`
`Prostate cancer
`
`By Mayo Clinic Staff
`
`Prostate cancer is cancer that occurs in a man's prostate — a small walnutshaped gland
`that produces the seminal fluid that nourishes and transports sperm.
`
`Prostate cancer is one of the most common types of cancer in men. Prostate cancer usually
`grows slowly and initially remains confined to the prostate gland, where it may not cause
`serious harm. While some types of prostate cancer grow slowly and may need minimal or
`no treatment, other types are aggressive and can spread quickly.
`
`Prostate cancer that is detected early — when it's still confined to the prostate gland — has
`a better chance of successful treatment.
`
`Prostate cancer may cause no signs or symptoms in its early stages.
`
`Prostate cancer that is more advanced may cause signs and symptoms such as:
`
`Trouble urinating
`Decreased force in the stream of urine
`Blood in the semen
`Discomfort in the pelvic area
`Bone pain
`Erectile dysfunction
`When to see a doctor
`
`Make an appointment with your doctor if you have any signs or symptoms that worry you.
`
`There is debate regarding the risks and benefits of screening for prostate cancer, and
`medical organizations differ on their recommendations. Discuss prostate cancer screening
`with your doctor. Together, you can decide what's best for you.
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`It's not clear what causes prostate cancer.
`
`Doctors know that prostate cancer begins when some cells in your prostate become
`abnormal. Mutations in the abnormal cells' DNA cause the cells to grow and divide more
`rapidly than normal cells do. The abnormal cells continue living, when other cells would die.
`The accumulating abnormal cells form a tumor that can grow to invade nearby tissue. Some
`abnormal cells can break off and spread (metastasize) to other parts of the body.
`
`Factors that can increase your risk of prostate cancer include:
`
`Older age. Your risk of prostate cancer increases as you age.
`Being black. Black men have a greater risk of prostate cancer than do men of other
`races. In black men, prostate cancer is also more likely to be aggressive or advanced.
`It's not clear why this is.
`Family history of prostate or breast cancer. If men in your family have had prostate
`cancer, your risk may be increased. Also, if you have a family history of genes that
`increase the risk of breast cancer (BRCA1 or BRCA2) or a very strong family history of
`breast cancer, your risk of prostate cancer may be higher.
`Obesity. Obese men diagnosed with prostate cancer may be more likely to have
`advanced disease that's more difficult to treat.
`
`Complications of prostate cancer and its treatments include:
`
`Cancer that spreads (metastasizes). Prostate cancer can spread to nearby organs,
`such as your bladder, or travel through your bloodstream or lymphatic system to your
`bones or other organs. Prostate cancer that spreads to the bones can cause pain and
`broken bones. Once prostate cancer has spread to other areas of the body, it may still
`respond to treatment and may be controlled, but it's unlikely to be cured.
`Incontinence. Both prostate cancer and its treatment can cause urinary incontinence.
`Treatment for incontinence depends on the type you have, how severe it is and the
`likelihood it will improve over time. Treatment options may include medications,
`catheters and surgery.
`Erectile dysfunction. Erectile dysfunction can be a result of prostate cancer or its
`treatment, including surgery, radiation or hormone treatments. Medications, vacuum
`devices that assist in achieving erection and surgery are available to treat erectile
`dysfunction.
`
`If you have signs or symptoms that worry you, start by seeing your family doctor or a
`general practitioner.
`
`If your doctor suspects you may have a problem with your prostate, you may be referred to
`a urinary tract specialist (urologist). If you're diagnosed with prostate cancer, you may be
`referred to a cancer specialist (oncologist) or a specialist who uses radiation therapy to treat
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`cancer (radiation oncologist).
`
`Because appointments can be brief, and because there's often a lot of ground to cover, it's a
`good idea to be prepared. Here's some information to help you get ready and what to
`expect from your doctor.
