Prostate Cancer
Table of Contents
Description
What is cancer of the prostate?
- Stage Explanation
Stages of cancer of the prostate
- Stage I (A)
- Stage II (B)
- Stage III (C)
- Stage IV (D)
- Recurrent
- Treatment Option Overview
-
How cancer of the prostate is treated
- Treatment by stage
- Stage I (A)
- Stage II (B)
- Stage III (C)
- Stage IV (D)
- Recurrent
-
- To Learn More
What is cancer of the prostate?
Cancer of the prostate, a common form of cancer, is a disease in which cancer
(malignant) cells are found in the prostate. The prostate is one of the male sex glands
and is located just below the bladder (the organ that collects and empties urine) and in
front of the rectum (the lower part of the intestine). The prostate is about the size of a
walnut. It surrounds part of the urethra, the tube that carries urine from the bladder to
the outside of the body. The prostate makes fluid that becomes part of the semen, the
white fluid that contains sperm.
Cancer of the prostate is found mainly in older men. As men age, the prostate may get
bigger and block the urethra or bladder. This may cause difficulty in urination or can
interfere with sexual functions. The condition is called benign prostatic hyperplasia
(BPH), and although it is not cancer, surgery may be needed to correct it. The symptoms of
BPH or of other problems in the prostate may be similar to symptoms for prostate cancer.
A doctor should be seen if any of the following symptoms appear: weak or interrupted
flow of urine, urinating often (especially at night), difficulty urinating, pain or
burning during urination, blood in the urine, or nagging pain in the back, hips, or
pelvis. Often there are no symptoms of early cancer of the prostate. When examining a
patient, a doctor will insert a gloved finger into the rectum (a rectal examination) to
feel for lumps in the prostate. A special test called an ultrasound, which uses sound
waves to make a picture of the bladder, may also be done.
If the doctor feels anything that is not normal, he or she may need to take cells from
the prostate and look at them under a microscope. The doctor will usually do this by
putting a needle into the prostate to remove some cells. To get to the prostate, the
doctor may put the needle through the rectum or through the space between the scrotum and
the anus (the perineum). This is called a fine needle aspiration or a needle biopsy.
The chance of recovery (prognosis) and choice of treatment depend on the stage of the
cancer (whether it is just in the prostate or has spread to other places in the body) and
the patient's general health.
Stages of cancer of the prostate
Once cancer of the prostate has been found (diagnosed), more tests will be done to find
out if cancer cells have spread from the prostate to tissues around it or to other parts
of the body. This is called "staging." To plan treatment, a doctor needs to know
the stage of the disease. The following stages are used for cancer of the prostate:
Stage I (A)
Prostate cancer at this stage cannot be felt and causes no symptoms. The cancer is only
in the prostate and usually is found accidentally when surgery is done for other reasons,
such as for benign prostatic hyperplasia. It can also be found by a needle biopsy that is
done because a blood test (called a prostate-specific antigen [PSA] test) showed an
elevated PSA level. Cancer cells may be found in only one area of the prostate or they may
be found in many areas of the prostate.
Stage II (B)
The tumor may be found by a needle biopsy that is done because a blood test showed an
elevated PSA level or it may be felt in the prostate during a rectal examination, even
though the cancer cells are found only in the prostate gland.
Stage III (C)
Cancer cells have spread outside the covering (capsule) of the prostate to tissues
around the prostate. The glands that produce semen (the seminal vesicles) may have cancer
in them.
Stage IV (D)
Cancer cells have spread (metastasized) to lymph nodes (near or far from the prostate)
or to organs and tissues far away from the prostate such as the bone, liver, or lungs.
Recurrent
Recurrent disease means that the cancer has come back (recurred) after it has been
treated. It may come back in the prostate or in another part of the body.
Prostate staging can also be described by using T (tumor size), N (extent of spread to
lymph nodes), and M (extent of spread to other parts of the body).
How cancer of the prostate is treated
There are treatments for all patients with cancer of the prostate. Five kinds of
treatment are commonly used:
- surgery (taking out the cancer)
- radiation therapy (using high-dose x-rays or other high-energy rays to kill cancer
cells)
- hormone therapy (using hormones to stop cancer cells from growing)
- chemotherapy (using drugs to kill cancer cells)
- biological therapy (using the body's immune system to fight cancer)
Surgery is a common treatment of cancer of the prostate. A doctor may take out the
cancer using one of the following operations.
