Prostate Cancer

Topic Overview

Is this topic for you?

For information on cancer that has come back or spread to other parts of the body, see the topic Prostate Cancer, Advanced or Metastatic.

What is prostate cancer?

Prostate cancer is the abnormal growth of cells in a man's prostate gland . The prostate sits just below the bladder. It makes part of the fluid for semen. In young men, the prostate is about the size of a walnut. It usually grows larger as you grow older.

Prostate cancer is common in men older than 65. It usually grows slowly and can take years to grow large enough to cause any problems. Most cases are treatable, because they are found with screening tests before the cancer has spread to other parts of the body.¹ Although most men may die with prostate cancer, most men do not die from it.

Experts don't know what causes prostate cancer, but they believe that your age, family history (genetics), and race affect your chances of getting it. What you eat, such as foods high in fats, may also play a part.²

What are the symptoms?

Prostate cancer usually does not cause symptoms in its early stages. Most men don't know they have it until it is found during a regular medical exam.

When problems are noticed, they are most often problems with urinating. But these same symptoms can also be caused by an enlarged prostate (benign prostatic hyperplasia). An enlarged prostate is common in older men.

See your doctor for a checkup if:

• You have trouble starting your urine stream.
• You have a weaker-than-normal urine stream.
• You cannot urinate at all.
• You have to urinate often.
• You feel like your bladder is not emptying completely when you urinate.
• You have to get up at night to urinate.
• You have pain or burning when you urinate.
• You have blood in your urine.
• You have a deep pain in your lower back, belly, hip, or pelvis.

How is prostate cancer diagnosed?

The most common way to check for prostate cancer is to have a digital rectal exam, in which the doctor puts a gloved, lubricated finger in your rectum to feel your prostate, and a prostate-specific antigen (PSA) blood test. A higher level of PSA may mean that you have prostate cancer, but it could also mean that you have an enlargement or infection of the prostate.

If your PSA is high, or if your doctor finds anything during the rectal exam, he or she may do a biopsy to figure out the cause. A biopsy means your doctor takes a sample of tissue from your prostate gland and sends it to a lab for testing.

Because many men have regular checkups, about 9 out of 10 prostate cancers are found in the early stages, with a 5-year survival rate of almost 100%.¹ The 5-year survival rate shows the percentage of men still alive 5 years or longer after diagnosis. It's important to remember that everyone's case is different, and these numbers may not show what will happen in your case.

Should you have regular tests for prostate cancer?

It is important to have regular health checkups, including a digital rectal exam. But experts disagree on whether regular PSA testing is right for all men. Testing could lead you to have cancer treatment that can cause other health problems, especially loss of bladder control and not being able to have an erection.

So talk with your doctor. Ask about your risk for prostate cancer, and discuss the pros and cons of PSA testing.

How is prostate cancer treated?

Your treatment will depend on what kind of cancer cells you have, how far they have spread, your age and general health, and your preferences.

You and your doctor may decide to treat your cancer with surgery, radiation, hormone therapy, or a combination. Or, if the cancer has not spread and you are around age 70 or older, you may be able to wait and watch to see what happens. During watchful waiting, you will have regular checkups with your doctor to see if your cancer has changed.

Choosing treatment for prostate cancer can be confusing. Talk with your doctor to choose the treatment that is best for you.

How can treatment affect your quality of life?

Your age and overall health will make a difference in how treatment may affect your quality of life. Any health problems you have before you are treated, especially urinary, bowel, or sexual function problems, will affect how you recover.

Both surgery and radiation can cause urinary incontinence (not being able to control urination) or impotence (not being able to have an erection). The level of urinary incontinence and how long it lasts and the quality of the erections a man has after treatment will depend on whether the cancer has spread. These also depend on what treatment is used.

Nerves that help a man have an erection are right next to the prostate. Surgery to remove the cancer may damage these nerves. Many times a special form of surgery, called nerve-sparing surgery, can preserve the nerves. But if the cancer has spread to the nerves, they may have to be removed during surgery.

These same nerves can also be damaged by the X-rays that are used in radiation therapy.

Medicines and mechanical aids may help men who are impotent because of treatment. Some men recover part or most of their ability to have an erection several months or even years after surgery.

Frequently Asked Questions

Health Tools

Health Tools help you make wise health decisions or take action to improve your health.

	Decision Points focus on key medical care decisions that are important to many health problems.
	Should I have a prostate-specific antigen (PSA) test to screen for prostate cancer?
	Should I have radiation therapy or a prostatectomy for localized prostate cancer?
	Actionsets are designed to help people take an active role in managing a health condition.
	Cancer: Controlling cancer pain

Cause

The exact cause of prostate cancer is not known, but experts believe that your age and family history (genetics) may have something to do with your chances of getting the disease. What you eat may add to your chances of getting it.²

The prostate usually gets larger as you age. Having an enlarged prostate (benign prostatic hyperplasia, or BPH) is very common among older men and does not increase your chances of developing prostate cancer. But an enlarged prostate is sometimes caused by prostate cancer instead of BPH.

