What You Need
`To Know About™
`Prostate
`Cancer
`
`U.S. DEPARTMENT OF
`
`HEALTH AND HUMAN SERVICES
`
`National Institutes of Health
`
`National Cancer Institute
`
`JANSSEN EXHIBIT 2091
`Wockhardt v. Janssen IPR2016-01582
`
`
`To Know About™
`Prostate
`Cancer
`
`U.S. DEPARTMENT OF
`
`HEALTH AND HUMAN SERVICES
`
`National Institutes of Health
`
`National Cancer Institute
`
`JANSSEN EXHIBIT 2091
`Wockhardt v. Janssen IPR2016-01582
`
`
`
`National Cancer Institute Services
`
`"is booklet is only one of many free
`publications for people with cancer.
`
`You may want more information for yourself,
`your family, and your friends.
`
`Call NCI’s Cancer Information Service
`1-800-4-CANCER (1-800-422-6237)
`
`Visit NCI’s website
`http://www.cancer.gov
`
`Chat online
`LiveHelp, NCI’s instant messaging service
`https://livehelp.cancer.gov
`
`cancergovstaff@mail.nih.gov
`
`Order publications
`http://www.cancer.gov/publications
`1-800-4-CANCER (1-800-422-6237)
`
`Get help with quitting smoking
`1-877-44U-QUIT (1-877-448-7848)
`
`
`
`About #is Booklet
`
`"is National Cancer Institute (NCI) booklet is for you—a
`man who has just been diagnosed with prostate cancer. In
`2012, about 242,000 American men will be diagnosed with
`prostate cancer.
`
`Words that may be new to you are shown in bold. See the
`Words to Know section on page 32 to learn what a new
`word means and how to pronounce it.
`
`"is booklet tells about medical care for men with prostate
`cancer. Learning about medical care for prostate cancer can
`help you take an active part in making choices about your
`care.
`
`You can read this booklet from front to back. Or, you can
`read only the sections you need right now.
`
`"is booklet has lists of questions that you may want to
`ask your doctor. Many people #nd it helpful to take a list
`of questions to a doctor visit. To help remember what your
`doctor says, you can take notes. You may also want to have a
`family member or friend go with you when you talk with the
`doctor—to take notes, ask questions, or just listen.
`
`
`
`Contents
`
`1 "e Prostate
`
`1
`
`Cancer Cells
`
`4
`
`Tests
`
`7
`
`Stages
`
`9
`
`Treatment
`
`26 Nutrition
`
`27
`
`Follow-up Care
`
`29
`
`Sources of Support
`
`30 Cancer Treatment Research
`
`32 Words To Know
`
`
`
`#e Prostate
`
`"e prostate is part of a man’s reproductive system. It’s
`located in front of the rectum and under the bladder. (See
`picture on page 2.) "e prostate surrounds the urethra, the
`tube through which urine $ows.
`
`A healthy prostate is about the size of a walnut. If the
`prostate grows too large, it squeezes the urethra. "is may
`slow or stop the normal $ow of urine.
`
`"e prostate is a gland. It makes part of the seminal fluid.
`During orgasm, the seminal $uid helps carry sperm out of
`the man’s body as part of semen.
`
`Cancer Cells
`
`Cancer begins in cells, the building blocks that make up all
`tissues and organs of the body, including the prostate.
`
`Normal cells in the prostate and other parts of the body
`grow and divide to form new cells as they are needed. When
`normal cells grow old or get damaged, they die, and new
`cells take their place.
`
`Sometimes, this process goes wrong. New cells form when
`the body doesn’t need them, and old or damaged cells don’t
`die as they should. "e buildup of extra cells o%en forms a
`mass of tissue called a growth or tumor.
`
`1
`
`
`
`"e first picture shows the prostate and nearby organs.
`"e second picture shows how the prostate surrounds
`the urethra.
