Here are some answers to frequently asked questions about prostate cancer.
Q: What is the prostate?
A: The prostate is a male sex gland that produces a thick fluid that forms part of the semen.
The prostate is about the size of a walnut, although it can grow larger. It's located below the bladder and in front of the rectum. It surrounds the upper part of the urethra, the tube that empties urine from the bladder. The prostate needs male hormones, including testosterone, to function.
Q: What causes prostate cancer?
A: The exact cause of prostate cancer is not known. Men whose close relatives have had prostate cancer are more likely to get it, suggesting that there are genetic factors. Some studies have found that diets high in red meat or high-fat dairy products seem to slightly increase risk. Studies are being done to see if exposure to certain materials, such as the metal cadmium, increases the risk of developing prostate cancer.
Q: What are the symptoms of prostate cancer?
A: Many men have no symptoms. The cancer is often found during a digital rectal examination (DRE) or a PSA blood test. These are the most common symptoms of prostate cancer (although prostate symptoms are more commonly caused by non-cancerous conditions, such as BPH):
A need to urinate often, especially at night
Weak or interrupted urine flow
Difficulty starting urination or holding back urine
Inability to urinate
Painful or burning urination
Blood in urine or semen
Pain or stiffness in the lower back, hips, or upper thighs
Prostate cancer that has spread to the bones may show up as bone pain, usually in the hips or back.
Q: How is a digital rectal examination done?
A: For a digital rectal exam (DRE), you bend over and the doctor or nurse practitioner inserts a lubricated, gloved finger into your rectum. The examiner can feel your prostate through the rectal wall. He or she will check for hard or lumpy areas.
Q: What does PSA mean?
A: PSA stands for "prostate-specific antigen." The PSA test measures the levels of PSA in the blood. PSA is produced by prostate tissue, whether it's normal or cancerous. The level of PSA in the blood may rise in men who have prostate cancer, BPH (an enlargement of the prostate), or an infection in the prostate. The function of PSA is not yet fully understood, but it doesn't seem to cause harm even when the blood level is very high. PSA does not cause the cancer to grow or spread. A doctor cannot diagnose prostate cancer with the PSA test alone, since elevated PSA level may also indicate other, noncancerous problems. However, the doctor will take the results of the PSA test into account when deciding whether to check further for signs of cancer.
Some doctors use the PSA blood test to screen for prostate cancer in men who don't have any symptoms. But it's not always clear how helpful this test is, and having the test can sometimes cause problems. Many expert groups recommend that men discuss the pros and cons of this test with their doctor before deciding whether to be screened for prostate cancer.
Q: What are considered normal PSA levels?
A: In men without prostate cancer, most doctors consider a normal test range to be from 0 to 4 ng/mL. This range changes slightly with age and race. When a man gets older, the normal range increases. A result of less than 4 is generally considered normal. Test results higher than 4 ng/mL are of concern, and suggest that further tests, such as a repeat PSA or a biopsy of the prostate, may be needed. Since PSA is a screening tool, it cannot tell the difference between cancer and other diseases of the prostate. However, a prostate biopsy can help tell the difference between cancer and other diseases of the prostate.
Q: What is a prostate biopsy?
A: A biopsy is a sample of tissue that is looked at under a microscope for cancer cells. Your urologist can take tissue samples from your prostate, often right in his or her office. Most of the time, the doctor performs the biopsy by inserting a needle through the perineum into the prostate. The perineum is the area between the anus and the testicles. The doctor usually uses a rectal ultrasound to help guide the needle into the prostate. To get a good tissue sampling, the doctor usually takes about 12 needle biopsies at the same time.
Q : What is staging?
A: Staging is the process of finding out how far a cancer has spread in the body. Staging involves several types of tests to see if the cancer can be detected beyond the prostate gland. It can spread to tissue nearby or to other organs further away. A doctor may use blood tests, X-rays, CT or MRI scans, and nuclear medicine scans to help determine the cancer's stage.
Q: What is the Gleason score?
A: The Gleason score is the most common system for grading prostate cancer. The pathologist looks at the biopsy specimen under a microscope. That allows him or her to determine the grade. Cancerous tissue that looks similar to the normal prostate is given a low grade. Abnormal, fast-growing tissue is given a high grade. The pathologist reports a final Gleason score between 2 and 10. Prostate cancers with low scores are less likely to spread to other organs than those with high scores.
Q: What parts of the body can prostate cancer spread to?
A: Prostate cancer can spread and form tumors in other parts of the body. When prostate cancer spreads, it often shows up in nearby lymph nodes first and then travels to the bones. It can also spread to the liver, bladder, and other organs.
Q: How is prostate cancer treated?
A: Not all men with prostate cancer need treatment. For those who do, there are a number of available treatments, including surgery, external radiation therapy, brachytherapy, hormone therapy, chemotherapy, and a prostate cancer vaccine. The doctor suggests a treatment plan to fit each man's needs based on the cancer's stage, the man's age, general health, and his feelings about the treatments and their possible side effects. A doctor will also be able to discuss the option of the patient taking part in a research study or clinical trial.
Q: What is watchful waiting?
A: There are times when it may be in the man's best interest not to treat the prostate cancer. For example, in older men whose prostate cancer is slow growing and found at an early stage, the possible side effects and risks of treatment may outweigh its possible benefits. In those cases, the doctor may suggest watchful waiting (also known as active surveillance). That means following the patient closely and treating him if it looks like the cancer is growing or if symptoms arise. Watchful waiting is a method of treatment and should not be considered "doing nothing."
Q: Should everyone get a second opinion?
A: Many people with cancer get a second opinion from another doctor. There are many reasons to get a second opinion. Here are some of those reasons:
Not feeling comfortable with the treatment decision
Being diagnosed with a rare type of cancer
Having several options for how to treat the cancer
Not being able to see a cancer expert
Q: How can someone get a second opinion?
