cancer is the most common type of cancer in men in the United
States (other than skin cancer). The following information
has been provided by The National Cancer Institute (NCI) in
the United States to help patients with prostate cancer and
their families and friends better understand this disease.
prostate is a male sex gland. It produces a thick fluid that
forms part of the semen. The prostate is about the size of
a walnut. It is located below the bladder and in front of
the rectum. The prostate surrounds the upper part of the urethra,
the tube that empties urine from the bladder.
prostate needs male hormones to function. The main male hormone
is testosterone, which is made mainly by the testicles. Some
male hormones are produced in small amounts by the adrenal
is a group of many different diseases that have some important
things in common. They all affect cells, the body's basic
unit of life. To understand cancer, it is helpful to know
about normal cells and what happens when cells become cancerous.
The body is made up of many types of cells. Normally, cells
grow and divide to produce more cells only when the body needs
them. This orderly process helps keep the body healthy.
If the cells keep dividing when new cells are not needed,
they form too much tissue. Excess tissue can form a mass,
called a tumor. Excess tissue can be benign or malignant.
tissue is not cancer. The cells do not invade nearby tissue
or spread to other parts of the body.
tissue is cancer. The cancer cells divide out of control.
They can invade and destroy nearby healthy tissue. Also,
cancer cells can break away from the tumor they form and
enter the bloodstream and lymphatic system, This is how
cancer spreads from the original (primary) tumor to form
new tumors in other parts of the body. The spread of cancer
is called metastasis.
prostatic hyperplasia (BPH) is the abnormal growth of benign
prostate cells. In BPH, the prostate grows larger and pushes
against the urethra and bladder, blocking the normal flow
of urine. More than half of the men in the United States between
the ages of 60 and 70 and as many as 90 percent between the
ages of 70 and 90 have symptoms of BPH. Although this condition
is seldom a threat to life, it may require treatment to relieve
cancers are named for the type of cell or organ in which they
begin. Cancer that begins in the prostate is called primary
prostate cancer (or prostatic cancer). Prostate cancer may
remain in the prostate gland, or it may spread to nearby lymph
nodes. Prostate cancer may also spread to the bones, bladder,
rectum, and other organs.
cancer spreads to other parts of the body, the new tumor has
the same malignant cells and the same name as the primary
tumor. For example, if prostate cancer spreads to the bones,
the cancer cells in the new tumor are prostate cancer cells.
The disease is metastatic prostate cancer; it is not bone
prostate cancer often does not cause symptoms. When symptoms
of prostate cancer do occur, they may include some of the
need to urinate frequently, especially at night;
starting urination or holding back urine;
or interrupted flow of urine;
or burning urination;
in urine or semen; and/or
pain or stiffness in the lower back, hips, or upper thighs.
of these symptoms may be caused by cancer or by other, less
serious health problems, such as BPH or an infection. Only
a doctor can tell the cause. A man who has symptoms like these
should see his family doctor or a urologist (a doctor who
specializes in treating diseases of the genitourinary system).
Do not wait to feel pain; early prostate cancer does not cause
symptoms occur, the doctor asks about the patient's medical
history, performs a physical exam, and may order laboratory
tests. The exams and tests may include the following:
rectal exam--the doctor inserts a gloved, lubricated
finger into the rectum and feels the prostate through
the rectal wall to check for hard or lumpy areas.
tests--a lab measures the levels of prostate-specific
antigen (PSA) and prostatic acid phosphatase (PAP) in
the blood. The level of PSA in the blood may rise in men
who have prostate cancer, BPH, or an infection in the
prostate. The level of PAP rises above normal in many
prostate cancer patients, especially if the cancer has
spread beyond the prostate. The doctor cannot diagnose
prostate cancer with these tests alone because elevated
PSA or PAP levels may also indicate other, noncancerous
problems. However, the doctor will take the results of
these tests into account in deciding whether to check
the patient further for signs of cancer.
test--a lab checks the urine for blood or infection.
doctor may order other tests to learn more about the cause
of the symptoms and to help determine whether conditions of
the prostate are benign or malignant, such as:
ultrasonography--sound waves that cannot be heard
by humans (ultrasound) are sent out by a probe inserted
into the rectum. The waves bounce off the prostate, and
a computer uses the echoes to create a picture called
pyelogram--a series of x-rays of the organs of the
--a procedure in which a doctor looks into the urethra
and bladder through a thin, lighted tube.
test results suggest that cancer may be present, the patient
will need to have a biopsy. A biopsy is the only sure way
to know whether a problem is cancer. During a biopsy, the
doctor removes a small amount of prostate tissue, usually
with a needle. A pathologist looks at the tissue under a microscope
to check for cancer cells. If cancer is present, the pathologist
usually reports the grade of the tumor. The grade tells how
closely the tumor resembles normal prostate tissue and suggests
how fast the tumor is likely to grow. One way of grading prostate
cancer, called the Gleason system, uses scores of 2 to 10.
