Prostate Cancer


General Information
What is prostate cancer?

Prostate cancer is a disease in which malignant (cancer) cells form in the tissues of the prostate. The prostate is a gland in the male reproductive system located just below the bladder (the organ that collects and empties urine) and in front of the rectum (the lower part of the intestine). It is about the size of a walnut and surrounds part of the urethra (the tube that empties urine from the bladder). The prostate gland produces fluid that makes up part of the semen.

Prostate cancer 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 function. The condition is called benign prostatic hyperplasia (BPH), and although it is not cancer, surgery may be needed to correct it. The symptoms of benign prostatic hyperplasia or of other problems in the prostate may be similar to symptoms for prostate cancer.

Possible signs of prostate cancer include a weak flow of urine or frequent urination.

These and other symptoms may be caused by prostate cancer or by other conditions. A doctor should be consulted if any of the following problems occur:

-Weak or interrupted flow of urine.
-Frequent urination (especially at night).
-Difficulty urinating.
-Pain or burning during urination.
-Blood in the urine or semen.
-Nagging pain in the back, hips, or pelvis.
-Painful ejaculation.

Tests that examine the prostate and blood are used to detect (find) and diagnose prostate cancer. The following tests and procedures may be used:

Digital rectal examination: The doctor or nurse inserts a lubricated gloved finger into the rectum and feels the prostate through the rectal wall for lumps or abnormal areas.

Prostate-specific antigen (PSA) test: A laboratory test that measures the levels of PSA in a blood sample. PSA is a substance produced by the prostate that may be found in an increased amount in the blood of men who have prostate cancer. PSA levels may also be high in men who have an infection or inflammation of the prostate, or benign prostatic hyperplasia (an enlarged, but non-cancerous, prostate).

Transrectal ultrasound: A procedure used to examine the prostate. An instrument is inserted into the rectum, and sound waves bounce off the prostate. These sound waves create echoes, which a computer uses to create a picture called a sonogram. Transrectal ultrasound may also be used during a biopsy procedure.

Biopsy: The removal of cells, tissues, or fluid to view under a microscope and check for signs of disease. There are 2 types of biopsy procedures used to diagnose prostate cancer:

Transrectal biopsy: A needle is inserted through the rectum into the prostate and a sample of prostate tissue is removed. This procedure is usually done using transrectal ultrasound to help guide the needle.

Transperineal biopsy: A needle is inserted through the skin between the scrotum and rectum into the prostate and a sample of prostate tissue is removed. A pathologist will examine the sample to check for cancer cells and determine the Gleason score. The Gleason score ranges from 2-10 and describes how likely it is that a tumor will spread. The lower the number, the less likely the tumor is to spread.

Certain factors affect treatment options and prognosis (chance of recovery). The treatment options and prognosis (chance of recovery) depend on the stage of the cancer (whether it affects part of the prostate, involves the whole prostate, or has spread to other places in the body), the Gleason score, the level of PSA, and the patient's age and general health.

Stages of Prostate Cancer

After prostate cancer has been diagnosed, tests are done to find out if cancer cells have spread within the prostate or to other parts of the body.
The process used to find out if cancer has spread within the prostate or to other parts of the body is called staging. The information gathered from the staging process determines the stage of the disease. It is important to know the stage in order to plan the best treatment. The following tests and procedures may be used in the staging process:

Radionuclide bone scan: A procedure used to create images of bones on a computer screen or on film. A small amount of radioactive material is injected into a blood vessel and travels through the bloodstream; it collects in the bones and is detected by a scanner.

MRI (magnetic resonance imaging): A procedure in which a magnet linked to a computer is used to create detailed pictures of areas inside the body. This test is also called nuclear magnetic resonance imaging (NMRI).

Pelvic lymphadenectomy: Lymph nodes in the pelvis may be removed to see if cancer has spread to them. Lymph nodes are small, bean-shaped structures that are found throughout the body. They filter substances in a fluid called lymph and help fight infection and disease.

CT scan (CAT scan): A CT scan creates a series of detailed pictures of areas inside the body, taken from different angles. The pictures are created by a computer linked to an x-ray machine. This test is also called computed tomography, computerized tomography, or computerized axial tomography.

Seminal vesicle biopsy: A needle is inserted into the seminal vesicles (glands that help produce semen) and fluid is removed and checked for cancer cells.

The results of these tests are viewed together with the results of the original tumor biopsy to determine the prostate cancer stage.

The following stages are used for prostate cancer:

Stage I
In stage I, cancer is found in the prostate only. It is usually found accidentally during surgery for other reasons, such as benign prostatic hyperplasia. Stage I prostate cancer may also be called stage A1 prostate cancer.