A: There are many ways to get a second opinion:
Ask your primary care doctor. A person's doctor may be able to suggest a specialist. This may be a surgeon, medical oncologist, or radiation oncologist. Sometimes, these doctors work together at cancer centers or hospitals. Do not be afraid to ask your doctor about a second opinion.
Call the National Cancer Institute's Cancer Information Service. The number is 800-4-CANCER (800-422-6237). They have information about treatment facilities. These include cancer centers and other programs supported by the National Cancer Institute.
Seek other options. Check with a local medical society, a nearby hospital or medical school, or cancer advocacy group to get names of doctors who can give you a second opinion. Or ask other people who have had cancer to refer you to someone.
Q: What is a prostatectomy?
A: A prostatectomy is surgery that removes all or part of the prostate. Surgery to remove the entire prostate is called radical prostatectomy. It's done in one of three ways:
In retropubic prostatectomy, the surgeon removes the prostate and nearby lymph nodes through an incision in the abdomen.
In perineal prostatectomy, the surgeon removes the prostate through an incision between the scrotum and the anus. The doctor may also remove nearby lymph nodes through a separate incision in the abdomen.
A surgeon does a laparoscopic prostatectomy through small incisions in the abdomen with a small scope and long, thin surgical tools. This is often done with the surgeon sitting at a control panel and controlling precise robotic arms.
Q: Is incontinence or dribbling of urine a long-term side effect of prostate surgery?
A: Unfortunately, it may take time for some men to regain control of their bladder after surgery for prostate cancer. As healing continues, incidences of incontinence or dribbling usually decrease, although some men may have long-term problems. Exercises to build muscle strength should help lessen the problem and may make it go away completely.
Q : How will prostate cancer surgery affect me sexually?
A: Impotence is not being able to have an erection. It's the most common side effect of prostate cancer surgery. A technique called nerve-sparing surgery can sometimes prevent permanent injury to the nerves that control erection, but it may not be an option in all cases. If a man regains the ability to have an erection, it may take up to two years after surgery. If the nerves connected to the tissue that controls erection have to be removed, permanent impotence will result.
Q: What options are available for men who suffer from impotence as a result of prostate cancer surgery?
A: Treatments can often help men who have impotence due to surgery for prostate cancer. Pills, injections, and vacuum pumps may help some men. If these are not helpful, different prostheses have been developed that can be implanted to aid in the return to normal sexual function. Doctors usually recommend waiting at least six months after the surgery to see if sexual function will return on its own before getting an implant.
Q: Does a prostatectomy cause sterility?
A: Yes. Sterility is the inability to father a child. It results from the removal of the prostate and the nearby seminal vesicles. The prostate gland helps create most of the fluid released during sexual intercourse and climax. The seminal vesicles also make some of the fluid. Therefore, men who have a prostatectomy no longer produce semen, so they have dry orgasms. This means that they cannot impregnate a woman.
Q: How can prostate cancer spread if my doctor "got it all" with surgery or radiation therapy?
A: Even the best treatment for prostate cancer may not remove or kill every last cancer cell in the body. Staging studies are done as part of the initial treatment planning to see if the cancer has spread or not. But it's important to remember that the best scans and X-rays can't look into the body like a microscope. Sometimes a few cells have escaped to other parts of the body, even if they can't be detected. These cells may grow over months or years to cause problems later. The doctor uses the tumor grade and staging tests to estimate how likely this is to happen for each patient.
Q: What is external radiation therapy for prostate cancer?
A: External radiation is often an option to treat prostate cancer that hasn't spread to distant parts of the body. This treatment is a lot like getting an X-ray, although the radiation is stronger. You lie on a table while radiation is aimed at the cancer, usually from several different angles. Treatments are usually given five days a week over several weeks. The effectiveness and major side effects of radiation therapy are similar to those for surgery, although each type of treatment has its own advantages and drawbacks. It's important to understand these before deciding on a treatment for prostate cancer.
Q: What is brachytherapy for prostate cancer?
A: Brachytherapy is a form of internal radiation therapy. For it, a doctor implants radioactive pellets or seeds in the prostate. The seeds kill cancer cells. Patients selected for brachytherapy usually have a lower Gleason score, lower PSA levels, and tumors that have not spread to other parts of the body.
Q: What is hormone therapy for prostate cancer?
A: Hormone therapy blocks the prostate cancer cells from getting the male hormones, including testosterone, they need to grow. When a man has hormone therapy, the level of testosterone is decreased. This drop in testosterone can affect all prostate cancer cells, even if they have spread to other parts of the body. There are several forms of hormone therapy. One is surgery to remove the testicles. Another is taking medicines to prevent the testicles from producing testosterone or to stop prostate cancer cells from being able to use it.
Q: What is chemotherapy for prostate cancer?
A: Chemotherapy is the use of drugs that kill cancer cells. This type of treatment is most often used for advanced prostate cancer that's no longer responding to hormone therapy. Chemotherapy can sometimes cause side effects such as nausea, vomiting, mouth sores, or hair loss. The side effects depend on the type of drug and the doses used.
Q: What is vaccine therapy for prostate cancer?
A: A vaccine is available to help some men with advanced prostate cancer that's no longer responding to hormone therapy. The vaccine boosts the body's immune system to help it fight the cancer. It is given as a series of three infusions into a vein. Side effects from the vaccine tend to be mild.
Q: Are there support groups for men with prostate cancer?
A: Yes. Support groups specifically for men dealing with prostate cancer are held all over the United States. Having someone to talk with who is going through similar experiences is often helpful. Support groups also offer patients information on treatment options, prognosis, and follow-up care. Your doctor can recommend one in your area.