages of prostate cancer.

Stage I

The cancer is only in the prostate. It might be too small to feel during a digital rectal exam. If the Gleason score and PSA level are known, the Gleason score is 6 or less, and the PSA level is under 10.

Stage II

The tumor is more advanced or a higher grade than Stage I, but the tumor doesn’t extend beyond the prostate.

Stage III

The tumor extends beyond the prostate. The tumor may have invaded a seminal vesicle, but cancer cells haven’t spread to lymph nodes. See the picture of a seminal vesicle.

Stage IV

The tumor may have invaded the bladder, rectum, or nearby structures (beyond the seminal vesicles). It may have spread to lymph nodes, bones, or other parts of the body.

Treatment

Men with prostate cancer have many treatment options. Treatment options include…

You may receive more than one type of treatment.

The treatment that's best for one man may not be best for another. The treatment that's right for you depends mainly on…

  • Your age
  • Gleason score (grade) of the tumor
  • Stage of prostate cancer
  • Your symptoms
  • Your general health

At any stage of disease, care is available to control pain and other symptoms, to relieve the side effects of treatment, and to ease emotional concerns. You can get information about coping on NCI's website at http://www.cancer.gov/cancertopics/coping.

Also, you can get information about coping from NCI's Cancer Information Service at 1-800-4-CANCER (1-800-422-6237). Or, chat using NCI's instant messaging service, LiveHelp (https://livehelp.cancer.gov).

Doctors Who Treat Prostate Cancer

Your health care team will include specialists. There are many ways to find doctors who treat prostate cancer:

  • Your doctor may be able to refer you to specialists.
  • You can ask a local or state medical society, or a nearby hospital or medical school for names of specialists.
  • NCI's Cancer Information Service can give you information about treatment centers near you. Call 1-800-4-CANCER (1-800-422-6237). Or, chat using LiveHelp (https://livehelp.cancer.gov), NCI's instant messaging service.
  • Other sources can be found in the NCI fact sheet How To Find a Doctor or Treatment Facility If You Have Cancer.

Your health care team may include the following specialists:

  • Urologist: A urologist is a doctor who specializes in treating problems in the urinary tract or male sex organs. This type of doctor can perform surgery (an operation).
  • Urologic oncologist: A urologic oncologist is a doctor who specializes in treating cancers of the male and female urinary tract and the male sex organs. This type of doctor also can perform surgery.
  • Medical oncologist: A medical oncologist is a doctor who specializes in treating cancer with drugs, such as chemotherapy, hormone therapy, or immunotherapy.
  • Radiation oncologist: A radiation oncologist is a doctor who specializes in treating cancer with radiation therapy.

Your health care team may also include an oncology nurse, a social worker, and a registered dietitian.

Your health care team can describe your treatment options, the expected results of each option, and the possible side effects. Because cancer treatments often damage healthy cells and tissues, side effects are common. These side effects depend on many factors, including the type of treatment. Side effects may not be the same for each man, and they may even change from one treatment session to the next.

Before treatment starts, ask your health care team about possible side effects and how treatment may change your normal activities. For example, you may want to discuss with your doctor the possible effects on sexual activity. The NCI booklet Treatment Choices for Men with Early-Stage Prostate Cancer can tell you more about treatments and their side effects.

You and your health care team can work together to develop a treatment plan that meets your medical and personal needs.

You may want to talk with your health care team about taking part in a research study (clinical trial) of new treatment methods. Research studies are an important option for men at any stage of prostate cancer. See the Cancer Treatment Research section.

Questions you may want to ask your doctor about treatment options

  • What are my treatment options? Which do you recommend for me? Why?
  • What are the expected benefits of each kind of treatment?
  • What are the risks and possible side effects of each treatment? How can the side effects be managed?
  • What can I do to prepare for treatment?
  • Will I need to stay in the hospital? If so, for how long?
  • What is the treatment likely to cost? Will my insurance cover it?
  • How will treatment affect my normal activities? Will it affect my sex life? Will I have urinary problems? Will I have bowel problems?
  • Would a research study (clinical trial) be right for me?

Second Opinion

Before starting treatment, you might want a second opinion about your diagnosis and treatment options. You may even want to talk to several different doctors about all treatment options, their side effects, and the expected results. For example, you may want to talk to a urologist, radiation oncologist, and medical oncologist.