`What you can do
`Be aware of any preappointment restrictions. At the time you make the appointment,
`be sure to ask if there's anything you need to do in advance, such as restrict your diet.
`Write down any symptoms you're experiencing, including any that may seem
`unrelated to the reason for which you scheduled the appointment.
`Write down key personal information, including any major stresses or recent life
`changes.
`Make a list of all medications, vitamins or supplements that you're taking.
`Consider taking a family member or friend along. Sometimes it can be difficult to
`remember all the information provided during an appointment. Someone who
`accompanies you may remember something that you missed or forgot.
`Write down questions to ask your doctor.
`
`Your time with your doctor is limited, so preparing a list of questions can help you make the
`most of your time together. List your questions from most important to least important in
`case time runs out. For prostate cancer, some basic questions to ask your doctor include:
`
`Do I have prostate cancer?
`How large is my prostate cancer?
`Has my prostate cancer spread beyond my prostate?
`What is my Gleason score?
`What is my prostatespecific antigen (PSA) level?
`Will I need more tests?
`What are my treatment options?
`Is there one treatment option you think is best for me?
`Do I need cancer treatment right away, or is it possible to wait and see if the cancer
`grows?
`What are the potential side effects of each treatment?
`What is the chance that my prostate cancer will be cured with treatment?
`If you had a friend or family member in my situation, what would you recommend?
`Should I see a specialist? What will that cost, and will my insurance cover it?
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`Are there brochures or other printed material that I can take with me? What websites do
`you recommend?
`
`In addition to the questions that you've prepared to ask your doctor, don't hesitate to ask
`other questions during your appointment.
`What to expect from your doctor
`
`Your doctor is likely to ask you a number of questions. Being ready to answer them may
`allow more time later to cover other points you want to address. Your doctor may ask:
`
`When did you first begin experiencing symptoms?
`Have your symptoms been continuous or occasional?
`How severe are your symptoms?
`What, if anything, seems to improve your symptoms?
`What, if anything, appears to worsen your symptoms?
`Screening for prostate cancer
`
`Whether to test healthy men with no symptoms for prostate cancer is controversial. Medical
`organizations don't agree on the issue of screening and whether it has benefits.
`
`Some medical organizations recommend men consider prostate cancer screening in their
`50s, or sooner for men who have risk factors for prostate cancer. Other organizations advise
`against screening.
`
`Discuss your particular situation and the benefits and risks of screening with your doctor.
`Together, you can decide whether prostate cancer screening is right for you.
`
`Prostate screening tests might include:)
`
`Digital rectal exam (DRE). During a DRE, your doctor inserts a gloved, lubricated finger
`into your rectum to examine your prostate, which is adjacent to the rectum. If your doctor
`finds any abnormalities in the texture, shape or size of your gland, you may need more
`tests.
`Prostatespecific antigen (PSA) test. A blood sample is drawn from a vein in your arm
`and analyzed for PSA, a substance that's naturally produced by your prostate gland. It's
`normal for a small amount of PSA to be in your bloodstream. However, if a higher than
`normal level is found, it may be an indication of prostate infection, inflammation,
`enlargement or cancer.
`
`PSA testing combined with DRE helps identify prostate cancers at their earliest stages, but
`studies have disagreed whether these tests reduce the risk of dying of prostate cancer. For
`that reason, there is debate surrounding prostate cancer screening.
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`Diagnosing prostate cancer
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`If an abnormality is detected on a DRE or PSA test, your doctor may recommend tests to
`determine whether you have prostate cancer, such as:
`
`Ultrasound. If other tests raise concerns, your doctor may use transrectal ultrasound to
`further evaluate your prostate. A small probe, about the size and shape of a cigar, is
`inserted into your rectum. The probe uses sound waves to make a picture of your
`prostate gland.
`Collecting a sample of prostate tissue. If initial test results suggest prostate cancer,
`your doctor may recommend a procedure to collect a sample of cells from your prostate
`(prostate biopsy). Prostate biopsy is often done using a thin needle that's inserted into
`the prostate to collect tissue. The tissue sample is analyzed in a lab to determine
`whether cancer cells are present.