Symptoms

Prostate cancer usually doesn't cause symptoms in its early stages. When there are symptoms, they may include:

• Having difficulty starting your urine stream. This is called hesitancy.
• Having a weaker-than-normal urine stream.
• Not being able to urinate at all.
• Having to urinate often.
• Feeling that your bladder is not emptying completely when you urinate.
• Having to get up at night to urinate. This is called nocturia.
• Having pain or a burning feeling when you urinate. This is called dysuria.
• Having blood in your urine. This is called hematuria.
• Having blood in your semen. This is called hematospermia.
• Having a deep pain in your lower back, abdomen, hip, or pelvis.

These symptoms may also be caused by:

• Benign prostatic hyperplasia (BPH), which is an enlarged prostate. This is very common in older men. The prostate usually grows larger with age. When it gets large enough, it can press against the urethra-the tube that carries urine from the bladder through your penis-and cause bladder problems.
• Prostatitis, an infection in the prostate.
• Urinary tract infection, an infection in any of the organs that make urine or the tubes that carry it out of the body.

Symptoms that may indicate the cancer has spread, or metastasized, to other parts of the body include:

• Weight loss.
• Bone pain, especially in the lower abdomen, hip, pelvis, or lower back.
• Swelling in the legs and feet.

For more information about prostate cancer that has come back or spread, see the topic Prostate Cancer, Advanced or Metastatic.

What Happens

Almost all prostate cancers are discovered in their early stages, and the 5-year survival rate is almost 100% when the cancer is found at an early stage.¹ The 5-year survival rate is the percentage of men who are still alive 5 years after they have been diagnosed. It is just an average. Everyone's case is different, and this number may not show what will happen in your case.

Prostate cancer is so common that some experts believe that every man would get it if he lived long enough. Studies of autopsies show that most men older than 85 who die of other causes have tumors in their prostates.³ It usually is a very slow-growing cancer that takes years to grow large enough to cause any problems. Sometimes, though, it grows quickly.

When prostate cancer spreads, it goes first to surrounding tissue, then to lymph nodes in the pelvis, and then on to the bones, lungs, or other organs. For more information, see the topic Prostate Cancer, Advanced or Metastatic.

What Increases Your Risk

Being older than 50 is the main risk factor for prostate cancer. A risk factor is anything that makes you more likely to get a particular disease. More than 65% of new prostate cancers are diagnosed in men who are 65 or older.¹ In addition, 90% of prostate cancer deaths occur in men who are older than 65.⁴

Your chances of getting the disease are higher if other men in your family have had it. Your risk is doubled if your father or brother developed prostate cancer. Your risk also depends on the age at which your relative was diagnosed.³ But most men who get prostate cancer have no family history of the disease.

Men whose families carry the gene changes that cause breast cancer, BRCA1 or BRCA2, are thought to be at increased risk for prostate cancer.⁵

Race and prostate cancer survival

African-American men and Jamaican men of African descent have a greater chance of getting the kind of prostate cancer that grows and spreads. Experts believe that there are many reasons for the differences in the prostate cancer disease and death rates among different races and around the world.⁶ One reason is a genetic link. Researchers have recently discovered a gene that occurs more often in African-American men and raises their risk of prostate cancer. Other genes may be involved too. It is hoped that these findings will lead to new treatments.⁷

Ethnicity and 5-year survival rate (percentage of men with prostate cancer who survive for 5 years or longer)⁸

The 5-year survival rate shows the percentage of men who are still alive 5 years or more after they are diagnosed. It is important to remember that these are only averages. Everyone's case is different, and these numbers may not show what will happen in your case.

Asian-American men develop prostate cancer more often than Asian men living in Japan and China. But the incidence of prostate cancer in Asian-American men is lower than that in Caucasian men and much lower than that in African-American men. A Western high-fat diet may be the cause.²

Other factors that may increase your risk

• What you eat. Men who live in countries where people eat more red meat and fats are more likely to be diagnosed with and die from prostate cancer, according to some studies. Eating more lycopene, found in tomatoes and beets, may decrease the risk. Getting enough selenium and vitamin E may also help.²
• Hormones. Researchers are studying the link between high testosterone levels and prostate cancer.⁶
• Where you live. There are places in the world where the rates of prostate cancer are low, such as in Japan or China. But when Japanese or Chinese men move to countries where the rate is higher, such as the United States, their rates go up.²

When To Call a Doctor

Call your doctor immediately if you:

• Are completely unable to urinate.
• Have painful urination and a fever higher than 100 °F (38 °C), chills, or body aches.
• Have blood or pus in your urine.

Call your doctor if you have painful urination and signs of a possible urinary tract infection that last longer than 24 hours. These signs include:

• A burning sensation while urinating.
• Pain in your lower back just below your ribs that is not related to any injury or physical exertion.
• Painful ejaculation.
• Difficulty starting or controlling your urination.

Call your doctor to schedule an appointment within 1 to 2 weeks if you have unexplained:

• Weight loss.
• Dull, aching pain in your lower back, hip, or pelvis.

