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. As men age, the prostate usually grows larger.
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. As with other cancers, treatment for prostate cancer works best when the cancer is found early. Often, prostate cancer that has spread responds to treatment. Older men who have prostate cancer usually die from other causes.
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.
What are the symptoms?
Prostate cancer usually
doesn't 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 urinary problems, such as:
Not being able to urinate at all.
Having a hard time starting or stopping the flow of urine.
Having to urinate often, especially at night.
Having pain or burning during urination.
You have difficulty having an erection.
You
have blood in your urine or semen.
You have deep and frequent 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
prostate biopsy to figure out the cause. A biopsy means that your
doctor takes tissue samples from your prostate gland and sends them to a lab
for 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 you have cancer that is low-risk and hasn't spread (early stage), you may be able to
wait and watch with active surveillance to see what happens. During active surveillance, 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's 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 (leaking urine) 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.
The exact cause of
prostate cancer isn't 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.
The prostate usually gets larger as
you age. Having an enlarged prostate (benign prostatic hyperplasia, or BPH) is very common among older men and doesn't
increase your chances of getting 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:
Urinary problems, such as:
Not being able to urinate at all.
Having a hard time starting or stopping the flow of urine.
Having to urinate often, especially at night.
Having pain or burning during urination.
Difficulty having an erection.
Blood in your urine or semen.
Deep and frequent pain in your lower back, belly, hip, or
pelvis.
Symptoms that may show that 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.
Prostate cancer is a common cancer affecting older men. It usually takes years to become large enough to cause any problems. Sometimes, though, it grows quickly.
Many prostate cancers are found early, when the cancer cells are only in the prostate. When prostate cancer spreads beyond the prostate, it goes first to the 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.
About 16 out of 100 men in the U.S. will get prostate cancer, but only about 3 will die because of it. That means about 97 out of 100 men will die of something other than prostate cancer.1
What Increases Your Risk
Some things can increase your chances of getting prostate cancer. These things are called risk factors. But many people who get prostate cancer don't have any of these risk factors. And some people who have risk factors don't get this cancer.
Age
Being older than 50 is the
main risk factor for
prostate cancer. About 6 out of 10 new prostate cancers are found in men who are 65 or older.2
Family history
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 had prostate cancer. Your risk also depends on the
age at which your relative was diagnosed.
Men whose families carry the gene changes that cause breast cancer,
BRCA1 or BRCA2, are thought to be at increased risk for prostate
cancer.
Race
Prostate cancer is more common among African-American men than men of other races. African-American men also have a greater chance of getting the kind of prostate cancer that grows and spreads.
In men of other races, non-Hispanic white men are more likely to get prostate cancer than Hispanic or Asian-American men.
Other factors
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 reduce the risk.
Hormones. Researchers are studying the link between
high
testosterone levels and prostate cancer.
When To Call a Doctor
Call your doctor right away if:
You cannot urinate.
You have symptoms of a urinary infection. For example:
You have blood or pus in your urine.
You have pain in your back just below your rib cage.
You have a fever, chills, or body aches.
It hurts to urinate.
You have groin or belly pain.
You have pain in your back or hips.
Your pain isn't controlled.
You are vomiting or nauseated.
Watch closely for changes in your health, and be sure to contact your doctor if:
You have pain when you ejaculate.
You have trouble starting or controlling your urine.
Who to see
The following health professionals can evaluate
urinary symptoms:
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,
a urologist, or a urologic or medical oncologist.
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.
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
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's 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 about doing a biopsy.
A transrectal ultrasound, in which the doctor inserts a probe into your rectum to check your prostate. The probe uses sound waves (ultrasound) to create a picture of the prostate.
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.
Tests after diagnosis
After prostate cancer has been diagnosed, tests will be done to see if the cancer has spread. Tests include:
After treatment for prostate cancer, you have regular checkups to check for any signs
that the cancer has come back or spread. Tests include:
Blood tests. Different types of blood tests are
used to see whether cancer has spread to your bones or liver.
A
bone scan to check for bone damage caused by the cancer spreading.
A
CT scan or MRI to look for a new tumor.
Screening tests
Screening for prostate cancer involves checking for signs
of the disease when there are no symptoms. It may be done with the digital rectal exam
and the PSA test. And while it's important to have regular health checkups, experts disagree on whether PSA testing should be used to routinely screen men for prostate cancer. Testing could lead you to have cancer treatments that you don't need.
So talk with your doctor. Ask about your risk for
prostate cancer, and discuss the pros and cons of PSA testing.
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.