Some men worry that the doctor will be offended if they ask for a second opinion. Usually the opposite is true. Most doctors welcome a second opinion. And many health insurance companies will pay for a second opinion if you or your doctor requests it. Some insurance companies actually require a second opinion.

If you get a second opinion, the second doctor may agree with your first doctor's diagnosis and treatment recommendation. Or, the second doctor may suggest another approach. Either way, you have more information and perhaps a greater sense of control. You can feel more confident about the decisions you make, knowing that you've looked at all of your options.

It may take some time and effort to gather your medical records and see another doctor. In most cases, it's not a problem to take several weeks to get a second opinion. The delay in starting treatment usually will not make treatment less effective. To make sure, you should discuss this delay with your doctor.

Active Surveillance

Your doctor may suggest active surveillance if you're diagnosed with early-stage prostate cancer that seems to be growing slowly. Your doctor may also offer this option if you are older or have other health problems.

Active surveillance is putting off treatment until test results show that your prostate cancer is growing or changing. If you and your doctor agree that active surveillance is a good idea, your doctor will check you regularly (such as every 3 to 6 months, at first). You'll get digital rectal exams and PSA tests. After about a year, your doctor may order another prostate biopsy to check the Gleason score. Your doctor may suggest treatment if your Gleason score rises, your PSA level starts to increase, or you develop symptoms. Your doctor may suggest surgery, radiation therapy, or another type of treatment.

By choosing active surveillance, you're putting off the side effects of surgery, radiation therapy, or other treatments. However, the risk for some men is that waiting to start treatment may reduce the chance to control cancer before it spreads. Having regular checkups reduces this risk.

For some men, it's stressful to live with an untreated prostate cancer. If you choose active surveillance but grow concerned later, you should discuss your feelings with your doctor. You can change your mind and have treatment at any time.

Questions you may want to ask your doctor about active surveillance

  • Is it safe for me to put off treatment? Does it mean I will not live as long as if I started treatment right away?
  • Can I change my mind later on?
  • How often will I have checkups? Which tests will I need? Will I need a repeat biopsy?
  • How will we know if the prostate cancer is getting worse?
  • Between checkups, what problems should I tell you about?

Surgery

Surgery is an option for men with early-stage cancer that is found only in the prostate. It's sometimes also an option for men with advanced prostate cancer to relieve symptoms.

There are several kinds of surgery to treat prostate cancer. Usually, the surgeon will remove the entire prostate and nearby lymph nodes. Your surgeon can describe each kind of surgery, compare the benefits and risks, and help you decide which kind might be best for you.

The entire prostate can be removed in several ways…

  • Through a large cut in the abdomen: The surgeon removes the prostate through a long incision in the abdomen below the belly button. This is called a radical retropubic prostatectomy. Because of the long incision, it's also called an open prostatectomy.
  • Through small cuts in the abdomen: The surgeon makes several small cuts in the abdomen, and surgery tools are inserted through the small cuts. A long, thin tube (a laparoscope) with a light and a camera on the end helps the surgeon see the prostate while removing it. This is called a laparoscopic prostatectomy.
  • With a robot: The surgeon may use a robot to remove the prostate through small incisions in the abdomen. The surgeon uses handles below a computer display to control the robot's arms.
  • Through a large cut between the scrotum and anus: The surgeon removes the prostate through an incision between the scrotum and anus. This is called a radical perineal prostatectomy. It's a type of open prostatectomy that is rarely used anymore.

Other surgery options for treating prostate cancer or relieving its symptoms are…

  • Freezing: For some men, cryosurgery is an option. The surgeon inserts a tool through a small cut between the scrotum and anus. The tool freezes and kills prostate tissue.
  • Heating: Doctors are testing high-intensity focused ultrasound therapy in men with prostate cancer. A probe is placed in the rectum. The probe gives off high-intensity ultrasound waves that heat up and kill the prostate tumor.
  • TURP: A man with advanced prostate cancer may choose transurethral resection of the prostate (TURP) to relieve symptoms. The surgeon inserts a long, thin scope through the urethra. A cutting tool at the end of the scope removes tissue from the inside of the prostate. TURP may not remove all of the cancer, but it can remove tissue that blocks the flow of urine.

You may be uncomfortable for the first few days or weeks after surgery. However, medicine can help control the pain. Before surgery, you should discuss the plan for pain relief with your doctor or nurse. After surgery, your doctor can adjust the plan if you need more pain relief.

The time it takes to heal after surgery is different for each man and depends on the type of surgery. You may be in the hospital for 1 to 3 days.