`
`2
`
`
`
`Growths in the prostate can be benign (not cancer) or
`malignant (cancer):
`
` ■ Benign growths (such as benign prostatic hypertrophy):
`(cid:116)(cid:1) Are rarely a threat to life
`(cid:116)(cid:1) Don’t invade the tissues around them
`(cid:116)(cid:1) Don’t spread to other parts of the body
`(cid:116)(cid:1) Can be removed and usually don’t grow back
`
` ■ Malignant growths (prostate cancer):
`(cid:116)(cid:1) May sometimes be a threat to life
`(cid:116)(cid:1) Can invade nearby organs and tissues (such as the
`bladder or rectum)
`(cid:116)(cid:1) Can spread to other parts of the body
`(cid:116)(cid:1) O%en can be removed but sometimes grow back
`
`Prostate cancer cells can spread by breaking away from
`a prostate tumor. "ey can travel through blood vessels
`or lymph vessels to reach other parts of the body. A%er
`spreading, cancer cells may attach to other tissues and grow
`to form new tumors that may damage those tissues.
`
`When prostate cancer spreads from its original place to
`another part of the body, the new tumor has the same
`kind of abnormal cells and the same name as the primary
`(original) tumor. For example, if prostate cancer spreads to
`the bones, the cancer cells in the bones are actually prostate
`cancer cells. "e disease is metastatic prostate cancer, not
`bone cancer. For that reason, it’s treated as prostate cancer,
`not bone cancer.
`
`3
`
`
`
`Tests
`
`A%er you learn that you have prostate cancer, you may need
`other tests to help with making decisions about treatment.
`
`Tumor Grade Test with Prostate Tissue
`
`"e prostate tissue that was removed during your biopsy
`procedure can be used in lab tests. "e pathologist studies
`prostate tissue samples under a microscope to determine the
`grade of the tumor. "e grade tells how di&erent the tumor
`tissue is from normal prostate tissue.
`
`Tumors with higher grades tend to grow faster than those
`with lower grades. "ey are also more likely to spread.
`Doctors use tumor grade along with your age and other
`factors to suggest treatment options.
`
`"e most commonly used system for grading prostate cancer
`is the Gleason score. Gleason scores range from 2 to 10.
`
`To come up with the Gleason score, the pathologist looks
`at the patterns of cells in the prostate tissue samples. "e
`most common pattern of cells is given a grade of 1 (most
`like normal prostate tissue) to 5 (most abnormal). If there
`is a second most common pattern, the pathologist gives it
`a grade of 1 to 5 and then adds the grades for the two most
`common patterns together to make the Gleason score (3 +
`4 = 7). If only one pattern is seen, the pathologist counts it
`twice (5 + 5 = 10).
`
`A high Gleason score (such as 10) means a high-grade
`prostate tumor. High-grade tumors are more likely than low-
`grade tumors to grow quickly and spread.
`
`4
`
`
`
`For more about tumor grade, see the NCI fact sheet
`Tumor Grade.
`
`Staging Tests
`
`Staging tests can show the stage (extent) of prostate cancer,
`such as whether cancer cells have spread to other parts of
`the body.
`
`When prostate cancer spreads, cancer cells are o%en found
`in nearby lymph nodes. If cancer has reached these lymph
`nodes, it may have also spread to other lymph nodes, the
`bones, or other organs.
`
`Your doctor needs to learn the stage of the prostate cancer to
`help you make the best decision about treatment.
`
`Staging tests may include…
`
` ■ Physical exam (digital rectal exam): If the tumor in the
`prostate is large enough to be felt, your doctor may be
`able to examine it. With a gloved and lubricated #nger,
`your doctor feels the prostate and surrounding tissues
`from the rectum. Hard or lumpy areas may suggest the
`presence of one or more tumors. Your doctor may also
`be able to tell whether it’s likely that the tumor has grown
`outside the prostate.
`
` ■ Bone scan: A small amount of a radioactive substance
`will be injected into a blood vessel. "e radioactive
`substance travels through your bloodstream and collects
`in the bones. A machine called a scanner makes pictures
`of your bones. Because higher amounts of the radioactive
`substance collect in areas where there is cancer, the
`pictures can show cancer that has spread to the bones.
`
`5
`
`
`
` ■ CT scan: An x-ray machine linked to a computer takes
`a series of detailed pictures of your lower abdomen
`or other parts of your body. You may receive contrast
`material by injection into a blood vessel in your arm or
`hand, or by enema. "e contrast material makes it easier
`to see abnormal areas. "e pictures from a CT scan can
`show cancer that has spread to the lymph nodes or other
`areas.