`Determining whether prostate cancer is aggressive
`
`When a biopsy confirms the presence of cancer, the next step is to determine the level of
`aggressiveness (grade) of the cancer cells. In a laboratory, a pathologist examines a
`sample of your cancer to determine how much cancer cells differ from the healthy cells. A
`higher grade indicates a more aggressive cancer that is more likely to spread quickly.
`
`The most common scale used to evaluate the grade of prostate cancer cells is called a
`Gleason score. Scoring combines two numbers and can range from 2 (nonaggressive
`cancer) to 10 (very aggressive cancer).
`Determining how far the cancer has spread
`
`Once a prostate cancer diagnosis has been made, your doctor works to determine the
`extent (stage) of the cancer. If your doctor suspects your cancer may have spread beyond
`your prostate, imaging tests such as these may be recommended:
`
`Bone scan
`Ultrasound
`Computerized tomography (CT) scan
`Magnetic resonance imaging (MRI)
`Positron emission tomography (PET) scan
`
`Not every person should have every test. Your doctor will help determine which tests are
`best for your individual case.
`
`Once testing is complete, your doctor assigns your cancer a stage. This helps determine
`your treatment options. The prostate cancer stages are:
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`Stage I. This stage signifies very early cancer that's confined to a small area of the
`prostate. When viewed under a microscope, the cancer cells aren't considered
`aggressive.
`Stage II. Cancer at this stage may still be small but may be considered aggressive when
`cancer cells are viewed under the microscope. Or cancer that is stage II may be larger
`and may have grown to involve both sides of the prostate gland.
`Stage III. The cancer has spread beyond the prostate to the seminal vesicles or other
`nearby tissues.
`Stage IV. The cancer has grown to invade nearby organs, such as the bladder, or
`spread to lymph nodes, bones, lungs or other organs.
`
`Your prostate cancer treatment options depend on several factors, such as how fast your
`cancer is growing, how much it has spread and your overall health, as well as the benefits
`and the potential side effects of the treatment.
`Immediate treatment may not be necessary
`
`For men diagnosed with very earlystage prostate cancer, treatment may not be necessary
`right away. Some men may never need treatment. Instead, doctors sometimes recommend
`active surveillance.
`
`In active surveillance, regular followup blood tests, rectal exams and possibly biopsies may
`be performed to monitor progression of your cancer. If tests show your cancer is
`progressing, you may opt for a prostate cancer treatment such as surgery or radiation.
`
`Active surveillance may be an option for cancer that isn't causing symptoms, is expected to
`grow very slowly and is confined to a small area of the prostate. Active surveillance may
`also be considered for a man who has another serious health condition or an advanced age
`that makes cancer treatment more difficult.
`
`Active surveillance carries a risk that the cancer may grow and spread between checkups,
`making it less likely to be cured.
`Radiation therapy
`
`Radiation therapy uses highpowered energy to kill cancer cells. Prostate cancer radiation
`therapy can be delivered in two ways:
`
`Radiation that comes from outside of your body (external beam radiation). During
`external beam radiation therapy, you lie on a table while a machine moves around your
`body, directing highpowered energy beams, such as Xrays or protons, to your prostate
`cancer. You typically undergo external beam radiation treatments five days a week for
`several weeks.
`Radiation placed inside your body (brachytherapy). Brachytherapy involves placing
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`many ricesized radioactive seeds in your prostate tissue. The radioactive seeds deliver
`a low dose of radiation over a long period of time. Your doctor implants the radioactive
`seeds in your prostate using a needle guided by ultrasound images. The implanted
`seeds eventually stop giving off radiation and don't need to be removed.
`
`Side effects of radiation therapy can include painful urination, frequent urination and urgent
`urination, as well as rectal symptoms, such as loose stools or pain when passing stools.