In most men, the prostate gland gets larger as they get older. Having symptoms of an enlarged prostate does not mean you have cancer, but you should be checked by your doctor. Symptoms of an enlarged prostate include difficulty urinating and sexual dysfunction, among others. For more information on an enlarged prostate, see the topic Benign Prostatic Hyperplasia (BPH).

Watchful Waiting

Watchful waiting means waiting to see what happens to your prostate cancer without treatment.

• The main reason to choose watching and waiting is to avoid the potentially serious side effects of surgery or radiation. With treatment there is a chance that you will have erection problems and bladder problems and also a small chance that you will have bowel problems. Some men whose cancer has been caught in its early stages choose to watch and wait because most prostate cancer grows slowly. This choice makes the most sense for some men in their 70s or 80s or men who are in poor health.
• The main reason to choose treatment (and not watchful waiting) is that it makes the cancer much less likely to grow and spread.⁹

During watchful waiting, you have regular digital rectal exams and PSA tests to check the growth of your cancer. As long as there is no change, you may continue to watch and wait. If the cancer begins to grow rapidly or spread, you may consider other treatment.

Who To See

The following health professionals can evaluate urinary symptoms:

• Family medicine physician
• Internal medicine doctor
• Urologist
• Physician assistant
• Nurse practitioner

The following doctors treat prostate cancer:

• Urologist
• Radiation oncologist
• Medical oncologist

You may want to get a second opinion from a different specialist before making your treatment decision. For example, if your doctor is a family medicine physician, you may want to talk to a radiation oncologist, urologist, or medical oncologist.

To prepare for your appointment, see the topic Making the Most of Your Appointment.

Exams and Tests

If you are having problems urinating, your doctor may use tests to see if you have an enlarged prostate (benign prostatic hyperplasia). This condition is the most common cause of urination problems.

Initial tests include:

• A digital rectal exam, in which the doctor inserts a gloved finger into your rectum to feel your prostate gland. Some prostate tumors can be found this way.
• A urine test, in which some of your urine is sent to a lab and checked for blood, infection, or abnormal cells. Prostate cancer can cause blood in the urine.
• A PSA test to measure the levels of prostate-specific antigen (PSA) in your blood. A higher level of PSA may be a sign of an enlargement, infection, or cancer of the prostate. If it is possible that an infection is raising your PSA, you may first have 4 to 6 weeks of antibiotics. Your doctor may suggest a second PSA test before thinking of doing a biopsy.
• AUA symptom score. This is a series of questions from the American Urological Association (AUA) that measures how bad your urinating problems are. Sometimes these problems are caused by prostate cancer that is blocking your urine flow.
• Urine-flow rate test. This test measures your urine and how fast it comes out. Sometimes a low flow rate is caused by prostate cancer.

If tests point to prostate cancer, your doctor may recommend a prostate biopsy, in which tissue is taken from the prostate and examined under a microscope. A biopsy is the only way to confirm whether you have prostate cancer.

After treatment for prostate cancer, you have regular checkups to check for any signs that the cancer has come back or spread. Tests that are done to evaluate the spread of the cancer and to plan further treatment may include:

• Blood tests. Different types of blood tests are used to see whether cancer has spread to your bones or liver.
• A bone scan. Radioactive material that shows up on X-rays is injected into your arm. An X-ray camera passes over your body, taking pictures as the radioactive material moves into your bones. Areas of bone damage show up in the pictures. Prostate cancer that has spread to the bones can cause this kind of damage.
• A CT scan. A CT scanner directs a series of X-rays through your body. CT scans can show tissue damage or diseases, such as an infection or tumor.
• A pelvic lymphadenectomy. This is an operation in which the lymph nodes near your prostate are removed and checked under a microscope to see if they contain cancer. It may be done at the same time as surgery to remove your prostate.
• An MRI. An MRI uses a strong magnetic field to make pictures of the prostate. The MRI can show tissue damage or disease, such as infection or a tumor.
• ProstaScint scan. This scan may be used to look for cancer cells after you have had surgery to remove cancer. Radioactive material that attaches itself to prostate cancer cells and shows up on X-rays is injected into a vein. Four days later, your body is scanned with a special camera, and lymph nodes and other areas that have been invaded by prostate cancer cells show up in the picture.
• PET scan. This kind of scanner produces 3-D images that give a better view of tumors. In rare cases, it is used to look at advanced prostate cancer.

Early Detection

Screening for prostate cancer-checking for signs of the disease when there are no symptoms-is done with the digital rectal exam and the PSA test. In the United States, about 75% of men who are age 50 or older have had a PSA test.¹⁰

Should I have a PSA test to screen for prostate cancer?

The number of deaths caused by prostate cancer has dropped over the past 20 years. This has been linked to more early diagnosis with PSA testing and to better cancer treatment.¹

Finding prostate cancer early leads you to some big decisions. Most prostate cancer grows slowly. And the side effects of treatment can change your quality of life-mainly not being able to have an erection (impotence) and not being able to control urination (incontinence). If you are around age 70 or older, these side effects may seem worse than early-stage cancer that may not grow much during your lifetime. But, especially for men 65 or younger, treatment makes the cancer less likely to grow and spread.⁹

Because your age and medical history are unique, it is important to learn the pros and cons of PSA testing and talk to your doctor before making a decision.

