Each year, more than 248,000 American men learn they have this disease. Prostate cancer is the second most common type of cancer among men in this country. Only skin cancer is more common.
Learning about medical care for prostate cancer can help you take an active part in making choices about your care.
Your doctor can check for prostate cancer before you have any symptoms. During an office visit, your doctor will ask about your personal and family medical history. You’ll have a physical exam. You may also have one or both of the following tests:
The digital rectal exam and PSA test are being studied in clinical trials to learn whether finding prostate cancer early can lower the number of deaths from this disease.
The digital rectal exam and PSA test can detect a problem in the prostate. However, they can’t show whether the problem is cancer or a less serious condition. If you have abnormal test results, your doctor may suggest other tests to make a diagnosis. For example, your visit may include other lab tests, such as a urine test to check for blood or infection. Your doctor may order other procedures:
If cancer cells are found, the pathologist studies tissue samples from the prostate under a microscope to report the grade of the tumor. The grade tells how much the tumor tissue differs from normal prostate tissue. It suggests how fast the tumor is likely to grow.
Tumors with higher grades tend to grow faster than those with lower grades. They are also more likely to spread. Doctors use tumor grade along with your age and other factors to suggest treatment options.
One system of grading is with the Gleason score. Gleason scores range from 2 to 10. To come up with the Gleason score, the pathologist uses a microscope to look at the patterns of cells in the prostate tissue. The most common pattern is given a grade of 1 (most like normal cells) to 5 (most abnormal). If there is a second most common pattern, the pathologist gives it a grade of 1 to 5, and adds the two most common grades together to make the Gleason score. If only one pattern is seen, the pathologist counts it twice. For example, 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.
Another system of grading prostate cancer uses grades 1 through 4 (G1 to G4). G4 is more likely than G1, G2, or G3 to grow quickly and spread. Read more in the Staging Section.
When prostate cancer spreads, it’s often found in nearby lymph nodes. If cancer has reached these nodes, it also may have spread to other lymph nodes, the bones, or other organs.
When 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 tumor. For example, if prostate cancer spreads to bones, the cancer cells in the bones are actually prostate cancer cells. The disease is metastatic prostate cancer, not bone cancer. For that reason, it’s treated as prostate cancer, not bone cancer. Doctors call the new tumor “distant” or metastatic disease.
Stage IIA: The tumor cannot be felt and involves half of 1 side of the prostate or even less than that. PSA levels are medium, and the cancer cells are well differentiated. This stage also includes larger tumors found only in the prostate, as long as the cancer cells are still well differentiated.
Stage IIB: The tumor may be large enough to be felt during DRE. The PSA level is medium. The cancer cells are moderately differentiated.
Stage IIC: The tumor may be large enough to be felt during DRE. The PSA level is medium. The cancer cells may be moderately or poorly differentiated.
Stage IIIA: The cancer has spread beyond the outer layer of the prostate into nearby tissues. It may also have spread to the seminal vesicles. The PSA level is high.
Stage IIIB: The tumor has grown outside of the prostate gland and may have invaded nearby structures, such as the bladder or rectum.
Stage IIIC: The cancer cells across the tumor are poorly differentiated, meaning they look very different from healthy cells.
Stage IVA: The cancer has spread to the regional lymph nodes.Stage IV:The cancer has spread beyond the prostate.
Stage IVB: The cancer has spread to distant lymph nodes, other parts of the body, or to the bones.
The treatment that’s right for you depends mainly on your age, the grade of the tumor (the Gleason score), the number of biopsy tissue samples that contain cancer cells, the stage of the cancer, your symptoms, and your general health. Your doctor can describe your treatment choices, the expected results of each, and the possible side effects. You and your doctor can work together to develop a treatment plan that meets your medical and personal needs.
You may choose active surveillance if the risks and possible side effects of treatment outweigh the possible benefits. Your doctor may suggest active surveillance if you’re diagnosed with early stage prostate cancer that seems to be slowly growing. Your doctor may also offer this option if you are older or have other serious health problems.
