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«What You Need To Know About TM Prostate Cancer U.S. DEPARTMENT OF HEALTH AND HUMAN SERVICES National Institutes of Health For more publications This ...»

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National Cancer Institute

What You Need

To Know About






National Institutes of Health

For more publications

This is only one of many free booklets for

people with cancer.

Here’s how to get other National Cancer

Institute (NCI) booklets:

• Call the NCI’s Cancer Information Service

at 1–800–4–CANCER (1–800–422–6237)

• Go to the NCI’s Web site at http://www.cancer.gov/publications For materials in Spanish

Here’s how to get NCI materials in Spanish:

• Call the NCI’s Cancer Information Service at 1–800–422–6237

• Go to the NCI’s Web site at http://www.cancer.gov/espanol Contents About This Booklet 1 The Prostate 2 Prostate Cancer Cells 2 Risk Factors 5 Symptoms 7 Detection and Diagnosis 8 Staging 12 Treatment 14 Second Opinion 28 Nutrition and Physical Activity 29 Follow-up Care 30 Sources of Support 31 Taking Part in Cancer Research 32 Dictionary 35 National Cancer Institute Information Resources 50 National Cancer Institute Publications 51 U.S. DEPARTMENT OF


National Institutes of Health National Cancer Institute About This Booklet This National Cancer Institute (NCI) booklet is about cancer* of the prostate. Each year, more than 186,000 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. This booklet tells about:

• Diagnosis and staging • Treatment options • Tests you may have after treatment • Taking part in research studies This booklet has lists of questions that you may want to ask your doctor. Many people find it helpful to take a list of questions to a doctor visit. To help remember what your doctor says, you can take notes or ask whether you may use a tape recorder. You may also want to have a family member or friend go with you when you talk with the doctor—to take notes, ask questions, or just listen.

For the latest information about prostate cancer, please visit our Web site at http://www.cancer.gov/ cancertopics/types/prostate. Or, contact our Cancer Information Service. We can answer your questions about cancer. We can also send you NCI booklets and fact sheets. Call 1–800–4–CANCER (1–800–422–6237) or instant message us through the LiveHelp service at http://www.cancer.gov/help.

*Words in italics are in the Dictionary on page 35. The Dictionary explains these terms. It also shows how to pronounce them.

–  –  –

The prostate is part of a man’s reproductive system.

It’s an organ located in front of the rectum and under the bladder. The prostate surrounds the urethra, the tube through which urine flows.

A healthy prostate is about the size of a walnut. If the prostate grows too large, it squeezes the urethra.

This may slow or stop the flow of urine from the bladder to the penis.

The prostate is a gland. It makes part of the seminal fluid. During ejaculation, the seminal fluid helps carry sperm out of the man’s body as part of semen.

Male hormones (androgens) make the prostate grow.

The testicles are the main source of male hormones, including testosterone. The adrenal gland also makes testosterone, but in small amounts.

Prostate Cancer Cells

Cancer begins in cells, the building blocks that make up tissues. Tissues make up the organs of the body.

Normal cells grow and divide to form new cells as the body needs them. When normal cells grow old or get damaged, they die, and new cells take their place.

Sometimes, this process goes wrong. New cells form when the body doesn’t need them, and old or damaged cells don’t die as they should. The buildup of extra cells often forms a mass of tissue called a growth or tumor.

–  –  –

Benign prostatic hyperplasia (BPH) is a benign growth of prostate cells. It is not cancer.

The prostate grows larger and squeezes the urethra. This prevents the normal flow of urine.

BPH is a very common problem. In the United States, most men over the age of 50 have symptoms of BPH. For some men, the symptoms may be severe enough to need treatment.

To learn about BPH and other prostate changes that are not cancer, read NCI’s booklet Understanding Prostate Changes: A Health Guide for Men.

Benign growths are not as harmful as malignant


• Benign growths (such as BPH):

—are rarely a threat to life —can be removed and probably won’t grow back —don’t invade the tissues around them —don’t spread to other parts of the body • Malignant tumors:

—may be a threat to life —often can be removed, but sometimes grow back —can invade and damage nearby tissues and organs —can spread to other parts of the body 4 Cancer cells can spread by breaking away from the prostate tumor. They enter blood vessels or lymph vessels, which branch into all the tissues of the body.

The cancer cells can attach to other tissues and grow to form new tumors that may damage those tissues. The spread of cancer is called metastasis. See the Staging section on page 12 for information about prostate cancer that has spread.

Risk Factors

When you’re told you have prostate cancer, it’s natural to wonder what may have caused the disease.

But no one knows the exact causes of prostate cancer.

Doctors seldom know why one man develops prostate cancer and another doesn’t.

However, research has shown that men with certain risk factors are more likely than others to develop prostate cancer. A risk factor is something that may increase the chance of getting a disease.