`
` ■ MRI: A strong magnet linked to a computer is used to
`make detailed pictures of your lower abdomen. An MRI
`can show whether cancer has spread to lymph nodes or
`other areas. Sometimes contrast material is used to make
`abnormal areas show up more clearly on the picture.
`
`Questions you may want to ask your doctor about tests
`
` ■ May I have a copy of the report from the pathologist?
`
` ■ What is the grade of the tumor?
`
` ■ Has the cancer spread from the prostate? If so,
`to where?
`
`6
`
`
`
`Stages
`
`Doctors describe the stages of prostate cancer using the
`Roman numerals I, II, III, and IV. A cancer that is Stage I is
`early-stage cancer, and a cancer that is Stage IV is advanced
`cancer that has spread to other parts of the body.
`
`"e stage of prostate cancer depends mainly on…
`
` ■ Whether the tumor has invaded nearby tissue, such as
`the bladder or rectum
`
` ■ Whether prostate cancer cells have spread to lymph
`nodes or other parts of the body, such as the bones
`
` ■ Grade (Gleason score) of the prostate tumor
`
` ■ PSA level
`
`On NCI’s website at http://www.cancer.gov/cancertopics/
`types/prostate, you can #nd pictures and more information
`about the stages of prostate cancer.
`
`Stage I
`
`"e cancer is only in the prostate. It might be too small to
`feel during a digital rectal exam. If the Gleason score and
`PSA level are known, the Gleason score is 6 or less, and the
`PSA level is under 10.
`
`Stage II
`
`"e tumor is more advanced or a higher grade than Stage I,
`but the tumor doesn’t extend beyond the prostate.
`
`7
`
`
`
`Stage III
`
` e tumor extends beyond the prostate. e tumor may have
`invaded a seminal vesicle, but cancer cells haven’t spread to
`lymph nodes. See page 2 for a picture of a seminal vesicle.
`
`Stage IV
`
` e tumor may have invaded the bladder, rectum, or nearby
`structures (beyond the seminal vesicles). It may have spread
`to lymph nodes, bones, or other parts of the body.
`
`You and your doctor will develop a treatment plan.
`
`8
`
`
`
`Treatment
`
`Men with prostate cancer have many treatment options.
`Treatment options include…
`
` ■ Active surveillance
`
` ■ Surgery
`
` ■ Radiation therapy
`
` ■ Hormone therapy
`
` ■ Chemotherapy
`
` ■ Immunotherapy
`
`You may receive more than one type of treatment.
`
`"e treatment that’s best for one man may not be best
`for another. "e treatment that’s right for you depends
`mainly on…
`
` ■ Your age
`
` ■ Gleason score (grade) of the tumor
`
` ■ Stage of prostate cancer
`
` ■ Your symptoms
`
` ■ Your general health
`
`At any stage of disease, care is available to control pain and
`other symptoms, to relieve the side effects of treatment,
`and to ease emotional concerns. You can get information
`about coping on NCI’s website at http://www.cancer.gov/
`cancertopics/coping.
`
`9
`
`
`
`Also, you can get information about coping from NCI’s
`Cancer Information Service at 1-800-4-CANCER (1-800-
`422-6237). Or, chat using NCI’s instant messaging service,
`LiveHelp (https://livehelp.cancer.gov).
`
`Doctors Who Treat Prostate Cancer
`
`Your health care team will include specialists. "ere are
`many ways to #nd doctors who treat prostate cancer:
`
` ■ Your doctor may be able to refer you to specialists.
`
` ■ You can ask a local or state medical society, or a nearby
`hospital or medical school for names of specialists.
`
` ■ NCI’s Cancer Information Service can give you
`information about treatment centers near you. Call
`1-800-4-CANCER (1-800-422-6237). Or, chat using
`LiveHelp (https://livehelp.cancer.gov), NCI’s instant
`messaging service.
`
` ■ Other sources can be found in the NCI fact sheet How To
`Find a Doctor or Treatment Facility If You Have Cancer.