Another system uses G1 through G4. Tumors with lower scores
are less likely to grow or spread than tumors with higher
man who needs a biopsy may want to ask the doctor some of
the following questions:
long will the procedure take? Will I be awake? Will it
soon will I know the results?
I do have cancer, who will talk to me about treatment?
the physical exam and test results do not suggest cancer,
the doctor may recommend medicine to reduce the symptoms caused
by an enlarged prostate. Surgery is another way to relieve
these symptoms. The surgery used in such cases is transurethral
resection of the prostate (TURP or TUR). In TURP, an instrument
is inserted through the penis to remove prostate tissue that
is pressing against the upper part of the urethra.
cancer is found in the prostate, the doctor needs to know
the stage, or extent, of the disease. Staging is a careful
attempt to find out whether the cancer has spread and, if
so, what parts of the body are affected. The doctor may use
various blood and imaging tests to learn the stage of the
disease. Treatment decisions depend on these findings.
results of staging tests help the doctor decide which stage
best describes a patient's disease:
I (A)--The cancer cannot be detected by rectal exam and
causes no symptoms. The cancer is usually found during
surgery to relieve problems with urination. State I tumors
may be in more than one area of the prostate, but there
is no evidence of spread outside the prostate.
II (B)--The tumor is felt in a rectal exam or detected
by a blood test, but there is no evidence that the cancer
has spread outside the prostate.
III (C)--The cancer has spread outside the prostate to
IV (D)--Cancer cells have spread to lymph nodes or to
other parts of the body.
doctor develops a treatment plan to fit each patient's needs.
Treatment for prostate cancer depends on the stage of the
disease and the grade of the tumor (how fast the cells are
likely to grow or spread to other organs). Other important
factors in planning treatment are the man's age and general
health and his feelings about the treatments and their possible
people with cancer want to learn all they can about their
disease, their treatment choices, and possible side effects
of treatment, so they can take an active part in decisions
about their medical care. There are a number of available
treatments for men with prostate cancer (surgery, radiation
therapy, and hormone therapy). Not all men require treatment.
The patient and his doctor may want to consider both the benefits
and possible side effects of each option, especially the effects
on sexual activity and urination, and other concerns about
quality of life.
may arise throughout the treatment process. From time to time,
patients may wish to ask members of their health care team
to explain things further. These are some questions
a patient may want to ask the doctor before treatment begins:
is the stage of the disease?
is the grade of the disease?
I need to be treated? What are the treatment choices?
What do you recommend for me?
are the expected benefits of each kind of treatment?
are the risks and possible side effects of each treatment?
treatment likely to affect my sex life?
I likely to have urinary problems?
new treatments being studied in clinical trials? Would
a trial be appropriate for me?
men whose prostate cancer is slow growing and found at an
early stage may not need treatment. Also, treatment may not
be advised for older men or men with other serious medical
problems. For these men, the possible side effects and the
risks of treatment may outweigh the possible benefits of treatment;
instead, the doctor may suggest "watchful waiting"--following
the patient closely and treating the patient later for symptoms
that may arise. Researchers are studying men with early stage
prostate cancer to determine when and in whom treatment may
be necessary and effective.
for prostate cancer may involve surgery, radiation therapy,
or hormone therapy. Sometimes, patients receive a combination
of these treatments. In addition, doctors are studying other
methods of treatment to find out whether they are effective
against this disease.
is a common treatment for the early stages of prostate cancer.
Surgery to remove the entire prostate is called radical prostatectomy.
It is done in one of two ways. In retropubic prostatectomy,
the prostate and nearby lymph nodes are removed through an
incision in the abdomen. In perineal prostatectomy, the prostate
is removed through an incision between the scrotum and the
anus. Nearby lymph nodes are sometimes removed through a separate
incision in the abdomen. If the pathologist finds cancer cells
in the lymph nodes, it may mean that the disease has spread
to other parts of the body.
are some questions a patient may want to ask the doctor before
kind of operation will it be?
will I feel after the operation?