`Erectile dysfunction can also occur.
`Hormone therapy
`
`Hormone therapy is treatment to stop your body from producing the male hormone
`testosterone. Prostate cancer cells rely on testosterone to help them grow. Cutting off the
`supply of hormones may cause cancer cells to die or to grow more slowly.
`
`Hormone therapy options include:
`
`Medications that stop your body from producing testosterone. Medications known
`as luteinizing hormonereleasing hormone (LHRH) agonists prevent the testicles from
`receiving messages to make testosterone. Drugs typically used in this type of hormone
`therapy include leuprolide (Lupron, Eligard), goserelin (Zoladex), triptorelin (Trelstar) and
`histrelin (Vantas). Other drugs sometimes used include ketoconazole and abiraterone
`(Zytiga).
`Medications that block testosterone from reaching cancer cells. Medications known
`as antiandrogens prevent testosterone from reaching your cancer cells. Examples
`include bicalutamide (Casodex), flutamide, and nilutamide (Nilandron). The drug
`enzalutamide (Xtandi) may be an option when other hormone therapies are no longer
`effective.
`Surgery to remove the testicles (orchiectomy). Removing your testicles reduces
`testosterone levels in your body.
`
`Hormone therapy is used in men with advanced prostate cancer to shrink the cancer and
`slow the growth of tumors. In men with earlystage prostate cancer, hormone therapy may
`be used to shrink tumors before radiation therapy. This can make it more likely that radiation
`therapy will be successful.
`
`Side effects of hormone therapy may include erectile dysfunction, hot flashes, loss of bone
`mass, reduced sex drive and weight gain.
`Surgery to remove the prostate
`
`Surgery for prostate cancer involves removing the prostate gland (radical prostatectomy),
`some surrounding tissue and a few lymph nodes. Ways the radical prostatectomy procedure
`can be performed include:
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`Using a robot to assist with surgery. During robotassisted surgery, the instruments
`are attached to a mechanical device (robot) and inserted into your abdomen through
`several small incisions. The surgeon sits at a console and uses hand controls to guide
`the robot to move the instruments. Robotic prostatectomy may allow the surgeon to
`make moreprecise movements with surgical tools than is possible with traditional
`minimally invasive surgery.
`Making an incision in your abdomen. During retropubic surgery, the prostate gland is
`taken out through an incision in your lower abdomen. Compared with other types of
`prostate surgery, retropubic prostate surgery may carry a lower risk of nerve damage,
`which can lead to problems with bladder control and erections.
`Making an incision between your anus and scrotum. Perineal surgery involves
`making an incision between your anus and scrotum in order to access your prostate. The
`perineal approach to surgery may allow for quicker recovery times, but this technique
`makes removing the nearby lymph nodes and avoiding nerve damage more difficult.
`Laparoscopic prostatectomy. During a laparoscopic radical prostatectomy, the doctor
`performs surgery through small incisions in the abdomen with the assistance of a tiny
`camera (laparoscope). This procedure requires great skill on the part of the surgeon, and
`it carries an increased risk that nearby structures may be accidentally cut. For this
`reason, this type of surgery is not commonly performed for prostate cancer in the U.S.
`anymore.
`
`Discuss with your doctor which type of surgery is best for your specific situation.
`
`Radical prostatectomy carries a risk of urinary incontinence and erectile dysfunction. Ask
`your doctor to explain the risks you may face based on your situation, the type of procedure
`you select, your age, your body type and your overall health.
`Freezing prostate tissue
`
`Cryosurgery or cryoablation involves freezing tissue to kill cancer cells.
`
`During cryosurgery for prostate cancer, small needles are inserted in the prostate using
`ultrasound images as guidance. A very cold gas is placed in the needles, which causes the
`surrounding tissue to freeze. A second gas is then placed in the needles to reheat the
`tissue. The cycles of freezing and thawing kill the cancer cells and some surrounding
`healthy tissue.