Stage II
In stage II, cancer is more advanced, but has not spread outside the prostate. Stage II prostate cancer may also be called stage A2, stage B1, or stage B2 prostate cancer.

Stage III
In stage III, cancer has spread beyond the outer layer of the prostate to nearby tissues. Cancer may be found in the seminal vesicles (glands that help produce semen). Stage III prostate cancer may also be called stage C prostate cancer.

Stage IV
In stage IV, cancer has metastasized (spread) to other parts of the body, such as the bladder, rectum, bone, liver, lungs, or to lymph nodes near or far from the prostate. Metastatic prostate cancer often spreads to the bones. Stage IV prostate cancer may also be called stage D1 or stage D2 prostate cancer.

Recurrent Prostate Cancer
Recurrent prostate cancer is cancer that has recurred (come back) after it has been treated. Recurrent prostate cancer may come back in the prostate or in other parts of the body.

Treatment Option Overview

There are different types of treatment for patients with prostate cancer. Different types of treatment are available for patients with prostate cancer. Some treatments are standard (the currently used treatment), and some are being tested in clinical trials. Before starting treatment, patients may want to think about taking part in a clinical trial. A treatment clinical trial is a research study meant to help improve current treatments or obtain information on new treatments for patients with cancer. When clinical trials show that a new treatment is better than the "standard" treatment, the new treatment may become the standard treatment.

Clinical trials are taking place in many parts of the country. Choosing the most appropriate cancer treatment is a decision that ideally involves the patient, family, and health care team.

Four types of standard treatment are used:

Watchful waiting
Watchful waiting is closely monitoring a patientís condition but withholding treatment until symptoms appear or change. This is usually used in older men with other medical problems and early stage disease.

Surgery
Patients in good health who are younger than 70 years old are usually offered surgery as treatment for prostate cancer. The following types of surgery are used:

-Pelvic lymphadenectomy: A surgical procedure to take out lymph nodes in the pelvis to see if they contain cancer. If the lymph nodes contain cancer, the doctor will not remove the prostate and may recommend other treatment.

-Radical prostatectomy: Surgery to remove the entire prostate. Radical prostatectomy is done only if tests show the cancer has not spread outside the prostate. The two types of radical prostatectomy are:

1.Retropubic prostatectomy: Surgery to remove the prostate through an incision made in the abdominal wall. Removal of surrounding lymph nodes (lymphadenectomy) can be done at the same time.
2.Perineal prostatectomy: Surgery to remove the prostate through an incision made between the scrotum and the anus. If surrounding lymph nodes are to be removed, this is usually done through a separate incision.

-Transurethral resection of the prostate: A surgical procedure to remove tissue from the prostate using an instrument inserted through the urethra. This operation is sometimes done to relieve symptoms caused by the tumor before other treatment is given. Transurethral resection of the prostate may also be done in men who cannot have a radical prostatectomy because of age or illness.

Impotence and leakage of urine from the bladder or stool from the rectum may occur in men treated with surgery. In some cases, doctors can use a technique known as nerve-sparing surgery. This type of surgery may save the nerves that control erection. However, men with large tumors or tumors that are very close to the nerves may not be able to have this surgery.

Radiation therapy
Radiation therapy is the use of x-rays or other types of radiation to kill cancer cells and shrink tumors. Radiation therapy may use external radiation (using a machine outside the body) or internal radiation. Internal radiation involves putting radioisotopes (materials that produce radiation) through thin plastic tubes into the area where cancer cells are found. Prostate cancer is treated with external and internal (implant) radiation. Radiation therapy may be used alone or in addition to surgery.

Impotence and urinary problems may occur in men treated with radiation therapy.

Hormone therapy
Hormones are chemicals produced by glands in the body and circulated in the bloodstream. Hormone therapy is the use of hormones to stop cancer cells from growing. Male hormones (especially testosterone) can help prostate cancer grow. To stop the cancer from growing, female hormones or drugs that decrease production of male hormones may be given.

Hormone therapy used in the treatment of prostate cancer may include the following:

Estrogens (hormones that promote female sex characteristics) can prevent the testicles from producing testosterone. However, estrogens are seldom used today in the treatment of prostate cancer because of the risk of serious side effects. Luteinizing hormone-releasing hormone agonists also can prevent the testicles from producing testosterone. Examples are leuprolide, goserelin, and buserelin. Antiandrogens can block the action of androgens (hormones that promote male sex characteristics). Two examples are flutamide and bicalutamide.
Drugs that can prevent the adrenal glands from making androgens include ketoconazole and aminoglutethimide.

Orchiectomy is surgery to remove the testicles, the main source of male hormones, to decrease hormone production.