After surgery, a tube will be inserted into your penis. The tube allows urine to drain from your bladder while the urethra is healing from the surgery. You'll have the tube for 5 to 14 days. Your nurse or doctor will show you how to care for it.

After surgery, some men may lose control of the flow of urine (urinary incontinence). Most men regain at least some bladder control after a few weeks. Your nurse or doctor can teach you an exercise to help you recover control of your bladder. For some men, however, incontinence may be permanent. Your health care team can show you ways to cope with this problem.

Surgery may also damage nerves near the prostate and cause erectile dysfunction. Sexual function usually improves over several months, but for some men, this problem can be permanent. Talk with your doctor about medicine and other ways to help manage the sexual side effects of prostate cancer treatment.

If your prostate is removed, you'll have dry orgasms, which means you'll no longer release semen. If you wish to father children, you may consider sperm banking before surgery.

Questions you may want to ask your doctor about surgery

  • Do you suggest surgery for me? If so, what kind of surgery do you recommend for me? Why?
  • How will I feel after surgery? How long will I be in the hospital?
  • If I have pain, how can we control it?
  • Will I have any lasting side effects? What is the chance that surgery will cause permanent incontinence or erectile dysfunction?

Radiation Therapy

Radiation therapy is an option for men with any stage of prostate cancer. Men with early-stage prostate cancer may choose radiation therapy instead of surgery. It may also be used after surgery to destroy any cancer cells that remain in the area. In men with advanced prostate cancer, radiation therapy may be used to help relieve pain.

Radiation therapy uses high-energy rays to kill cancer cells. It affects cells only in the part of the body that is treated.

Doctors use two types of radiation therapy to treat prostate cancer. Some men receive both types:

  • Machine outside the body: The radiation comes from a large machine outside the body. This is called external radiation therapy. Computers may be used to more closely target the prostate cancer. For example, intensity-modulated radiation therapy, proton radiation therapy, and 3-dimensional conformal radiation therapy are types of radiation therapy that use computers to lessen damage to healthy tissue. You'll go to a hospital or clinic for treatment. Treatments are usually 5 days a week for 8 to 9 weeks. Each treatment session lasts only a few minutes.
  • Radioactive material inside the body (brachytherapy): Two methods are used for men with prostate cancer. One method places dozens of radioactive seeds inside needles, and the needles are inserted into the prostate. When the needles are removed, the seeds are left behind. The seeds give off radiation for a few weeks or months. They don't need to be removed once the radiation is gone. You won't need to stay in the hospital for treatment. Another method involves inserting several tubes into the prostate. Radioactive material is loaded into the tubes. The treatment session lasts for a few minutes, and the radioactive material is removed. This treatment may be repeated as many as five times. You'll stay in the hospital for 1 or 2 days, and then the tubes will be removed. When you leave the hospital, no radioactivity remains in your body.

Side effects depend mainly on the type of radiation therapy and how much radiation is given.

Both types of radiation therapy can cause diarrhea or rectal pain. You may feel that you need to empty your bladder more often. You may feel pain or burning when you empty your bladder. These side effects usually go away.

You're likely to become tired during external radiation therapy, especially in the later weeks of treatment. Although getting enough rest is important, most people say they feel better when they exercise every day. Try to go for a short walk, do gentle stretches, or do yoga.

Radiation therapy can also harm the skin. During external radiation therapy, it's common for the skin in the treated area to become red, dry, and tender. The skin near the anus is especially sensitive. Check with your doctor before using lotion or cream on the treated area. You may lose hair in that area, and it may not grow back. Brachytherapy may make the area look swollen and bruised. After treatment is over, the skin will slowly heal.

You may wish to discuss with your doctor the possible long-term effects of radiation therapy for prostate cancer. Radiation may harm the penis, rectum, and bladder, and side effects may develop 6 months or more after treatment ends.

For example, both types of radiation therapy may cause erectile dysfunction, bleeding from the rectum, diarrhea, or rectal discharge. Other possible problems include finding blood in your urine, feeling an urgent need to empty your bladder, or needing to empty your bladder more often than you used to. If any of these problems occur, your doctor can tell you how to manage them.

The NCI booklet Radiation Therapy and You has helpful ideas for coping with radiation therapy side effects.

