Illness & Conditions - Health Conditions
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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. 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:
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.
Frequently Asked Questions
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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.
Prostate cancer usually doesn't cause symptoms in its early stages. When there are symptoms, they may include:
Symptoms that may show that the cancer has spread, or metastasized, to other parts of the body include:
For more information about prostate cancer that has come back or spread, see the topic Prostate Cancer, Advanced or Metastatic.
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.
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
Your chances of getting the disease are higher if other men in your family have had it.
When To Call a Doctor
Call your doctor right away if:
Watch closely for changes in your health, and be sure to contact your doctor if:
Who to see
The following health professionals can evaluate urinary symptoms:
The following doctors treat prostate cancer:
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.
To prepare for your appointment, see the topic Making the Most of Your Appointment.
Exams and Tests
Tests if you have symptoms
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.
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:
Tests after treatment
After treatment for prostate cancer, you have regular checkups to check for any signs that the cancer has come back or spread. Tests include:
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.
Choosing treatment for prostate cancer can be confusing. Any treatment can cause serious side effects.
Your treatment decision will depend on:
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:
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.
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.
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:
Being physically active and staying at a healthy body weight also can help reduce the risk of prostate cancer. 4
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:
For more information, see the topic Getting Support When You Have Cancer.
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 for prostate cancer may be done to:
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.
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 or watchful waiting
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
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 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:
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.
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.
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:
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
Last Revised: September 12, 2012
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.
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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