I have pain, how will you help?
I have any lasting side effects?
therapy is another way to treat prostate cancer. In radiation
therapy (also called radiotherapy), high-energy rays are used
to damage cancer cells and stop them from growing and dividing.
Like surgery, radiation therapy is local therapy; it can affect
cancer cells only in the treated area. In early stage prostate
cancer, radiation can be used instead of surgery, or it may
be used after surgery to destroy any cancer cells that may
remain in the area. In advanced stages, it may be given to
relieve pain or other problems. Radiation may be directed
at the body by a machine (external radiation), or it may come
from a small container of radioactive material placed directly
into or near the tumor (internal radiation). Some patients
receive both kinds of radiation therapy.
external radiation therapy for prostate cancer, the patient
is treated in an outpatient department of a hospital or clinic.
Treatment generally is given 5 days a week for about 6 weeks.
This schedule helps protect healthy tissues by spreading out
the total dose of radiation. The rays are aimed at the pelvic
area. At the end of treatment, an extra "boost"
of radiation is often directed at a smaller area, where the
internal (or implant) radiation therapy, a brief stay in the
hospital may be needed when the radioactive material is implanted.
The implant may be temporary or permanent. When a temporary
implant is removed, there is no radioactivity in the body.
The amount of radiation in a permanent implant is not generally
dangerous to other people, but patients may be advised to
avoid prolonged close contact with others for a period of
are some questions a patient may want to ask the doctor before
having radiation therapy:
is the goal of this treatment?
will the radiation be given?
will the treatment begin? When will it end?
will I feel during therapy?
can I do to take care of myself during therapy?
will we know if the radiation therapy is working?
I be able to continue my normal activities during treatment?
therapy prevents the prostate cancer cells from getting
the male hormones they need to grow. When a man undergoes
hormone therapy, the level of male hormones is decreased.
This drop in hormone level can affect all prostate cancer
cells, even if they have spread to other parts of the body.
For this reason, hormone therapy is called systemic therapy.
are several forms of hormone therapy. One is surgery to remove
the testicles. This operation, called orchiectomy, eliminates
the main source of male hormones. The use of luteinizing
hormone-releasing hormone (LHRH) agonist is another type of
hormone therapy. LHRH agonists prevent the testicles from
producing testosterone. In another form of hormone therapy,
patients take the female hormone estrogen to stop the testicles
from producing testosterone.
orchiectomy or treatment with an LHRH agonist or estrogen,
the body no longer gets testosterone from the testicles. However,
the adrenal glands still produce small amounts of male hormones.
Sometimes, the patient is also given an antiandrogen, a drug
that blocks the effect of any remaining male hormones. This
combination of treatment is known as a total androgen blockade.
cancer that has spread to other parts of the body usually
can be controlled with hormone therapy for a period of time,
often several years. Eventually, however, most prostate cancers
are able to grow with very little or no male hormones. When
this happens, hormone therapy is no longer effective, and
the doctor may suggest other forms of treatment that are under
Effects of Treatment
doctors plan treatment very carefully, it is hard to limit
the effects of treatment so that only cancer cells are removed
or destroyed. Because treatment also damages healthy cells
and tissues, it often causes unwanted, and sometimes serious,
side effects of cancer treatment depend mainly on the type
and extent of the treatment. Also, each patient reacts differently.
Doctors and nurses can explain the possible side effects of
treatment, and they can often suggest ways to help relieve
symptoms that may occur during and after treatment. It is
important to let the doctor know if any side effects occur.
patients are often uncomfortable during the first few days
after surgery, their pain can be controlled with medicine.
Patients should feel free to discuss pain relief with the
doctor or nurse. It is also common for patients to feel tired
or weak for a while. The length of time it takes to recover
from an operation varies for each patient.
to remove the prostate may cause permanent impotence and sometimes
causes urinary incontinence. These side effects are somewhat
less common than in the past. Some surgeons use new methods,
especially when removing small tumors. These techniques, called
nerve-sparing surgery, may prevent permanent injury to the
nerves that control erection and damage to the opening of
the bladder. When this surgery is fully successful, impotence
and urinary incontinence are only temporary. However, men
who have a prostatectomy no longer produce semen, so they
have dry orgasms.
therapy may cause patients to become very tired as treatment
continues. Resting is important, but doctors usually advise
patients to try to stay as active as they can. Patients may
have diarrhea or frequent and uncomfortable urination. In
addition, when patients receive external radiation therapy,
it is common for the skin in the treated area to become red,
dry, and tender. Radiation therapy can also cause hair loss
in the pelvic area. The loss may be temporary or permanent,
depending on the amount of radiation used.
therapy causes impotence in some men. This does not occur
as often with internal radiation therapy as with external
radiation therapy; internal radiation therapy is not as likely
to damage the nerves that control erection.