`
`Initial attempts to use cryosurgery for prostate cancer resulted in high complication rates
`and unacceptable side effects. However, newer technologies have lowered complication
`rates, improved cancer control and made the procedure easier to tolerate. Cryosurgery may
`be an option for men who haven't been helped by radiation therapy.
`Chemotherapy
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`Chemotherapy uses drugs to kill rapidly growing cells, including cancer cells. Chemotherapy
`can be administered through a vein in your arm, in pill form or both.
`
`Chemotherapy may be a treatment option for men with prostate cancer that has spread to
`distant areas of their bodies. Chemotherapy may also be an option for cancers that don't
`respond to hormone therapy.
`Biological therapy
`
`Biological therapy (immunotherapy) uses your body's immune system to fight cancer cells.
`One type of biological therapy called sipuleucelT (Provenge) has been developed to treat
`advanced, recurrent prostate cancer.
`
`This treatment takes some of your own immune cells, genetically engineers them in a
`laboratory to fight prostate cancer, then injects the cells back into your body through a vein.
`Some men do respond to this therapy with some improvement in their cancer, but the
`treatment is very expensive and requires multiple treatments.
`
`No complementary or alternative treatments will cure prostate cancer. However,
`complementary and alternative prostate cancer treatments may help you cope with the side
`effects of cancer and its treatment.
`
`Nearly everyone diagnosed with cancer experiences some distress at some point. If you're
`distressed, you may feel sad, angry or anxious. You may experience difficulty sleeping or
`find yourself constantly thinking about your cancer.
`
`Several complementary medicine techniques may help you cope with your distress,
`including:
`
`Art therapy
`Dance or movement therapy
`Exercise
`Meditation
`Music therapy
`Relaxation techniques
`Spirituality
`
`Discuss your feelings and concerns with your doctor. In some cases, treatment for distress
`may require medications.
`
`When you receive a diagnosis of prostate cancer, you may experience a range of feelings
`— including disbelief, fear, anger, anxiety and depression. With time, each man finds his
`own way of coping with a prostate cancer diagnosis.
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`Until you find what works for you, try to:
`
`Learn enough about prostate cancer to feel comfortable making treatment
`decisions. Learn as much as you need to know about your cancer and its treatment in
`order to understand what to expect from treatment and life after treatment. Ask your
`doctor, nurse or other health care professional to recommend some reliable sources of
`information to get you started.
`Keep your friends and family close. Your friends and family can provide support
`during and after your treatment. They may be eager to help with the small tasks you
`won't have energy for during treatment. And having a close friend or family member to
`talk to can be helpful when you're feeling stressed or overwhelmed.
`Connect with other cancer survivors. Friends and family can't always understand
`what it's like to face cancer. Other cancer survivors can provide a unique network of
`support. Ask your doctor or other member of your health care team about support groups
`or organizations in your community that can connect you with other cancer survivors.
`Organizations such as the American Cancer Society offer online chat rooms and
`discussion forums.
`Take care of yourself. Take care of yourself during cancer treatment by eating a diet
`full of fruits and vegetables. Try to exercise most days of the week. Get enough sleep
`each night so that you wake feeling rested.
`Continue sexual expression. If you experience erectile dysfunction, your natural
`reaction may be to avoid all sexual contact. But consider touching, holding, hugging and
`caressing as ways to continue sharing sexuality with your partner.
`
`You can reduce your risk of prostate cancer if you:
`
`Choose a healthy diet full of fruits and vegetables. Avoid highfat foods and instead
`focus on choosing a variety of fruits, vegetables and whole grains. Fruits and vegetables
`contain many vitamins and nutrients that can contribute to your health.
`
`Whether you can prevent prostate cancer through diet has yet to be conclusively proved.
`But eating a healthy diet with a variety of fruits and vegetables can improve your overall
`health.