- Radical prostatectomy is the removal of the prostate and some of the
tissue around it. The doctor may do the surgery by cutting into the space
between the scrotum and the anus (the perineum) in an operation called a
perineal prostatectomy or by cutting into the lower abdomen in an operation
called a retropubic prostatectomy. Radical prostatectomy is done only if
the cancer has not spread outside the prostate. Often before the
prostatectomy is done, the doctor will do surgery to take out lymph nodes
in the pelvis to see if they contain cancer. This is called a pelvic lymph
node dissection. If the lymph nodes contain cancer, usually the doctor
will not do a prostatectomy and may or may not recommend other therapy at
this time. Impotence and leakage of urine from the bladder can occur in men
treated with surgery.
- Transurethral resection is a procedure in which the cancer is cut from the
prostate using a tool with a small wire loop on the end that is put into the
prostate through the urethra. This operation is sometimes done to relieve
symptoms caused by the tumor before other treatment or in men who cannot
have a radical prostatectomy because of age or other illness.
- Cryosurgery is a type of surgery that kills the cancer by freezing it.
Radiation therapy is the use of high-energy x-rays to kill cancer cells and shrink
tumors. Radiation may come from a machine outside the body (external radiation therapy) or
from putting materials that produce radiation (radioisotopes) through thin plastic tubes
in the area where the cancer cells are found (internal radiation therapy). Impotence may
occur in men treated with radiation therapy.
Hormone therapy is the use of hormones to stop cancer cells from growing. Hormone
therapy for prostate cancer can take several forms. Male hormones (especially
testosterone) can help prostate cancer grow. To stop the cancer from growing, female
hormones or drugs called LHRH agonists that decrease the amount of male hormones made may
be given. Sometimes an operation to remove the testicles (orchiectomy) is done to stop the
testicles from making testosterone. This treatment is usually used in men with advanced
prostate cancer. Growth of breast tissue is a common side effect of therapy with female
hormones (estrogens). Other side effects that can occur after orchiectomy and other
hormone therapies include hot flashes, impaired sexual function, and loss of desire for
sex.
Chemotherapy is the use of drugs to kill cancer cells. Chemotherapy may be taken by
pill, or it may be put into the body by inserting a needle into a vein or muscle.
Chemotherapy is called a systemic treatment because the drug enters the bloodstream,
travels through the body, and can kill cancer cells outside the prostate. To date,
chemotherapy has not had significant value in treating prostate cancer, but clinical
trials are in progress to find more effective drugs.
Biological therapy tries to get the body to fight cancer. It uses materials made by the
body or made in a laboratory to boost, direct, or restore the body's natural defenses
against disease. Biological treatment is sometimes called biological response modifier
(BRM) therapy or immunotherapy.
Treatment by stage
Treatment of cancer of the prostate depends on the stage of the disease, and the
patient's age and overall health. A doctor may choose to follow the patient's condition
more closely rather than starting treatment immediately. This decision depends on whether
the patient has symptoms of the disease, is elderly, has another more serious illness, or
has only slightly abnormal tumor cells.
Standard treatment may be considered because of its effectiveness in patients in past
studies, or participation in a clinical trial may be considered. Not all patients are
cured with standard therapy and some standard treatments may have more side effects than
are desired. For these reasons, clinical trials are designed to find better ways to treat
cancer patients and are based on the most up-to-date information. Clinical trials are
ongoing in most parts of the country for most stages of cancer of the prostate. To learn
more about clinical trials, call the Cancer Information Service at 1-800-4-CANCER
(1-800-422-6237); TTY at 1-800-332-8615.
Treatment may be one of the following:
- 1. A doctor may follow the patient's condition closely without any treatment. The doctor
may choose this option because the cancer is not causing any symptoms or other problems,
and may be growing slowly.
2. External radiation therapy.
3. Surgery to remove the prostate and the tissue around it (radical prostatectomy), with
or without new techniques to preserve the nerves necessary for an erection (nerve sparing
technique). Radiation therapy may be given after surgery in some cases.
4. Internal radiation therapy.
5. Clinical trials of new techniques of external radiation therapy to protect normal
tissues from radiation.