`
`Your health care team may include the following specialists:
`
` ■ Urologist: A urologist is a doctor who specializes in
`treating problems in the urinary tract or male sex organs.
`"is type of doctor can perform surgery (an operation).
`
` ■ Urologic oncologist: A urologic oncologist is a doctor
`who specializes in treating cancers of the male and
`female urinary tract and the male sex organs. "is type
`of doctor also can perform surgery.
`
` ■ Medical oncologist: A medical oncologist is a doctor
`who specializes in treating cancer with drugs, such as
`chemotherapy, hormone therapy, or immunotherapy.
`
`10
`
`
`
` ■ Radiation oncologist: A radiation oncologist is a
`doctor who specializes in treating cancer with
`radiation therapy.
`
`Your health care team may also include an oncology nurse, a
`social worker, and a registered dietitian.
`
`Your health care team can describe your treatment options,
`the expected results of each option, and the possible side
`e&ects. Because cancer treatments o%en damage healthy
`cells and tissues, side e&ects are common. "ese side e&ects
`depend on many factors, including the type of treatment.
`Side e&ects may not be the same for each man, and they may
`even change from one treatment session to the next.
`
`Before treatment starts, ask your health care team about
`possible side e&ects and how treatment may change your
`normal activities. For example, you may want to discuss
`with your doctor the possible e&ects on sexual activity. "e
`NCI booklet Treatment Choices for Men with Early-Stage
`Prostate Cancer can tell you more about treatments and their
`side e&ects.
`
`You and your health care team can work together to develop
`a treatment plan that meets your medical and personal
`needs.
`
`You may want to talk with your health care team about
`taking part in a research study (clinical trial) of new
`treatment methods. Research studies are an important
`option for men at any stage of prostate cancer. See the
`Cancer Treatment Research section on page 30.
`
`11
`
`
`
`Questions you may want to ask your doctor about
`treatment options
`
` ■ What are my treatment options? Which do you
`recommend for me? Why?
`
` ■ What are the expected benefits of each kind of
`treatment?
`
` ■ What are the risks and possible side effects of each
`treatment? How can the side effects be managed?
`
` ■ What can I do to prepare for treatment?
`
` ■ Will I need to stay in the hospital? If so, for how long?
`
` ■ What is the treatment likely to cost? Will my insurance
`cover it?
`
` ■ How will treatment affect my normal activities? Will it
`affect my sex life? Will I have urinary problems? Will I
`have bowel problems?
`
` ■ Would a research study (clinical trial) be right for me?
`
`Second Opinion
`
`Before starting treatment, you might want a second opinion
`about your diagnosis and treatment options. You may even
`want to talk to several di&erent doctors about all treatment
`options, their side e&ects, and the expected results. For
`example, you may want to talk to a urologist, radiation
`oncologist, and medical oncologist.
`
`12
`
`
`
`Some men worry that the doctor will be o&ended if they
`ask for a second opinion. Usually the opposite is true.
`Most doctors welcome a second opinion. And many health
`insurance companies will pay for a second opinion if you or
`your doctor requests it. Some insurance companies actually
`require a second opinion.
`
`If you get a second opinion, the second doctor may
`agree with your #rst doctor’s diagnosis and treatment
`recommendation. Or, the second doctor may suggest
`another approach. Either way, you have more information
`and perhaps a greater sense of control. You can feel more
`con#dent about the decisions you make, knowing that you’ve
`looked at all of your options.
`
`It may take some time and e&ort to gather your medical
`records and see another doctor. In most cases, it’s not a
`problem to take several weeks to get a second opinion. "e
`delay in starting treatment usually will not make treatment
`less e&ective. To make sure, you should discuss this delay
`with your doctor.
`
`Active Surveillance
`
`Your doctor may suggest active surveillance if you’re
`diagnosed with early-stage prostate cancer that seems to be
`growing slowly. Your doctor may also o&er this option if you
`are older or have other health problems.