Studies have found the following risk factors for

prostate cancer:

• Age over 65: Age is the main risk factor for prostate cancer. The chance of getting prostate cancer increases as you get older. In the United States, most men with prostate cancer are over 65. This disease is rare in men under 45.

• Family history: Your risk is higher if your father, brother, or son had prostate cancer.

• Race: Prostate cancer is more common among black men than white or Hispanic/Latino men. It’s less common among Asian/Pacific Islander and American Indian/Alaska Native men.

5 • Certain prostate changes: Men with cells called high-grade prostatic intraepithelial neoplasia (PIN) may be at increased risk of prostate cancer. These prostate cells look abnormal under a microscope.

• Certain genome changes: Researchers have found specific regions on certain chromosomes that are linked to the risk of prostate cancer. According to recent studies, if a man has a genetic change in one or more of these regions, the risk of prostate cancer may be increased. The risk increases with the number of genetic changes that are found. Also, other studies have shown an elevated risk of prostate cancer among men with changes in certain genes, such as BRCA1 and BRCA2.

Having a risk factor doesn’t mean that a man will develop prostate cancer. Most men who have risk factors never develop the disease.

Many other possible risk factors are under study. For example, researchers have studied whether vasectomy (surgery to cut or tie off the tubes that carry sperm out of the testicles) may pose a risk, but most studies have found no increased risk. Also, most studies have shown that the chance of getting prostate cancer is not increased by tobacco or alcohol use, BPH, a sexually transmitted disease, obesity, a lack of exercise, or a diet high in animal fat or meat. Researchers continue to study these and other possible risk factors.

Researchers are also studying how prostate cancer may be prevented. For example, they are studying the possible benefits of certain drugs, vitamin E, selenium, green tea extract, and other substances. These studies are with men who have not yet developed prostate cancer.

6 Symptoms

A man with prostate cancer may not have any symptoms. For men who do have symptoms, the

common symptoms include:

• Urinary problems —Not being able to pass urine —Having a hard time starting or stopping the urine flow —Needing to urinate often, especially at night —Weak flow of urine —Urine flow that starts and stops —Pain or burning during urination • Difficulty having an erection • Blood in the urine or semen • Frequent pain in the lower back, hips, or upper thighs Most often, these symptoms are not due to cancer.

BPH, an infection, or another health problem may cause them. If you have any of these symptoms, you should tell your doctor so that problems can be diagnosed and treated.

7 Detection and Diagnosis

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:

• Digital rectal exam: Your doctor inserts a lubricated, gloved finger into the rectum and feels your prostate through the rectal wall. Your prostate is checked for hard or lumpy areas.

• Blood test for prostate-specific antigen (PSA): A lab checks the level of PSA in your blood sample.

The prostate makes PSA. A high PSA level is commonly caused by BPH or prostatitis (inflammation of the prostate). Prostate cancer may also cause a high PSA level. See the NCI fact sheet The Prostate-Specific Antigen (PSA) Test: Questions and Answers.

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:

8 • Transrectal ultrasound: The doctor inserts a probe into the rectum to check your prostate for abnormal areas. The probe sends out sound waves that people cannot hear (ultrasound). The waves bounce off the prostate. A computer uses the echoes to create a picture called a sonogram.

• Transrectal biopsy: A biopsy is the removal of tissue to look for cancer cells. It’s the only sure way to diagnose prostate cancer. The doctor inserts needles through the rectum into the prostate. The doctor removes small tissue samples (called cores) from many areas of the prostate. Transrectal ultrasound is usually used to guide the insertion of the needles. A pathologist checks the tissue samples for cancer cells.

9 You may want to ask the doctor these questions before having a transrectal ultrasound

or biopsy:

• Where will the procedure take place? Will I have to go to the hospital?

• How long will it take? Will I be awake?

• Will it hurt? Will I need local anesthesia?

• What are the risks? What are the chances of infection or bleeding afterward?

• How do I prepare for it? Will I need to avoid taking aspirin to reduce the chance of bleeding? Will I need an enema before the procedure?

• How long will it take me to recover? Will I be given an antibiotic or other medicine afterward?

• How soon will I know the results? If a biopsy is done, will I get a copy of the pathology report?

• If I do have cancer, who will talk to me about the next steps? When?

If Cancer Is Not Found If cancer cells are not found in the biopsy sample, ask your doctor how often you should have checkups.

Information about BPH and other benign prostate problems can be found in the NCI booklet Understanding Prostate Changes: A Health Guide for Men.

10 If Cancer Is Found 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.

For more about tumor grade, see the NCI fact sheet Tumor Grade: Questions and Answers.

11 Staging

If the biopsy shows that you have cancer, your doctor needs to learn the extent (stage) of the disease to help you choose the best treatment. Staging is a careful attempt to find out whether the tumor has invaded nearby tissues, whether the cancer has spread and, if so, to what parts of the body.

Some men may need tests that make pictures of the


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