6. Other clinical trials.
Treatment may be one of the following:
- 1. A doctor may follow the patient's condition closely without treatment. The doctor may
choose this option because the cancer is not causing any symptoms or other problems, and
may be growing slowly.
2. External radiation therapy. Clinical trials are testing new types of radiation.
3. Surgery to remove the prostate and the tissue around it (radical prostatectomy), with
or without techniques to preserve the nerves necessary for an erection (nerve sparing
technique). Usually some of the lymph nodes in the pelvis are also removed (pelvic lymph
node dissection). Radiation therapy may be given following surgery
4. Internal radiation therapy.
5. Clinical trials of new techniques of external radiation therapy to protect normal
tissues from radiation.
6. A clinical trial of cryosurgery.
7. Other clinical trials.
Treatment may be one of the following:
- 1. Hormone therapy.
2. External radiation therapy. Hormone therapy may be given in addition to radiation.
3. Surgery to remove the prostate and the tissue around it (radical prostatectomy).
Usually some of the lymph nodes in the pelvis are also removed (pelvic lymph node
dissection). Radiation therapy may be given following surgery.
4. Careful observation without immediate treatment.
If the patient is unable to have surgery or radiation therapy to cure the disease,
palliative treatments (treatments to relieve the symptoms of the disease, such as problems
urinating) may be given. In this case, treatment may be one of the following:
- 1. Radiation therapy to relieve symptoms.
2. Hormone therapy.
3. Surgery to cut the cancer from the prostate using a tool with a small wire loop on the
end that is put into the prostate through the urethra (transurethral resection).
4. Clinical trials of other forms of radiation therapy.
5. Clinical trials of cryosurgery.
6. Other clinical trials.
Treatment may be one of the following:
- 1. Hormone therapy.
2. External radiation therapy. Clinical trials are testing new forms of radiation. Hormone
therapy may be given in addition to radiation.
3. Radiation therapy to relieve symptoms.
4. Surgery to relieve symptoms.
5. If the patient is older or has another more serious illness, a doctor may follow the
patient's condition closely without treatment. The doctor may choose this option because
the cancer is not causing any symptoms or other problems, and may be growing slowly.
6. Other types of radiotherapy.
7. Clinical trials of surgery to remove the prostate and the tissue around it (radical
prostatectomy) and surgery to remove the testicles (orchiectomy).
8. A clinical trial of chemotherapy.
Treatment depends on many things, including what treatment the patient had before. If
the patient had surgery to remove the prostate (prostatectomy) and the cancer comes back
in only a small area, radiation therapy may be given. If the disease has spread to other
parts of the body, hormone therapy will probably be given. Radiation therapy or
chemotherapy may be given to relieve symptoms, such as bone pain. Patients may also choose
to take part in a clinical trial of chemotherapy or biological therapy.
TO LEARN MORE..... CALL 1-800-4-CANCER
To learn more about cancer of the prostate, call the National Cancer Institute's Cancer
Information Service at 1-800-4-CANCER (1-800-422-6237); TTY at 1-800-332-8615. By dialing
this toll-free number, you can speak with a trained information specialist who can answer
your questions.
The Cancer Information Service also has booklets about cancer that are available to the
public and can be sent on request. The following booklet about prostate cancer may be
helpful:
- What You Need To Know About Prostate Cancer
The following general booklets on questions related to cancer may also be helpful:
- What You Need To Know About Cancer
Taking Time: Support for People with Cancer and the People Who Care About
- Them
What Are Clinical Trials All About?
Chemotherapy and You: A Guide to Self-Help During Treatment
Radiation Therapy and You: A Guide to Self-Help During Treatment
Eating Hints for Cancer Patients
Advanced Cancer: Living Each Day
When Cancer Recurs: Meeting the Challenge Again
There are many other places where people can get material and information about cancer
treatment and services. The social service office at a hospital can be checked for local
and national agencies that help with getting information about finances, getting to and
from treatment, getting care at home, and dealing with problems.
For more information from the National Cancer Institute, please write to this address:
- National Cancer Institute
Office of Cancer Communications
31 Center Drive, MSC 2580
Bethesda, MD 20892-2580
Date Last Modified: 08/98
If you want to know more about cancer and how it is treated, or if you wish to know
about clinical trials for your type of cancer, you can call the NCI's Cancer Information
Service at 1-800-422-6237, toll free. A trained information specialist can talk
with you and answer your questions.
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