`
`Active surveillance is putting o& treatment until test results
`show that your prostate cancer is growing or changing. If
`you and your doctor agree that active surveillance is a good
`idea, your doctor will check you regularly (such as every 3
`to 6 months, at #rst). You’ll get digital rectal exams and PSA
`tests. A%er about a year, your doctor may order another
`
`13
`
`
`
`prostate biopsy to check the Gleason score. Your doctor may
`suggest treatment if your Gleason score rises, your PSA level
`starts to increase, or you develop symptoms. Your doctor
`may suggest surgery, radiation therapy, or another type of
`treatment.
`
`By choosing active surveillance, you’re putting o& the side
`e&ects of surgery, radiation therapy, or other treatments.
`However, the risk for some men is that waiting to start
`treatment may reduce the chance to control cancer before it
`spreads. Having regular checkups reduces this risk.
`
`For some men, it’s stressful to live with an untreated prostate
`cancer. If you choose active surveillance but grow concerned
`later, you should discuss your feelings with your doctor. You
`can change your mind and have treatment at any time.
`
`Questions you may want to ask your doctor about
`active surveillance
`
` ■ Is it safe for me to put off treatment? Does it mean I
`will not live as long as if I started treatment right away?
`
` ■ Can I change my mind later on?
`
` ■ How often will I have checkups? Which tests will I
`need? Will I need a repeat biopsy?
`
` ■ How will we know if the prostate cancer is getting
`worse?
`
` ■ Between checkups, what problems should I tell you
`about?
`
`14
`
`
`
`Surgery
`
`Surgery is an option for men with early-stage cancer that is
`found only in the prostate. It’s sometimes also an option for
`men with advanced prostate cancer to relieve symptoms.
`
`"ere are several kinds of surgery to treat prostate cancer.
`Usually, the surgeon will remove the entire prostate and
`nearby lymph nodes. Your surgeon can describe each kind of
`surgery, compare the bene#ts and risks, and help you decide
`which kind might be best for you.
`
`"e entire prostate can be removed in several ways…
`
` ■ #rough a large cut in the abdomen: "e surgeon
`removes the prostate through a long incision in the
`abdomen below the belly button. "is is called a radical
`retropubic prostatectomy. Because of the long incision,
`it’s also called an open prostatectomy.
`
` ■ #rough small cuts in the abdomen: "e surgeon makes
`several small cuts in the abdomen, and surgery tools
`are inserted through the small cuts. A long, thin tube (a
`laparoscope) with a light and a camera on the end helps
`the surgeon see the prostate while removing it. "is is
`called a laparoscopic prostatectomy.
`
` ■ With a robot: "e surgeon may use a robot to remove
`the prostate through small incisions in the abdomen.
`"e surgeon uses handles below a computer display to
`control the robot’s arms.
`
` ■ #rough a large cut between the scrotum and
`anus: "e surgeon removes the prostate through an
`incision between the scrotum and anus. "is is called
`a radical perineal prostatectomy. It’s a type of open
`prostatectomy that is rarely used anymore.
`
`15
`
`
`
`Other surgery options for treating prostate cancer or
`relieving its symptoms are…
`
` ■ Freezing: For some men, cryosurgery is an option. "e
`surgeon inserts a tool through a small cut between the
`scrotum and anus. "e tool freezes and kills prostate
`tissue.
`
` ■ Heating: Doctors are testing high-intensity focused
`ultrasound therapy in men with prostate cancer. A
`probe is placed in the rectum. "e probe gives o& high-
`intensity ultrasound waves that heat up and kill the
`prostate tumor.
`
` ■ TURP: A man with advanced prostate cancer may
`choose transurethral resection of the prostate (TURP)
`to relieve symptoms. "e surgeon inserts a long, thin
`scope through the urethra. A cutting tool at the end of
`the scope removes tissue from the inside of the prostate.
`TURP may not remove all of the cancer, but it can
`remove tissue that blocks the $ow of urine.
`
`You may be uncomfortable for the #rst few days or weeks
`a%er surgery. However, medicine can help control the pain.
`Before surgery, you should discuss the plan for pain relief
`with your doctor or nurse. A%er surgery, your doctor can
`adjust the plan if you need more pain relief.
`
`"e time it takes to heal a%er surgery is di&erent for each
`man and depends on the type of surgery. You may be in the
`hospital for 1 to 3 days.