Questions you may want to ask your doctor about radiation therapy

  • Which type of radiation therapy can I consider? Are both types an option for me?
  • When will treatment start? When will it end? How often will I have treatments?
  • How will I feel during treatment? Will I need to stay in the hospital? Will I be able to drive myself to and from treatment?
  • What can I do to take care of myself before, during, and after treatment?
  • How will we know the treatment is working?
  • How will I feel after radiation therapy?
  • What side effects should I tell you about?
  • Are there any lasting effects?

Hormone Therapy

Men with advanced prostate cancer usually receive hormone therapy. In addition, a man with early-stage prostate cancer may have hormone therapy before, during, and after radiation therapy. Hormone therapy may also be used after surgery.

Hormone therapy keeps prostate cancer cells from getting male hormones (androgens such as testosterone). Male hormones can cause prostate cancers to grow.

Types of hormone therapy include…

  • A drug that can prevent the testicles from making testosterone (LH-RH agonist)
  • A drug that can block the action of male hormones (antiandrogen)
  • Surgery to remove the testicles, which are the body's main source of testosterone
  • A drug that can prevent the adrenal glands from making testosterone

Your doctor can help you decide which type of hormone therapy or which combination is best for you.

The side effects of hormone therapy depend on the type used. The most common side effects are erectile dysfunction, hot flashes, and loss of sexual desire. Other possible side effects include breast growth, an increase in body fat around the waist, and an increase in sugar level in your blood.

Also, hormone therapy can weaken your bones. Your doctor can suggest medicines that may reduce your risk of breaking a bone.

An LH-RH agonist may make pain and other symptoms worse at first. This temporary problem is called a flare. To prevent a flare, your doctor may give you an antiandrogen for a few weeks along with the   LH-RH agonist.

Although the side effects of hormone therapy may be upsetting, your health care team can suggest ways to manage them.

Questions you may want to ask your doctor about hormone therapy

  • What kind of hormone therapy can I consider? Would you suggest drugs or surgery? Why?
  • If I have drugs, when will treatment start? How often will I have treatments? When will treatment end?
  • If I have surgery, how long will I need to stay in the hospital?
  • How will I feel during treatment?
  • What can I do to take care of myself during treatment?
  • How will we know the treatment is working?
  • Which side effects should I tell you about?
  • Will there be long-term side effects?

Chemotherapy

Chemotherapy may be used for men with advanced prostate cancer.

Chemotherapy uses drugs to kill cancer cells. The drugs for prostate cancer are usually given directly into a vein (intravenously) through a thin needle.

You may receive chemotherapy in a clinic, at the doctor's office, or at home. Men rarely need to stay in the hospital during treatment.

The side effects depend mainly on which drugs are given and how much. Chemotherapy kills fast-growing cancer cells, but the drugs can also harm normal cells that divide rapidly:

  • Blood cells: When drugs lower the levels of healthy blood cells, you're more likely to get infections, bruise or bleed easily, and feel very weak and tired. Your health care team will check for low levels of blood cells. If your levels are low, your health care team may stop the chemotherapy for a while or reduce the dose of the drug. There are also medicines that can help your body make new blood cells.
  • Cells in hair roots: Chemotherapy may cause hair loss. If you lose your hair, it will grow back after treatment, but the color and texture may be changed.
  • Cells that line the digestive tract: Chemotherapy can cause a poor appetite, nausea and vomiting, diarrhea, or mouth and lip sores. Your health care team can give you medicines and suggest other ways to help with these problems.

Other side effects include shortness of breath and a problem with your body holding extra water. Your health care team can give you medicine to protect against too much water building up in the body.

Your health care team can suggest ways to control many of these problems. Most go away when treatment ends.

The NCI booklet Chemotherapy and You has helpful ideas for coping with side effects.

Immunotherapy

Immunotherapy may be used for men with advanced prostate cancer who are not helped by hormone therapy. Immunotherapy stimulates the immune system to kill cancer cells.

For immunotherapy for prostate cancer, a treatment is made from some of your own blood cells. You'll receive a total of three injections of treatment. The injections are given one at a time, usually 2 weeks apart.

The most common side effects are headache, backache, feeling very tired, and having a fever and chills. These effects usually go away.

This type of immunotherapy is also known as a treatment vaccine. For more information, you may want to read the NCI fact sheet Cancer Vaccines.

Questions you may want to ask your doctor about chemotherapy or immunotherapy

  • Which drug or therapy do you suggest for me? What will it do?
  • What is the expected benefit of treatment?
  • What are the possible side effects? What can we do about them?
  • Which side effects should I tell you about?
  • When will treatment start? When will it end? How often will I have treatments?
  • How will we know the treatment is working?
  • Will there be lasting side effects?