What to think about

It is expected that prostate cancer will account for 29% (218,890) of new cancer cases in men in the United States in 2007. About 90% of those will be discovered in the early stages, and the overall 5-year survival rate for men whose cancer is found early is almost 100%.¹

Treatment Overview

Prostate cancer is often curable. About 90% of new cases of prostate cancer are caught early. Almost 100% of men with these early cancers survive 5 years or more after being diagnosed.¹

Choosing treatment for prostate cancer can be confusing. Any treatment can cause serious side effects.

The main choices for treating prostate cancer include surgery to remove the prostate gland (prostatectomy), radiation, cryosurgery, hormone therapy, and watchful waiting.

Watchful waiting may be a good option if you are around age 70 or older. During watchful waiting, you have regular checkups with your doctor to see if your cancer has changed.

In general, healthy men who are younger than 60 and whose cancer has not spread are treated with surgery or radiation. Surgery removes the prostate gland and its cancer. Radiation destroys the cancer and may damage nearby healthy cells. With these treatments, there is a chance of having erection problems, some chance of having urine leakage problems, and a small chance of having bowel problems.

Because of these side effects, some men, especially some older men, may decide that the cure is worse than the disease. Studies show that some men are willing to accept the risk of a shorter life span in return for a better quality of life than what they would have with treatment.¹¹

Your treatment decision will depend on:

• Your age.
• Any serious health problems, including any urinary, bowel, or sexual function problems.
• Your PSA level.
• What kind of cancer cells you have. This is called the grade or Gleason score of your cancer. Most prostate cancer cells grow very slowly, but some types of cells grow quickly and spread to other areas of the body.
• How far your cancer has spread. This is called the stage of your cancer.
• The side effects of treatment.
• Your personal feelings and concerns.

Prostate cancer is curable if it is detected and treated early. Unlike many other cancers, it is usually slow-growing. Most men will die with prostate cancer but not of prostate cancer. This slow growth means you have time to learn all you can before deciding whether to have treatment or which treatment to have.

Initial treatment

The main choices for treating prostate cancer include prostatectomy, radiation, cryotherapy, hormone therapy, and watchful waiting.

• Surgery involves removing the cancer by removing the prostate gland. This operation is called a prostatectomy. Before removing the prostate, the surgeon may remove some lymph nodes in the area to see if the cancer has spread.
  • Nerve-sparing surgery helps preserve the nerves that are along the side of the prostate and that are needed for an erection. This surgery is only done when there is little chance of leaving cancer cells behind. If you already have sexual function issues, nerve-sparing surgery may not be the best choice for you.
  • Laparoscopic radical prostatectomy is surgery done through several very small incisions in the belly. Laparoscopic surgery is done with a tiny camera and special instruments to remove the prostate.
  • Robotic-assisted laparoscopic radical prostatectomy is surgery done through small incisions in the belly with robotic arms that translate the surgeon's hand motions into finer and more precise movements. This surgery requires specially trained doctors. With an surgeon who does a large number of these procedures, men who have this procedure heal more quickly and report fewer problems with impotence and incontinence.¹²
• Radiation treatments, which include external and internal radiation, have been improved with newer technologies that reduce side effects and other problems caused by radiation in the past.
  • External radiation. Also called external beam radiotherapy, or EBRT, radiation therapy uses high-energy rays, such as X-rays, to destroy the cancer. It is usually given in multiple doses over several weeks. Radiation destroys tissue, so it may damage the nerves along the side of the prostate that affect your ability to have an erection. If you already have bowel problems, external radiation may make your symptoms worse. The three most common forms of external radiation are listed here:
    • Conformal radiotherapy (3D-CRT) uses a three-dimensional planning system to target a strong dose of radiation to the prostate cancer. This helps to protect healthy tissue from radiation.
    • Intensity-modulated radiation therapy (IMRT) uses a carefully adjusted amount of radiation. This protects healthy tissue more than conformal radiotherapy does.
    • Proton therapy uses a different type of energy (protons) rather than X-rays. This allows a higher amount of specifically directed radiation, which protects nearby healthy tissue the most, especially the rectum.¹³ Sometimes proton therapy is combined with X-ray therapy.
  • Internal radiation (brachytherapy). Brachytherapy is a one-time radiation treatment that uses tiny radioactive seeds. After you are given anesthesia, the doctor uses a needle to inject the seeds into your prostate, where they slowly release radiation directly into the cancer. Sometimes external radiation or hormone therapy is added to brachytherapy. If you already have urinary problems, brachytherapy may make your symptoms worse.
    • High-dose rate brachytherapy (HDR brachytherapy). For this form of brachytherapy, radioactive material is placed into the prostate for a very brief period of time (seconds to minutes) and then removed. The radiation is delivered this way several times. Early results from studies show that HDR brachytherapy is as helpful as other kinds of internal radiation.¹⁴
• Cryosurgery, also called cryoablation, freezes the prostate gland to kill the cancer. This is often done when surgery is not an option and when the cancer is advanced but still inside the prostate gland. And the results, including side effects such as incontinence or an injury to the rectum, depend very much on the doctor's skill and experience. Cryosurgery may not work as well as prostatectomy or external radiation, but the long-term results are not yet known. With cryosurgery, the prostate gland is not removed.
• Hormone therapy, also called androgen deprivation therapy or (ADT), is used in most cases with either surgery or radiation. Hormone therapy by itself does not have survival rates that are as good as combined therapies.¹⁵ Hormone therapy cannot cure prostate cancer. But it will usually shrink the tumor and slow the rate of cancer growth, sometimes for years. Taking a hormone-therapy medicine lowers your level of testosterone and other male hormones. Another way to lower male hormones is by having surgery to remove the testicles, called an orchiectomy.
• Watchful waiting is a treatment choice, especially among men who are age 70 or older. This is a period of time during which you are checked and tested regularly by your doctor but you are not being treated. This choice may be good if you are in your later years, tests show your cancer has been caught early and is the slow-growing kind, and you do not want to have the side effects of surgery or radiation.