Treatment may be more successful if prostate cancer is found and treated early. Unlike many other cancers, prostate cancer is usually slow-growing. For most men, this slow growth means they have time to learn all they can
before deciding whether to have treatment or which treatment to have.
Types of treatment
The main treatments for prostate cancer include:
Active surveillance. This
is a treatment choice for any man who has low-risk cancer that has not spread (early stage). To learn more, see Other Treatment.
Surgery to remove the cancer by removing the prostate gland. This operation is called a
prostatectomy.
Radiation treatments,
which include external and internal radiation. These treatments have been improved with newer
technologies that reduce side effects and other problems caused by radiation.
To learn more, see Other Treatment.
A diagnosis of prostate cancer usually means that you
will be seeing your doctor regularly for years to come. So it's 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 your treatment succeed.
Additional information about prostate cancer is provided by the National Cancer Institute at www.cancer.gov/cancertopics/types/prostate.
Coping with cancer
A cancer diagnosis can change your life. You may feel like your world has turned upside down and you have lost all control. Talking with family, friends, or a counselor can really help. Ask your doctor about support groups. Or call the American Cancer Society (1-800-227-2345) or visit the website at www.cancer.org.
Follow-up care
After surgery or radiation
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 find it early.
If you choose active surveillance
If you decide on active surveillance, you will have regular checkups and tests, including prostate biopsies. It is possible that a curable cancer could spread
and become incurable during a 6-month period, but this isn't common. If there
is no change in your condition, you may continue active surveillance. If tests show that your
cancer is growing, it may be time to start other treatment.
Treatment decisions
Age isn't 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
or urologic 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.3
Prevention
One thing you can do that may lower the risk for prostate cancer is eat more low-fat, high-fiber foods and 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.
Being physically active and staying at a healthy body weight also can help reduce the risk of prostate cancer.4
Home Treatment
Managing symptoms and side effects
During any stage of
prostate cancer, there are things you can do at home
to help manage the symptoms of cancer or the side effects of treatment or both. If your doctor has given you instructions or medicines to treat symptoms or side effects, be sure to use them. Healthy habits such as eating right and getting enough
sleep and exercise can help control your symptoms and side effects.
Try the following tips to manage:
Nausea or vomiting. Watch for and treat early signs of dehydration, such as having a dry mouth or feeling lightheaded when you stand up. Eating smaller meals may help. So can a little bit of ginger candy or ginger tea.
Pain. Not all forms of cancer or cancer treatment cause pain. But if you do have pain, there are many home treatments that can help.
Diarrhea. Rest your stomach, and be alert for signs of dehydration. Check with your
doctor before using any nonprescription medicines for your diarrhea. Be sure to
drink enough fluids.
Constipation. Make sure you drink enough fluids and eat fruits, vegetables, and
fiber in your diet each day. Do not use a laxative without first talking to
your doctor.
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.
Managing stress
Learning that you have prostate cancer and being treated for it can be very stressful. Find ways to reduce your stress.
You may want to talk with family or friends. Some people find that spending time alone is what they need.
Consider meeting with a counselor or joining a support group of others who have prostate cancer.
Your doctor may also be able to help you find other sources of support and information. Learning relaxation techniques, such as yoga or visualization exercises, may also help you reduce your stress.
Your feelings about your body may change after treatment. Dealing with your body image may involve talking openly about your worries with your partner and discussing your feelings with a doctor.
Hormones are medicines 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.
Hormone
therapy can't 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.
Surgery
Surgery for prostate cancer may
be done to:
Remove the prostate and its cancer (prostatectomy). Nearby lymph nodes also may be removed to check for cancer (lymphadenectomy) during a prostatectomy.
Fix urinary problems that are caused by a tumor pressing on the
urethra (transurethral resection of the prostate, or TURP).
Radical prostatectomy
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 to remove the prostate is done with a tiny camera and
special tools. 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.
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.
Surgery may completely remove your prostate
cancer. But it isn't possible to know for sure before surgery whether the
cancer has spread beyond the prostate. When cancer has spread, it can't always
be cured with surgery alone.
Active surveillance means that you will be watched closely by your doctor. If you are a younger or active man who is at low risk, this will mean regular checkups. If the cancer starts to grow more quickly, you will need to have other treatment, such as surgery. Your regular
checkups may include digital rectal exams,
PSA tests, and biopsies.
Active surveillance is a good treatment choice for younger or active men who have low-risk cancer that hasn't spread.5
The main reason to choose active surveillance is to avoid or delay the side effects of treatments.