Nutrition

Eating well is important before, during, and after cancer treatment. You need the right amount of calories to maintain a good weight. You also need enough protein to keep up your strength. Eating well may help you feel better and have more energy.

Sometimes, especially during or soon after treatment, you may not feel like eating. You may be uncomfortable or tired. You may find that foods don’t taste as good as they used to. In addition, poor appetite, nausea, vomiting, mouth blisters, and other side effects of treatment can make it hard for you to eat.

Your doctor, a registered dietitian, or another health care provider can suggest ways to help you meet your nutrition needs. Also, the NCI booklet Eating Hints has many useful recipes and lists of foods that can help with side effects.

Follow-up Care

You’ll need regular checkups (such as every 6 months) after treatment for prostate cancer. Checkups help ensure that any changes in your health are noted and treated if needed. If you have any health problems between checkups, contact your doctor.

Prostate cancer may come back after treatment. Your doctor will check for the return of cancer.

Checkups also help detect health problems that can result from cancer treatment.

Checkups may include a digital rectal exam and a PSA test. A rise in PSA level can mean that cancer has returned after treatment. Your doctor may also order a biopsy, a bone scan, CT scans, an MRI, or other tests.

You may find it helpful to read the NCI booklet Facing Forward: Life After Cancer Treatment. You may also want to read the NCI fact sheet Follow-up Care After Cancer Treatment.

Sources of Support

Learning that you have prostate cancer can change your life and the lives of those close to you. These changes can be hard to handle. It’s normal for you, your  family, and your friends to need help coping with the feelings that a diagnosis of cancer can bring.

Concerns about treatments and managing side effects, hospital stays, and medical bills are common. You may also worry about caring for your family, keeping your job, or continuing daily activities.

Here’s where you can go for support:

  • Doctors, nurses, and other members of your health care team can answer questions about treatment, working, or other activities.
  • Social workers, counselors, or members of the clergy can be helpful if you want to talk about your feelings or concerns. Often, social workers can suggest resources for financial aid, transportation, home care, or emotional support.
  • Support groups can also help. In these groups, men with prostate cancer or their family members meet with other patients or their families to share what they have learned about coping with the disease and the effects of treatment. Groups may offer support in person, over the telephone, or on the Internet. You may want to talk with a member of your health care team about finding a support group.
  • NCI’s Cancer Information Service can help you locate programs, services, and NCI publications. Call 1-800-4-CANCER (1-800-422-6237). Or, chat using LiveHelp (https://livehelp.cancer.gov), NCI’s instant messaging service.
  • Your doctor or a sex counselor may be helpful if you and your partner are concerned about the effects of prostate cancer on your sex life. Ask your doctor about possible treatment of side effects and whether these side effects are likely to last. Whatever the outlook, you and your partner may find it helps to discuss your concerns.

For tips on coping, you may want to read the NCI booklet Taking Time: Support for People With Cancer.

Cancer Treatment Research

Cancer research has led to real progress in prostate cancer detection, treatment, and supportive care. Because of research, men with prostate cancer can look forward to a better quality of life and less chance of dying from the disease. Continuing research offers hope that, in the future, even more men with this disease will be treated successfully.

Doctors continue to search for new and better ways to treat prostate cancer. All over the world, doctors are conducting many types of cancer treatment research studies (clinical trials).

NCI is sponsoring many studies with men who have prostate cancer, such as studies of chemotherapy, hormone therapy, radiation therapy, and their combinations.

Even if a man who takes part in a clinical trial doesn’t benefit directly from the treatment under study, he may still make an important contribution by helping doctors learn more about prostate cancer and how to control it. Although clinical trials may pose some risks, researchers do all they can to protect their patients.

If you’re interested in being part of a clinical trial, talk with your doctor. You may want to read the NCI booklet Taking Part in Cancer Treatment Research Studies. It describes how treatment studies are carried out and explains their possible benefits and risks.

NCI’s website has a section on research studies at http://www.cancer.gov/clinicaltrials. It has general information about clinical trials as well as detailed information about specific ongoing studies of prostate cancer. Check for treatment research studies for prostate cancer that are now accepting patients.

NCI’s Cancer Information Service can answer your questions and provide information about clinical trials. Contact CIS at 1-800-4-CANCER (1-800-422-6237) or at LiveHelp (https://livehelp.cancer.gov).