Choosing active surveillance doesn’t mean you’re giving up. It means you’re putting off the side effects of surgery or radiation therapy. Having surgery or radiation therapy is no guarantee that a man will live longer than a man who chooses to put off treatment.
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 first). After about one year, your doctor may order another biopsy to check the Gleason score. You may begin treatment if your Gleason score rises, your PSA level starts to rise, or you develop symptoms. You’ll receive surgery, radiation therapy, or another approach.
Active surveillance avoids or delays the side effects of surgery and radiation therapy, but this choice has risks. For some men, it may reduce the chance to control cancer before it spreads. Also, it may be harder to cope with surgery or radiation therapy when you’re older.
If you choose active surveillance but grow concerned later, you should discuss your feelings with your doctor. Another approach is an option for most men.
Surgery is an option for men with early (Stage I or II) prostate cancer. It’s sometimes an option for men with Stage III or IV prostate cancer. The surgeon may remove the whole prostate or only part of it.
Before the surgeon removes the prostate, the lymph nodes in the pelvis may be removed. If prostate cancer cells are found in the lymph nodes, the disease may have spread to other parts of the body. If cancer has spread to the lymph nodes, the surgeon does not always remove the prostate and may suggest other types of treatment.
There are several types of surgery for prostate cancer. Each type has benefits and risks. You and your doctor can talk about the types of surgery and which may be right for you:
Surgery can damage the nerves around the prostate. Damaging these nerves can make a man impotent (unable to have an erection). In some cases, your surgeon can protect the nerves that control erection. But if you have a large tumor or a tumor that’s very close to the nerves, surgery may cause impotence. Impotence can be permanent. You can talk with your doctor about medicine and other ways to help manage the sexual side effects of cancer treatment.
If your prostate is removed, you will no longer produce semen. You’ll have dry orgasms. If you wish to father children, you may consider sperm banking or a sperm retrieval procedure before surgery.
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 also may be used after surgery to destroy any cancer cells that remain in the area. In later stages of prostate cancer, radiation treatment may be used to help relieve pain.
Radiation therapy (also called radiotherapy) uses high-energy rays to kill cancer cells. It affects cells only in the treated area.
Doctors use two types of radiation therapy to treat prostate cancer. Some men receive both types:
Both internal and external radiation can cause impotence. You can talk with your doctor about ways to help cope with this side effect.
A man with prostate cancer may have hormone therapy before, during, or after radiation therapy. Hormone therapy is also used alone for prostate cancer that has returned after treatment.
Male hormones (androgens) can cause prostate cancer to grow. Hormone therapy keeps prostate cancer cells from getting the male hormones they need to grow. The testicles are the body’s main source of the male hormone testosterone. The adrenal gland makes other male hormones and a small amount of testosterone.
Hormone therapy uses drugs or surgery:
After orchiectomy or treatment with an LH-RH agonist, your body no longer gets testosterone from the testicles, the major source of male hormones. Because the adrenal gland makes small amounts of male hormones, you may receive an antiandrogen to block the action of the male hormones that remain. This combination of treatments is known as total androgen blockade (also called combined androgen blockade). However, studies have shown that total androgen blockade is no more effective than surgery or an LH-RH agonist alone.
Doctors usually treat prostate cancer that has spread to other parts of the body with hormone therapy. For some men, the cancer will be controlled for two or three years, but others will have a much shorter response to hormone therapy. In time, most prostate cancers can grow with very little or no male hormones, and hormone therapy alone is no longer helpful. At that time, your doctor may suggest chemotherapy or other forms of treatment that are under study. In many cases, the doctor may suggest continuing with hormone therapy because it may still be effective against some of the cancer cells.
Chemotherapy may be used for prostate cancer that has spread and no longer responds to hormone therapy.
Visit the National Cancer Institute where this information and more can be found about Prostate Cancer or ask your cancer care team questions about your individual situation.