The main reason to choose other treatment (and not active surveillance) is to not miss the chance to cure the cancer. If the cancer grows and spreads, it may be harder to treat.
Watchful waiting also means that you will be
closely watched by your doctor. But the goal of watchful waiting is to treat symptoms that cause
problems rather than to cure the cancer. For some older men or those who aren't expected to live more than 10 years, the main reason to choose watchful waiting is to have the best possible quality of life.
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 hasn't 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.
Radiation treatment for prostate cancer includes:
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 most common forms of external
radiation are:
Conformal radiotherapy (3D-CRT). It
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). It uses newer 3D-CRT technology to target the cancer.
Proton beam therapy. This is radiation therapy that uses a different type of energy (protons)
rather than X-rays. This allows a higher amount of specifically directed
radiation, which protects nearby healthy tissues (especially the
rectum). Sometimes proton beam therapy is combined with
X-ray therapy. (It is available only at big medical centers.)
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 (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.
Cryosurgery, also called cryoablation, freezes the
prostate gland to kill the cancer. This is often done when surgery isn't 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. With cryosurgery, the
prostate gland isn't removed.
Clinical trials
Your doctor may talk to you about joining a research study called a clinical trial if one is available in your area. Clinical trials are research studies to look for ways to improve treatments for prostate cancer.
One treatment being studied in clinical trials in the U.S. is high-intensity focused ultrasound (HIFU). This 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. HIFU is a treatment that is used in Canada, Europe, and the United States. In the U.S., HIFU is being used in clinical trials. It is not yet FDA-approved.
Complementary therapy
People sometimes use complementary therapies along with medical treatment to help relieve symptoms and side
effects of cancer treatments. Some of the complementary therapies that may be helpful include:
Acupuncture to relieve pain. Acupuncture may also help reduce hot flashes from taking hormone therapy.
Mind-body treatments like those mentioned above may help
you feel better and cope better with treatment. These treatments also may reduce chronic low back pain, joint pain,
headaches, and pain from treatments.
Before you try a complementary therapy, talk to your doctor about
the possible value and potential side effects. Let your doctor know if you are already
using any such therapies. Complementary therapies aren't 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.
Other Places To Get Help
Organizations
AUA Foundation: The Official Foundation of the American Urological
Association
1000 Corporate Boulevard
Linthicum, MD 21090
Phone:
1-800-828-7866
Phone:
(410) 689-3700
Fax:
(410) 689-3998
Email:
auafoundation@auafoundation.org
Web Address:
www.urologyhealth.org
UrologyHealth.org is a website written by urologists
for patients. Visitors can find specific topics by using the "search"
option.
The website provides information about adult and
pediatric urologic topics, including kidney, bladder, and prostate conditions.
You can find a urologist, sign up for a free quarterly newsletter, or click on
the Urology A–Z page to find materials about urologic problems.
Centers for Disease Control and Prevention
(CDC)
1600 Clifton Road
Atlanta, GA 30333
Phone:
1-800-CDC-INFO (1-800-232-4636)
TDD:
1-888-232-6348
Email:
cdcinfo@cdc.gov
Web Address:
www.cdc.gov
The Centers for Disease Control and Prevention (CDC) is
an agency of the U.S. Department of Health and Human Services. The CDC works
with state and local health officials and the public to achieve better health
for all people. The CDC creates the expertise, information, and tools that
people and communities need to protect their health—by promoting health,
preventing disease, injury, and disability, and being prepared for new health
threats.
The American Cancer Society's Man to Man program
provides community-based education and support for men with prostate cancer.
Self-help and support groups focus on prostate cancer, treatment, side effects,
and coping with the disease and with treatment.
Program services
and activities depend on the location. Some locations offer groups for men
along with their wives or partners. And other locations may offer a group
setting called Side by Side for the wives or partners to meet separately.
To locate a program in your area, call the American Cancer
Society toll-free at the number shown above.
National Cancer Institute (NCI)
6116 Executive Boulevard
Suite 300
Bethesda, MD 20892-8322
Phone:
1-800-4-CANCER (1-800-422-6237)
Web Address:
www.cancer.gov (or
https://livehelp.cancer.gov/app/chat/chat_launch for live help
online)
The National Cancer Institute (NCI) is a U.S. government
agency that provides up-to-date information about the prevention, detection,
and treatment of cancer. NCI also offers supportive care to people who have cancer
and to their families. NCI information is also available to doctors, nurses,
and other health professionals. NCI provides the latest information about
clinical trials. The Cancer Information Service, a service of NCI, has trained
staff members available to answer questions and send free publications.