The side effects of treatment are important to think about. Removing the prostate gland during surgery can cause impotence (not being able to have an erection) and urinary incontinence (not being able to control urination). Destroying the prostate gland with radiation may cause impotence and incontinence, but not as much as surgery can. But radiation sometimes causes diarrhea and bowel problems.² Hormone therapy can cause loss of sex drive and erections, risk of weak bones (osteoporosis), hot flashes, and weight gain.

The ability to have an erection sometimes returns or at least improves over time. So does the ability to control urine leakage.

Should I have a prostatectomy or radiation therapy to treat localized prostate cancer?

A diagnosis of prostate cancer usually means that you will be seeing your doctor regularly for years to come, so it is a good idea to build a relationship that is based on full and honest information. Ask your doctor questions about your cancer so that you can make the best decision about treatment. Your doctor also may give you some advice on changes to make in your life to help treatment be successful.

Your treatment options will be different if you are diagnosed with prostate cancer that has come back or has spread outside the prostate. For more information, see the topic Prostate Cancer, Advanced or Metastatic.

Dealing with your emotions

You may feel many emotions after being diagnosed with prostate cancer. Most men feel some denial, anger, and grief. There is no "normal" or "right" way to react. There are many things you can do to help yourself deal with your emotional reaction to prostate cancer. Talking with family and friends helps some people. Others find that they need to spend time alone.

If your reaction is interfering with your ability to make decisions about your health, it is important to talk to your doctor. Your cancer treatment center may offer psychological or financial services. You may also contact your local chapter of the American Cancer Society to help you find a support group. Talking with other men who have had similar feelings can be very helpful.

For more information about specific treatments, see the following topics:

• Prostate Cancer - Health Professional Information [NCI PDQ]
• Prostate Cancer - Patient Information [NCI PDQ]

Ongoing treatment

If you choose surgery or radiation to treat your prostate cancer, it will be important to have regular checkups. If your cancer comes back, this will help your doctor catch it early. It will also help your doctor treat any complications you may have from your treatment. Your regular follow-up program may include:

• Physical exams.
• PSA tests, to measure the levels of prostate-specific antigen (PSA) in your blood. A higher level of PSA may indicate an enlargement, infection, or cancer of the prostate. A rising PSA level after treatment for prostate cancer can mean your cancer has come back.
• Digital rectal exams, to check for changes in and around your rectum.
• Urinalysis, to check for blood in your urine.
• Biopsies, to examine suspicious tissue.

Prostate cancer and its treatment also may cause nausea, pain, or other side effects. You can use home treatment to manage some of these side effects. If you experience nausea, wait for 1 hour after vomiting has stopped and then sip a rehydration drink to restore lost fluids and nutrients. Your doctor may prescribe medicines to control nausea and vomiting. Constipation and diarrhea may be eased if you drink enough fluids.

For more information about managing pain, see the topic Cancer Pain.

If you decide to watch and wait instead of having treatment, you will have regular checkups with your doctor to check on your cancer. You will have digital rectal exams and PSA tests every 3 to 6 months. It is possible that a curable cancer could spread and become incurable during a 6-month period, but this is not common. If there is no change in your condition, you may continue to watch and wait. If the cancer begins to grow or spread, you may consider medicines, surgery, or radiation.

Treatment if the condition gets worse

For information on prostate cancer that spreads or comes back, see the topic Prostate Cancer, Advanced or Metastatic.

What To Think About

Another treatment used in Europe and Canada is high-intensity focused ultrasound (HIFU). HIFU uses an intense heat from focused sound waves to kill cancer cells. HIFU is also used for men who have cancer inside the prostate but who cannot have surgery. With time, studies will show if HIFU works as well as surgery and/or radiation therapy. HIFU is not yet FDA-approved for use in the United States.