`
`A%er surgery, a tube will be inserted into your penis. "e
`tube allows urine to drain from your bladder while the
`urethra is healing from the surgery. You’ll have the tube for
`5 to 14 days. Your nurse or doctor will show you how to care
`for it.
`
`16
`
`
`
`A%er surgery, some men may lose control of the $ow of
`urine (urinary incontinence). Most men regain at least some
`bladder control a%er a few weeks. Your nurse or doctor can
`teach you an exercise to help you recover control of your
`bladder. For some men, however, incontinence may be
`permanent. Your health care team can show you ways to
`cope with this problem.
`
`Surgery may also damage nerves near the prostate and cause
`erectile dysfunction. Sexual function usually improves over
`several months, but for some men, this problem can be
`permanent. Talk with your doctor about medicine and other
`ways to help manage the sexual side e&ects of prostate cancer
`treatment.
`
`If your prostate is removed, you’ll have dry orgasms, which
`means you’ll no longer release semen. If you wish to father
`children, you may consider sperm banking before surgery.
`
`Questions you may want to ask your doctor
`about surgery
`
` ■ Do you suggest surgery for me? If so, what kind of
`surgery do you recommend for me? Why?
`
` ■ How will I feel after surgery? How long will I be in the
`hospital?
`
` ■ If I have pain, how can we control it?
`
` ■ Will I have any lasting side effects? What is the chance
`that surgery will cause permanent incontinence or
`erectile dysfunction?
`
`17
`
`
`
`Radiation #erapy
`
`Radiation therapy is an option for men with any stage of
`prostate cancer. Men with early-stage prostate cancer may
`choose radiation therapy instead of surgery. It may also be
`used a%er surgery to destroy any cancer cells that remain in
`the area. In men with advanced prostate cancer, radiation
`therapy may be used to help relieve pain.
`
`Radiation therapy uses high-energy rays to kill cancer cells.
`It a&ects cells only in the part of the body that is treated.
`
`Doctors use two types of radiation therapy to treat prostate
`cancer. Some men receive both types:
`
` ■ Machine outside the body: "e radiation comes from a
`large machine outside the body. "is is called external
`radiation therapy. Computers may be used to more
`closely target the prostate cancer. For example, intensity-
`modulated radiation therapy, proton radiation therapy,
`and 3-dimensional conformal radiation therapy are
`types of radiation therapy that use computers to lessen
`damage to healthy tissue. You’ll go to a hospital or clinic
`for treatment. Treatments are usually 5 days a week for
`8 to 9 weeks. Each treatment session lasts only a few
`minutes.
`
` ■ Radioactive material inside the body (brachytherapy):
`Two methods are used for men with prostate cancer. One
`method places dozens of radioactive seeds inside needles,
`and the needles are inserted into the prostate. When the
`needles are removed, the seeds are le% behind. "e seeds
`give o& radiation for a few weeks or months. "ey don’t
`need to be removed once the radiation is gone. You won’t
`need to stay in the hospital for treatment.
`
`18
`
`
`
`Another method involves inserting several tubes into the
`prostate. Radioactive material is loaded into the tubes.
`"e treatment session lasts for a few minutes, and the
`radioactive material is removed. "is treatment may be
`repeated as many as #ve times. You’ll stay in the hospital
`for 1 or 2 days, and then the tubes will be removed.
`When you leave the hospital, no radioactivity remains in
`your body.
`
`Side e&ects depend mainly on the type of radiation therapy
`and how much radiation is given.
`
`Both types of radiation therapy can cause diarrhea or rectal
`pain. You may feel that you need to empty your bladder
`more o%en. You may feel pain or burning when you empty
`your bladder. "ese side e&ects usually go away.
`
`You’re likely to become tired during external radiation
`therapy, especially in the later weeks of treatment. Although
`getting enough rest is important, most people say they feel
`better when they exercise every day. Try to go for a short
`walk, do gentle stretches, or do yoga.