Spanish-speaking staff members are also available.
Prostate Cancer Foundation
1250 Fourth Street
Santa Monica, CA 90401
Phone:
1-800-757-CURE (1-800-757-2873) (310) 570-4700
Fax:
(310) 570-4701
Email:
info@pcf.org
Web Address:
www.prostatecancerfoundation.org
The Prostate Cancer Foundation is the world's leading organization for funding prostate cancer research. On its website, you'll find information on prostate cancer detection, treatment, and support groups.
Zelefsky MJ, et al. (2008). Cancer of the prostate. In VT DeVita Jr et al., eds., Devita, Hellman, and Rosenberg's Cancer: Principles and Practice of Oncology, 8th ed., vol. 1, pp. 1392–1452. Philadelphia: Lippincott Williams and Wilkins.
American Cancer Society (2012). Cancer Facts and Figures 2012. Atlanta: American Cancer Society. Available online: http://www.cancer.org/Research/CancerFactsFigures/CancerFactsFigures/cancer-facts-figures-2012.
Rosenberg JE, Kantoff PW (2011). Prostate cancer. In EG Nabel, ed., ACP Medicine, section 12, chap. 9. Hamilton, ON: BC Decker.
Kushi LH, et al. (2012). American Cancer Society guidelines on nutrition and physical activity for cancer prevention. CA: A Cancer Journal for Clinicians, 62: 30–67.
National Comprehensive Cancer Network (2012). Prostate cancer. NCCN Clinical Practice Guidelines in Oncology, version 2.2012. Available online: http://www.nccn.org/professionals/physician_gls/f_guidelines.asp.
Other Works Consulted
Keating NL, et al. (2010). Diabetes and cardiovascular disease during androgen deprivation therapy: Observational study of veterans with prostate cancer. Journal of the National Cancer Institute, 102(1): 39–46.
Malcolm JB, et al. (2010). Quality of life after open or robotic prostatectomy, cryoablation or brachytherapy for localized prostate cancer. Journal of Urology, 183(5): 1822–1828.
National Cancer Institute (2011). Prostate Cancer Treatment (PDQ)—Patient Version. Available online: http://www.cancer.gov/cancertopics/pdq/treatment/prostate/patient.
National Comprehensive Cancer Network (2012). Prostate cancer. NCCN Clinical Practice Guidelines in Oncology, version 2.2012. Available online: http://www.nccn.org/professionals/physician_gls/f_guidelines.asp.
Pagana KD, Pagana TJ (2010). Mosby’s Manual of Diagnostic and Laboratory Tests, 4th ed. St. Louis: Mosby Elsevier.
Schaeffer EM, et al. (2012). Radical retropubic and perineal prostatectomy. In AJ Wein et al., eds., Campbell-Walsh Urology, 10th ed., vol. 3, pp. 2801–2829. Philadelphia: Saunders.
Su L, Smith JA (2012). Laparoscopic and robotic-assisted laparoscopic radical prostatectomy and pelvic lymphadenectomy. In AJ Wein et al., eds., Campbell-Walsh Urology, 10th ed., vol. 3, pp. 2830–2849. Philadelphia: Saunders.
Zelefsky MJ, et al. (2011). Cancer of the prostate. In VT DeVita Jr et al., eds., DeVita, Hellman and Rosenberg's Cancer: Principles and Practice of Oncology, 9th ed., pp. 1220–1271. Philadelphia: Lippincott Williams and Wilkins.
Zelefsky MJ, et al. (2008). Cancer of the prostate. In VT DeVita Jr et al., eds., Devita, Hellman, and Rosenberg's Cancer: Principles and Practice of Oncology, 8th ed., vol. 1, pp. 1392–1452. Philadelphia: Lippincott Williams and Wilkins.
American Cancer Society (2012). Cancer Facts and Figures 2012. Atlanta: American Cancer Society. Available online: http://www.cancer.org/Research/CancerFactsFigures/CancerFactsFigures/cancer-facts-figures-2012.
Rosenberg JE, Kantoff PW (2011). Prostate cancer. In EG Nabel, ed., ACP Medicine, section 12, chap. 9. Hamilton, ON: BC Decker.
Kushi LH, et al. (2012). American Cancer Society guidelines on nutrition and physical activity for cancer prevention. CA: A Cancer Journal for Clinicians, 62: 30–67.
National Comprehensive Cancer Network (2012). Prostate cancer. NCCN Clinical Practice Guidelines in Oncology, version 2.2012. Available online: http://www.nccn.org/professionals/physician_gls/f_guidelines.asp.
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