Age is not a reason to avoid surgery. But if you are 70 or older, other medical conditions, such as heart disease, may affect your decision. Men who are older also have a higher rate of incontinence and impotence after surgery. Age is especially important to think about if you have early-stage cancer, which generally grows slowly.

Get a second or even a third opinion before making your treatment decisions. You may hear differing advice or opinions, which may seem confusing. But talking with other doctors can help you make your decision. If your doctor is a medical oncologist, you may want to talk with other prostate cancer specialists, such as a urologist, a radiation oncologist, or a surgeon.

Studies show that fewer side effects are reported at large medical centers, where the surgeons do prostatectomies more often and so are more experienced and skilled.²

Prevention

You can take steps that may lower your chances of getting prostate cancer.¹¹

Eat more low-fat, high-fiber foods, or foods with omega-3 fatty acids, such as:

• Soy products, like tofu and soy beans.
• Tomatoes and foods that contain tomato sauce.
• Vegetables like broccoli, cauliflower, and cabbage.
• Fish, like salmon, albacore tuna, and sardines.
• Walnuts and flaxseed, and their oils.

Researchers are looking into other things that may help prevent prostate cancer. These include:

• Medicines, such as finasteride or nonsteroidal anti-inflammatory drugs (NSAIDs).
• Drinking red wine or green tea.
• Supplements, such as vitamins D and E, and selenium.

Home Treatment

During any stage of prostate cancer, there are things you can do at home to help manage the side effects of cancer or treatment. See the following tips for managing:

• Nausea or vomiting. After vomiting has stopped for 1 hour, sip a rehydration drink to restore lost fluids and nutrients. Watch for and treat early signs of dehydration. Older adults can quickly become dehydrated from vomiting. Your doctor may also prescribe medicines to control nausea and vomiting.
• Pain. You may wish to try taking aspirin or similar drugs or an alternative therapy such as biofeedback to help relieve your pain. Be sure to discuss with your doctor any home treatments you use for pain.
• Diarrhea. Do not eat until you are feeling better. Take small sips of water or a rehydration drink often and small bites of salty crackers. Begin eating mild foods (such as rice, dry toast or crackers, bananas, broth, and applesauce) the next day or sooner, depending on how you feel.
• Constipation. Make sure you drink enough liquids. Most adults should drink 8 to 10 glasses of water, or noncaffeinated beverages each day. Include fruits, vegetables, and fiber in your diet each day.
• Sleep problems. Often, simple measures such as having a regular bedtime, getting some exercise during the day, and having no caffeine late in the day can help with sleep problems.
• Urinary problems. Home treatment for urinary incontinence includes eliminating caffeinated drinks from your diet and setting a schedule of urinating every 3 to 4 hours, regardless of whether you feel the need. Try doing pelvic floor (Kegel) exercises to strengthen your pelvic muscles.

During your treatment, you may experience emotional problems. See the following tips for managing:

• Stress. Expressing your feelings to others may help you understand and cope with them. Learning relaxation techniques may also be helpful.
• Poor body image. Your feelings about your body may change after treatment for cancer. Talk openly about your concerns with your partner, and discuss your feelings with your doctor, who may also be able to refer you to organizations that can offer additional support and information.

Healthy habits such as eating right and getting enough sleep and exercise can help control your symptoms.

You should not have to accept pain as part of having cancer treatment or having cancer. For tips on pain management, see:

Cancer: Controlling cancer pain.

Medications

Hormones are drugs that can affect the growth of prostate cancer cells. Hormone therapy is sometimes used with radiation treatment or surgery to help make sure that all cancer cells are destroyed.

Chemotherapy is the use of powerful drugs-either injected or taken as pills-to destroy cancer cells. Many men decide to have chemotherapy for treatment of late-stage prostate cancer, but researchers are studying whether chemotherapy should be used before or after surgery to treat early-stage, high-risk prostate cancer.¹¹

Surgery

Surgery is one of two main treatments for early-stage prostate cancer. Radiation is the other. Surgery may be done to remove the prostate and its cancer. It may done to remove and test lymph nodes in the area to see whether the cancer has spread. It also may be done to fix urinary problems that are caused by a tumor pressing on the urethra.

The stage of your prostate cancer along with your age and general health will affect the type of surgery you choose.

Surgery Choices

Radical prostatectomy is an operation to remove the entire prostate and any nearby tissue that may contain cancer. It can be done as open surgery through an incision (cut) in the belly, or as laparoscopic surgery through several very small incisions in the belly. Laparoscopic surgery is done with a tiny camera and special instruments to remove the prostate. Sometimes lymph nodes in the area also are removed so that they can be checked for signs of cancer. This is called a lymph node biopsy

Nerve-sparing surgery helps preserve the nerves that are along the side of the prostate and that are needed for an erection. This is only done when there is little chance of leaving cancer cells behind. If you already have sexual function issues, nerve-sparing surgery may not be the best choice for you.

Laparoscopic surgery is most often done by hand. A few doctors now do this surgery by guiding robotic arms that hold the surgery tools. This is called robot-assisted prostatectomy.