`
`Choose healthy foods over supplements. No studies have shown that supplements
`play a role in reducing your risk of prostate cancer. Instead, choose foods that are rich in
`vitamins and minerals so that you can maintain healthy levels of vitamins in your body.
`Exercise most days of the week. Exercise improves your overall health, helps you
`maintain your weight and improves your mood. There is some evidence that men who
`don't exercise have higher PSA levels, while men who exercise may have a lower risk of
`prostate cancer.
`
`Try to exercise most days of the week. If you're new to exercise, start slow and work
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`your way up to more exercise time each day.
`
`Maintain a healthy weight. If your current weight is healthy, work to maintain it by
`exercising most days of the week. If you need to lose weight, add more exercise and
`reduce the number of calories you eat each day. Ask your doctor for help creating a plan
`for healthy weight loss.
`Talk to your doctor about increased risk of prostate cancer. Men with a high risk of
`prostate cancer may consider medications or other treatments to reduce their risk. Some
`studies suggest that taking 5alpha reductase inhibitors, including finasteride (Propecia,
`Proscar) and dutasteride (Avodart), may reduce the overall risk of developing prostate
`cancer. These drugs are used to control prostate gland enlargement and hair loss in
`men.
`
`However, some evidence indicates that men taking these medications may have an
`increased risk of getting a more serious form of prostate cancer (highgrade prostate
`cancer). If you're concerned about your risk of developing prostate cancer, talk with your
`doctor.
`References
`
`1. Prostate cancer. Fort Washington, Pa.: National Comprehensive Cancer Network.
`http://www.nccn.org/professionals/physician_gls/f_guidelines.asp. Accessed Jan. 21, 2015.
`
`2. Wein AJ, ed., et al. CampbellWalsh Urology. 10th ed. Philadelphia, Pa.: Saunders Elsevier; 2012.
`http://wwwclinicalkey.com. Accessed Jan. 21, 2015.
`
`3. Gunderson LL. Clinical Radiation Oncology. 3rd ed. Philadelphia, Pa.: Saunders Elsevier; 2012.
`http://www.clincalkey.com. Accessed Jan. 21, 2015.
`
`4. What you need to know about prostate cancer. National Cancer Institute.
`http://www.cancer.gov/publications/patienteducation/wyntkprostatecancer. Accessed Jan. 21, 2015.
`
`5. Niederhuber JE, et al., eds. Prostate cancer. Abeloff's Clinical Oncology. 5th ed. Philadelphia, Pa.: Churchill
`Livingstone Elsevier; 2014. http://www.clinicalkey.com. Accessed Jan. 21, 2015.
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`6. Distress management. Fort Washington, Pa.: National Comprehensive Cancer Network.
`http://www.nccn.org/professionals/physician_gls/f_guidelines.asp. Accessed Jan. 21, 2015.
`
`7. Skolarus TA, et al. American Cancer Society prostate cancer survivorship care guidelines. CA: A Cancer
`Journal for Clinicians. 2014;64:225.
`
`8. Smith RA, et al. Cancer screening in the United States, 2015: A review of current American Cancer Society
`guidelines and current issues in cancer screening. CA: A Cancer Journal for Clinicians. 2015;65:30.
`
`9. Prostate cancer prevention (PDQ). National Cancer Institute.
`http://www.cancer.gov/cancertopics/pdq/prevention/prostate/healthprofessional. Accessed Jan. 21, 2015.
`
`10. Cuzick J, et al. Prevention and early detection of prostate cancer. Lancet Oncology 2014;15:e484.
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`11. Cook AJ. Decision Support System. Mayo Clinic, Rochester, Minn. Oct. 8, 2014.
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`12. Castle EP (expert opinion). Mayo Clinic, Phoenix/Scottsdale, Ariz. Feb. 13, 2015.
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`March 03, 2015
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`Original article: http://www.mayoclinic.org/diseasesconditions/prostatecancer/basics/definition/con20029597
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