Hot flashes, impaired sexual function, and loss of desire for sex may occur in men treated with hormone therapy.

Other types of treatment are being tested in clinical trials.

Cryosurgery
Cryosurgery is performed with an instrument that freezes and destroys prostate cancer cells. This treatment is being studied as an alternative to conventional surgery and radiation therapy.

Chemotherapy
Chemotherapy is the use of drugs to kill cancer cells. Chemotherapy may be taken by mouth, or it may be put into the body by inserting a needle into a vein or muscle. Either type of chemotherapy is called systemic treatment because the drugs enter the bloodstream, travel through the body, and can kill cancer cells throughout the body.

Biological therapy
Biological therapy is treatment to stimulate the ability of the immune system to fight cancer. Substances made by the body or made in a laboratory are used to boost, direct, or restore the body's natural defenses against disease. Biological therapy is sometimes called biological response modifier (BRM) therapy or immunotherapy.

This summary section refers to specific treatments under study in clinical trials, but it may not mention every new treatment being studied.

Treatment Options By Stage

Stage I Prostate Cancer
Treatment of stage I prostate cancer may include the following:

1.Watchful waiting.
2.External-beam radiation therapy.
3.Radical prostatectomy, usually with pelvic lymphadenectomy, with or without radiation therapy after surgery. It may be possible to remove the prostate without damaging nerves that are necessary for an erection.
4.Implant radiation therapy.
5.A clinical trial of radiation therapy.
6.A clinical trial evaluating new treatment options.

This summary section refers to specific treatments under study in clinical trials, but it may not mention every new treatment being studied.

Stage II Prostate Cancer
Treatment of stage II prostate cancer may include the following:

1.Watchful waiting.
2.External-beam radiation therapy.
3.Radical prostatectomy, usually with pelvic lymphadenectomy, with or without radiation therapy after surgery. It may be possible to remove the prostate without damaging nerves that are necessary for an erection.
4.Implant radiation therapy.
5.A clinical trial of radiation therapy.
6.A clinical trial of ultrasound-guided cryosurgery.
7.A clinical trial of hormone therapy followed by radical prostatectomy.
8.A clinical trial evaluating new treatment options.

This summary section refers to specific treatments under study in clinical trials, but it may not mention every new treatment being studied.

Stage III Prostate Cancer
Treatment of stage III prostate cancer may include the following:

1.External-beam radiation therapy with or without hormone therapy.
2.Hormone therapy.
3.Radical prostatectomy, usually with pelvic lymphadenectomy, with or without radiation therapy after surgery.
4.Watchful waiting.
5.Transurethral resection of the prostate as palliative therapy to relieve symptoms caused by the cancer.
6.A clinical trial of radiation therapy.
7.A clinical trial of ultrasound-guided cryosurgery.
8.A clinical trial evaluating new treatment options.

This summary section refers to specific treatments under study in clinical trials, but it may not mention every new treatment being studied.

Stage IV Prostate Cancer
Treatment of stage IV prostate cancer may include the following:

1.Hormone therapy.
2.External-beam radiation therapy with or without hormone therapy.
3.Radiation therapy or transurethral resection of the prostate as palliative therapy to relieve symptoms caused by the cancer.
4.Watchful waiting.
5.A clinical trial of radical prostatectomy with orchiectomy.
6.A clinical trial of chemotherapy.

This summary section refers to specific treatments under study in clinical trials, but it may not mention every new treatment being studied.

Treatment Options for Recurrent Prostate Cancer

Treatment of recurrent prostate cancer may include the following:

1.Radiation therapy.
2.Prostatectomy for patients initially treated with radiation therapy.
3.Hormone therapy.
4.Pain medication, external radiation therapy, internal radiation therapy with radioisotopes such as strontium-89, or other treatments as palliative therapy to lessen bone pain.
5.A clinical trial of ultrasound-guided cryosurgery.
6.A clinical trial of chemotherapy or biological therapy.

This summary section refers to specific treatments under study in clinical trials, but it may not mention every new treatment being studied.






The information on this page was obtained from the National Cancer Institute. The National Cancer Institute provides accurate, up-to-date information on many types of cancer, information on clinical trials, resources for people dealing with cancer, and information for researchers and health professionals.

The National Cancer Institute is in no way affiliated with the Mary Stolfa Cancer Foundation.

The information on this web site is provided for general information only. It is not intended as medical advice, and should not be relied upon as a substitute for consultations with qualified health professionals who are familiar with your individual medical needs. The MSCF disclaims all obligations and liabilities for damages arising from the use or attempted use of the information, including but not limited to direct, indirect, special, and consequential damages, attorneys' and experts' fees and court costs. Any use of the information will be at the risk of the user.





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