`
`Radiation therapy can also harm the skin. During external
`radiation therapy, it’s common for the skin in the treated
`area to become red, dry, and tender. "e skin near the anus
`is especially sensitive. Check with your doctor before using
`lotion or cream on the treated area. You may lose hair in that
`area, and it may not grow back. Brachytherapy may make the
`area look swollen and bruised. A%er treatment is over, the
`skin will slowly heal.
`
`You may wish to discuss with your doctor the possible
`long-term e&ects of radiation therapy for prostate cancer.
`Radiation may harm the penis, rectum, and bladder, and side
`e&ects may develop 6 months or more a%er treatment ends.
`
`19
`
`
`
`For example, both types of radiation therapy may cause
`erectile dysfunction, bleeding from the rectum, diarrhea, or
`rectal discharge. Other possible problems include #nding
`blood in your urine, feeling an urgent need to empty your
`bladder, or needing to empty your bladder more o%en than
`you used to. If any of these problems occur, your doctor can
`tell you how to manage them.
`
`"e NCI booklet Radiation "erapy and You has helpful
`ideas for coping with radiation therapy side e&ects.
`
`Questions you may want to ask your doctor about
`radiation therapy
`
` ■ Which type of radiation therapy can I consider? Are
`both types an option for me?
`
` ■ When will treatment start? When will it end? How
`often will I have treatments?
`
` ■ How will I feel during treatment? Will I need to stay in
`the hospital? Will I be able to drive myself to and from
`treatment?
`
` ■ What can I do to take care of myself before, during, and
`after treatment?
`
` ■ How will we know the treatment is working?
`
` ■ How will I feel after radiation therapy?
`
` ■ What side effects should I tell you about?
`
` ■ Are there any lasting effects?
`
`20
`
`
`
`Hormone #erapy
`
`Men with advanced prostate cancer usually receive hormone
`therapy. In addition, a man with early-stage prostate cancer
`may have hormone therapy before, during, and a%er
`radiation therapy. Hormone therapy may also be used
`a%er surgery.
`
`Hormone therapy keeps prostate cancer cells from getting
`male hormones (androgens such as testosterone). Male
`hormones can cause prostate cancers to grow.
`
`Types of hormone therapy include…
`
` ■ A drug that can prevent the testicles from making
`testosterone (LH-RH agonist)
`
` ■ A drug that can block the action of male hormones
`(antiandrogen)
`
` ■ Surgery to remove the testicles, which are the body’s
`main source of testosterone
`
` ■ A drug that can prevent the adrenal glands from making
`testosterone
`
`Your doctor can help you decide which type of hormone
`therapy or which combination is best for you.
`
`"e side e&ects of hormone therapy depend on the type
`used. "e most common side e&ects are erectile dysfunction,
`hot $ashes, and loss of sexual desire. Other possible side
`e&ects include breast growth, an increase in body fat around
`the waist, and an increase in sugar level in your blood.
`
`Also, hormone therapy can weaken your bones. Your doctor
`can suggest medicines that may reduce your risk of breaking
`a bone.
`
`21
`
`
`
`An LH-RH agonist may make pain and other symptoms
`worse at #rst. "is temporary problem is called a $are. To
`prevent a $are, your doctor may give you an antiandrogen
`for a few weeks along with the LH-RH agonist.
`
`Although the side e&ects of hormone therapy may be
`upsetting, your health care team can suggest ways to manage
`them.
`
`Questions you may want to ask your doctor about
`hormone therapy
`
` ■ What kind of hormone therapy can I consider? Would
`you suggest drugs or surgery? Why?
`
` ■ If I have drugs, when will treatment start? How often
`will I have treatments? When will treatment end?
`
` ■ If I have surgery, how long will I need to stay in the
`hospital?
`
` ■ How will I feel during treatment?
`
` ■ What can I do to take care of myself during treatment?
`
` ■ How will we know the treatment is working?
`
` ■ Which side effects should I tell you about?
`
` ■ Will there be long-term side effects?
`
`22
`
`
`
`Chemotherapy
`
`Chemotherapy may be used for men with advanced
`prostate cancer.
`
`Chemotherapy uses drugs to kill cancer cells. "e drugs
`for prostate cancer are usually given directly into a vein
`(intravenously) through a thin needle.