What To Think About

Removing the prostate can cause erection problems and bladder problems. But for many men, these problems get better over time. If you decide to have surgery, find a surgeon who does at least 40 prostate surgeries a year. Studies show that men have fewer side effects from surgery when they have a skilled and experienced surgeon.¹⁶

Surgery may completely remove your prostate cancer. But it is not possible to know for sure before surgery whether the cancer has spread beyond the prostate. When cancer has spread, it cannot always be cured with surgery alone.

Other Treatment

Radiation therapy

Radiation therapy may be used alone or combined with hormone treatment or surgery to treat prostate cancer. Like surgery, it is most effective in treating cancer that has not spread outside the prostate. When combined with surgery, radiation is used to destroy any cancer cells that might be left behind and to relieve pain when the cancer has spread.

There are two main types of radiation treatment for prostate cancer:

• External beam radiation, in which a machine aims high-energy X-rays or protons at the cancer from outside the body. External radiation also includes conformal radiotherapy, intensity-modulated radiation therapy, and proton therapy.
  • Conformal radiotherapy (3D-CRT) uses a three-dimensional planning system to target a strong dose of radiation to the prostate cancer. This helps to protect healthy tissue from radiation.
  • Intensity-modulated radiation therapy (IMRT) uses a carefully adjusted amount of radiation. This provides even more protection for healthy tissue than conformal radiotherapy.
  • Proton therapy uses a different type of energy (protons) rather than X-rays. This allows a higher amount of specifically directed radiation, which offers the most protection possible to nearby healthy tissue, especially the rectum.¹³ Sometimes proton therapy is combined with X-ray therapy.
• Brachytherapy, in which tiny seeds containing radioactive material are injected directly into or near the cancer and left there. In time, the material loses its radioactivity and the seeds can remain where they are.

Side effects

Radiation treatment may cause erection problems and bladder problems. It sometimes causes diarrhea. The ability to have an erection sometimes returns or at least improves over time. So does the ability to control urination.

Side effects are common. Some men develop long-term problems that may have a big impact on the quality of their lives. Long-term problems that can be caused by radiation treatment include:

• An irritated rectum that can cause an urgent need to pass stool. This is called proctitis.
• An inflamed bladder and urination problems. This is called cystitis.
• An inflamed intestine and diarrhea. This is called enteritis.
• Being unable to have an erection. This is called impotence.
• Being unable to control urination. This is called incontinence.
• Painful urination. This is called dysuria.

Immunotherapy

Researchers also are testing many new ways to treat prostate cancer using the body's immune system to destroy the cancer cells. This type of treatment is called immunotherapy. Much has been learned in the past 20 years about the body's ability to attack prostate cancer cells with help from the outside, and research is still being done in this area. This type of treatment either stimulates your immune system or adds to it, for example, by giving you immune cells from another person.

Complementary therapy

Complementary therapies, such as acupuncture, herbs, biofeedback, meditation, yoga, and vitamins, are sometimes used along with medical treatment. Some people feel that they benefit from some of these therapies.

Before you try a complementary therapy, talk to your doctor about its possible value and side effects. Let your doctor know if you are already using any such therapies. Complementary therapies are not meant to take the place of standard medical treatment, but they may improve your quality of life and help you deal with the stress and side effects of cancer treatment.

Clinical trials

Clinical trials are being run to find ways to prevent, detect, diagnose, and treat prostate cancer. For example, researchers are studying whether vitamin E and selenium, which is a mineral found in certain foods, can prevent prostate cancer.

Other Places To Get Help

Organizations

Related Information

• Benign Prostatic Hyperplasia (BPH)
• Cancer Pain
• Early Disease Detection
• Erection Problems (Erectile Dysfunction)
• Groin Problems and Injuries
• Prostate Cancer, Advanced or Metastatic
• Prostatitis
• Urinary Incontinence in Men

References

Citations

1. American Cancer Society (2006). Cancer Facts and Figures 2006, pp. 1-56. Atlanta: American Cancer Society. Available online: http://www.cancer.org/docroot/STT/stt_0.asp.

2. Kantoff PW (2007). Prostate cancer. In DC Dale, DD Federman, eds., ACP Medicine, section 12, chap. 9. New York: WebMD.

3. Gronberg H (2003). Prostate cancer epidemiology. Lancet, 361(9360): 859-864.

4. U.S. Preventive Services Task Force (2003). Screening for prostate cancer: Recommendations and rationale. American Family Physician, 67(4): 787-792.

5. National Institutes of Health (2007). Prostate cancer genetics: Fact sheet. Available online: http://www.nih.gov/about/researchresultsforthepublic.

6. Klein EA, et al. (2007). Epidemiology, etiology, and prevention of prostate cancer. In AJ Wein et al., eds., Campbell-Walsh Urology, 9th ed., vol. 3, pp. 2854-2873. Philadelphia: Saunders Elsevier.

7. Robbins C, et al. (2007). Confirmation study of prostate cancer risk variants at 8q24 in African Americans identifies a novel risk locus. Genome Research, 17(12): 1717-1722.

