Diseases and Conditions
`
`Prostate cancer
`
`By Mayo Clinic Staff
`
`Prostate cancer is cancer that occurs in a man's prostate — a small walnut-shaped 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.
`
`It's not clear what causes prostate cancer.
`
`Doctors know that prostate cancer begins when some cells in your prostate become abnormal. Mutations
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`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 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 pre-appointment 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.
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`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 prostate-specific 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?
`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?
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`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.
`Prostate-specific 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.
`Diagnosing prostate cancer
`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).
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`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:
`
`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 early-stage 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 follow-up 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
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`likely to be cured.
`Radiation therapy
`Radiation therapy uses high-powered 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 high-powered
`energy beams, such as X-rays 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 many rice-
`sized 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
`hormone-releasing hormone (LH-RH) 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 anti-
`androgens 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 early-stage 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.
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`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:
`
`Using a robot to assist with surgery. During robot-assisted 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 more-precise 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 sipuleucel-T (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.
`
`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
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`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 high-fat 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 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 5-alpha 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.
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`However, some evidence indicates that men taking these medications may have an increased risk of
`getting a more serious form of prostate cancer (high-grade 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. Campbell-Walsh 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/patient-
`education/wyntk-prostate-cancer. 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.
`
`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.
`
`11. Cook AJ. Decision Support System. Mayo Clinic, Rochester, Minn. Oct. 8, 2014.
`
`12. Castle EP (expert opinion). Mayo Clinic, Phoenix/Scottsdale, Ariz. Feb. 13, 2015.
`
`March 03, 2015
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`Original article: http://www.mayoclinic.org/diseases-conditions/prostate-cancer/basics/definition/con-20029597
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