`
`You may receive chemotherapy in a clinic, at the doctor’s
`o*ce, or at home. Men rarely need to stay in the hospital
`during treatment.
`
`"e side e&ects depend mainly on which drugs are given and
`how much. Chemotherapy kills fast-growing cancer cells,
`but the drugs can also harm normal cells that divide rapidly:
`
` ■ Blood cells: When drugs lower the levels of healthy
`blood cells, you’re more likely to get infections, bruise
`or bleed easily, and feel very weak and tired. Your health
`care team will check for low levels of blood cells. If
`your levels are low, your health care team may stop the
`chemotherapy for a while or reduce the dose of the drug.
`"ere are also medicines that can help your body make
`new blood cells.
`
` ■ Cells in hair roots: Chemotherapy may cause hair loss. If
`you lose your hair, it will grow back a%er treatment, but
`the color and texture may be changed.
`
` ■ Cells that line the digestive tract: Chemotherapy can
`cause a poor appetite, nausea and vomiting, diarrhea,
`or mouth and lip sores. Your health care team can give
`you medicines and suggest other ways to help with
`these problems.
`
`23
`
`
`
`Other side e&ects include shortness of breath and a problem
`with your body holding extra water. Your health care team
`can give you medicine to protect against too much water
`building up in the body.
`
`Your health care team can suggest ways to control many of
`these problems. Most go away when treatment ends.
`
`"e NCI booklet Chemotherapy and You has helpful ideas
`for coping with side e&ects.
`
`Immunotherapy
`
`Immunotherapy may be used for men with advanced
`prostate cancer who are not helped by hormone therapy.
`Immunotherapy stimulates the immune system to kill
`cancer cells.
`
`For immunotherapy for prostate cancer, a treatment is made
`from some of your own blood cells. You’ll receive a total of
`three injections of treatment. "e injections are given one at
`a time, usually 2 weeks apart.
`
`"e most common side e&ects are headache, backache,
`feeling very tired, and having a fever and chills. "ese e&ects
`usually go away.
`
`"is type of immunotherapy is also known as a treatment
`vaccine. For more information, you may want to read the
`NCI fact sheet Cancer Vaccines.
`
`24
`
`
`
`Questions you may want to ask your doctor about
`chemotherapy or immunotherapy
`
` ■ Which drug or therapy do you suggest for me? What
`will it do?
`
` ■ What is the expected benefit of treatment?
`
` ■ What are the possible side effects? What can we do
`about them?
`
` ■ Which side effects should I tell you about?
`
` ■ When will treatment start? When will it end? How
`often will I have treatments?
`
` ■ How will we know the treatment is working?
`
` ■ Will there be lasting side effects?
`
`25
`
`
`
`Nutrition
`
`Eating well is important before, during, and a#er cancer
`treatment. You need the right amount of calories to maintain
`a good weight. You also need enough protein to keep up
`your strength. Eating well may help you feel better and have
`more energy.
`
`Sometimes, especially during or soon a#er treatment, you
`may not feel like eating. You may be uncomfortable or tired.
`You may $nd that foods don’t taste as good as they used to.
`In addition, poor appetite, nausea, vomiting, mouth blisters,
`and other side e%ects of treatment can make it hard for you
`to eat.
`
`Eating well may help you feel better.
`
`26
`
`
`
`Your doctor, a registered dietitian, or another health care
`provider can suggest ways to help you meet your nutrition
`needs. Also, the NCI booklet Eating Hints has many useful
`recipes and lists of foods that can help with side e&ects.
`
`Follow-up Care
`
`You’ll need regular checkups (such as every 6 months) a%er
`treatment for prostate cancer. Checkups help ensure that
`any changes in your health are noted and treated if needed.
`If you have any health problems between checkups, contact
`your doctor.
`
`Prostate cancer may come back a%er treatment. Your doctor
`will check for the return of cancer.
`
`Checkups also help detect health problems that can result
`from cancer treatment.
`
`Checkups may include a digital rectal exam and a PSA test.
`A rise in PSA level can mean that cancer has returned a%er
`treatment. Your doctor may also order a biopsy, a bone scan,
`CT
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