LHRH agonists, and estrogen often cause side effects such
as loss of sexual desire, impotence, and hot flashes. When
first taken, an LHRH agonist tends to increase tumor growth
and may make the patient's symptoms worse. This temporary
problem is called "tumor flare." Gradually, however,
the drug causes a man's testosterone level to fall. Without
testosterone, tumor growth slows down and the patient's condition
improves. Prostate cancer patients who receive estrogen or
an antiandrogen may have nausea, vomiting, or tenderness and
swelling of the breasts. (Estrogen is used less now than in
the past because it increases a man's risk of heart problems.
This form of treatment is not appropriate for men who have
a history of heart disease.)
side effects of chemotherapy depend mainly on the specific
drugs that are used. The National Cancer Institute publication
Chemotherapy and You may be helpful to patients experiencing
the side effects of chemotherapy.
therapy may cause flu-like symptoms such as chills, fever,
muscle aches, weakness, loss of appetite, nausea, vomiting,
or diarrhea. Patients may also bleed or bruise easily, and
some get a rash. Some of these problems can be severe, but
they go away after the treatment stops.
for Cancer Patients
nutrition is important. Patients who eat well often feel better
and have more energy. Eating well during cancer treatment
means getting enough calories and protein to prevent weight
loss, regain strength, and rebuild normal tissues.
patients find it hard to eat well during treatment. They may
lose their appetite. In addition to loss of appetite, common
side effects of treatment, such as nausea and vomiting, can
make eating difficult. Foods taste different to some patients.
Also, people undergoing treatment may not feel like eating
when they are uncomfortable or tired.
followup exams are important for any man who has had prostate
cancer. The doctor will suggest an appropriate followup schedule.
The doctor will examine the patient regularly to be sure that
the disease has not returned or progressed, and decide what
other medical care may be needed. Followup exams may include
x-rays, scans, and laboratory tests, including the PSA blood
the Future Holds
are finding better ways to treat prostate cancer, and the
outlook for men with prostate cancer keeps improving. Still,
it is natural for patients and their families to be concerned
about what the future holds. Sometimes people use statistics
to try to figure out the chances of being cured. It is important
to remember, however, that statistics are averages based on
large numbers of patients. They cannot be used to predict
what will happen to a particular patient because no two patients
are alike; treatments and responses vary greatly. The doctor
who takes care of the patient is in the best position to discuss
the patient's prognosis (chance of recovery or control of
doctors talk about surviving cancer, they may use the term
remission rather than cure. Even though many prostate cancer
patients recover completely, doctors use this term because
the disease can recur, or reappear after treatment.
causes of prostate cancer are not yet understood. Researchers
are looking at factors that may increase the risk of this
disease. The more they can learn about these risk factors,
the better the chance of finding ways to prevent and treat
in the United States show that prostate cancer is found mainly
in men over age 55; the average age of patients at the time
of diagnosis is 72. This disease is more common in black men
than in white men. In fact, black men in the United States
have the highest rate of prostate cancer in the world. Doctors
cannot explain why one man gets prostate cancer and another
does not, but they do know that no one can "catch"
prostate cancer from another person. Prostate cancer is not
studies have shown that a man has a higher risk for prostate
cancer if his father or brother has had the disease. However,
researchers are uncertain why some families have a higher
incidence of prostate cancer.
are studying the effects of diet. Some evidence suggests that
a diet high in fat increases the risk of prostate cancer and
a diet high in fruits and vegetables decreases the risk, but
these links have not been proven.
have studied whether having a vasectomy increases a man's
risk for prostate cancer. Some studies suggest there may be
such a link, but other studies have not supported this claim.
studies show that farmers and workers exposed to the metal
cadmium during welding, electroplating, or making batteries
may have an increased risk of getting this disease. Also,
workers in the rubber industry appear to develop prostate
cancer more often than members of the general public. However,
more research is needed to confirm these results.
are also doing studies to determine whether BPH or a sexually
transmitted virus increases the risk for prostate cancer.
At this time, they do not have clear evidence of increased
risk in either case.