8. National Cancer Institute (2007). Prostate Cancer (PDQ): Prevention-Health Professional Version. Available online: http://www.nci.nih.gov/cancertopics/pdq/prevention/prostate/HealthProfessional.

9. Bill-Axelson A, et al. (2005). Radical prostatectomy versus watchful waiting in early prostate cancer. New England Journal of Medicine, 352(19): 1977-1984.

10. Punglia RS, et al. (2003). Effect of verification bias on screening for prostate cancer by measurement of prostate-specific antigen. New England Journal of Medicine, 349(4): 335-342.

11. Scher HI, et al. (2005). Cancer of the prostate. In VT DeVita Jr et al., eds., Cancer: Principles and Practice of Oncology, 7th ed., pp. 1192-1259. Philadelphia: Lippincott Williams and Wilkins.

12. Badani KK, et al. (2007). Evolution of robotic radical prostatectomy: Assessment after 2,766 procedures. Cancer, 110(9): 1951-1958.

13. Brada M, et al. (2007). Proton therapy in clinical practice: Current clinical evidence. Journal of Clinical Oncology, 25(8): 965-970.

14. D'Amico AV, et al. (2007). Radiation therapy for prostate cancer. In AJ Wein et al., eds., Campbell-Walsh Urology, 9th ed., vol. 3, pp. 3006-3031. Philadelphia: Saunders Elsevier.

15. Iversen P, et al. (2004). Bicalutamide (150 mg) versus placebo as immediate therapy alone or as adjuvant to therapy with curative intent for early nonmetastatic prostate cancer: 5.3-year median followup from the Scandinavian Prostate Cancer Group Study No. 6. Journal of Urology, 172(5, Part 1): 1871-1876.

16. Agency for Healthcare Research and Quality (2008). Comparative Effectiveness of Therapies for Clinically Localized Prostate Cancer: Executive Summary (AHRQ Pub. No. 08-EHC010-1). Rockville, MD: Agency for Healthcare Research and Quality. Available online: http://effectivehealthcare.ahrq.gov/healthInfo.cfm?infotype=rr&ProcessID=9&DocID=79.

Other Works Consulted

• Agency for Healthcare Research and Quality (2008). Comparative Effectiveness of Therapies for Clinically Localized Prostate Cancer: Executive Summary (AHRQ Pub. No. 08-EHC010-1). Rockville, MD: Agency for Healthcare Research and Quality. Available online: http://effectivehealthcare.ahrq.gov/healthInfo.cfm?infotype=rr&ProcessID=9&DocID=79.

• Ahmed HU, et al. (2007). Will focal therapy become a standard of care for men with localized prostate cancer? Nature Clinical Practice Oncology, 4(11): 632-642.

• Chen RC, et al. (2008). Treatment "mismatch" in early prostate cancer: Do treatment choices take patient quality of life into account? Cancer, 112(1): 61-68.

• D'Amico, et al. (2008). Androgen suppression and radiation vs radiation alone for prostate cancer: A randomized trial. JAMA, 299(3): 289-295.

• Elkord E (2007). Immunology and immunotherapy approaches for prostate cancer. Prostate Cancer Prostatic Disease, 10(3): 224-236.

• Hartke DM, Resnick MI (2007). Radical perineal prostatectomy. In AJ Wein et al., eds., Campbell-Walsh Urology, 9th ed., vol. 3, pp. 2979-2984. Philadelphia: Saunders Elsevier.

• Iversen P, et al. (2004). Bicalutamide (150 mg) versus placebo as immediate therapy alone or as adjuvant to therapy with curative intent for early nonmetastatic prostate cancer: 5.3-year median followup from the Scandinavian Prostate Cancer Group Study No. 6. Journal of Urology, 172(5, Part 1): 1871-1876.

• National Comprehensive Cancer Network and the American Cancer Society (2007). Clinical Practice Guidelines in Oncology: Prostate Cancer, V.2.2007. Jenkintown, PA: National Comprehensive Cancer Network. Available online: http://www.nccn.org/professionals/physician_gls/f_guidelines.asp#site.

• National Institutes of Health (2007). Prostate cancer genetics: Fact sheet. Available online: http://www.nih.gov/about/researchresultsforthepublic.

• Redman MW, et al. (2008). Finasteride does not increase the risk of high-grade prostate cancer: A bias-adjusted modeling approach. Cancer Prevention Research. Published online May 18, 2008 (doi:10.1158/1940-6207.CAPR-08-0092).

• Su L, Smith JA (2007). Laparoscopic and robotic-assisted laparoscopic radical prostatectomy and pelvic lymphadenectomy. In AJ Wein et al., eds. Campbell-Walsh Urology, 9th ed., vol. 3, pp. 2985-3005. Philadelphia: Saunders Elsevier.

• Tsai HK, et al. (2007). Androgen deprivation therapy for localized prostate cancer and the risk of cardiovascular mortality. Journal of the National Cancer Institute, 99(20): 1516-1524.

• Tunn U (2007). The current status of intermittent androgen deprivation (IAD) therapy for prostate cancer: Putting IAD under the spotlight. British Journal of Urology International, 99(Suppl 1): 19-24.

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