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.
Cancer that forms in tissues of the prostate (a gland in the male reproductive system found below the bladder and in front of the rectum). Prostate cancer usually occurs in older men.
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:
Having a risk factor doesn't mean that a man will develop prostate cancer. Most men who have risk factors never develop the disease.
A man with prostate cancer may not have any symptoms. For men who do have symptoms, the common symptoms include:
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.
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:
You may want to ask the doctor these questions before having a transrectal ultrasound or biopsy:
Men with prostate cancer have many treatment options. The treatment that's best for one man may not be best for another. The options include active surveillance (also called watchful waiting), surgery, radiation therapy, hormone therapy, and chemotherapy. You may have a combination of treatments.
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 want to ask your doctor these questions before choosing your treatment:
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.
You may want to ask your doctor these questions before choosing active surveillance:
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:
You may be uncomfortable for the first few days or weeks after surgery. However, medicine can help control the pain. Before surgery, you should discuss the plan for pain relief with your doctor or nurse. After surgery, your doctor can adjust the plan if you need more pain relief.
The time it takes to heal after surgery is different for each man and depends on the type of surgery. You may be in the hospital for one to three days.
After surgery, the urethra needs time to heal. You'll have a catheter. A catheter is a tube put through the urethra into the bladder to drain urine. You'll have the catheter for 5 days to 3 weeks. Your nurse or doctor will show you how to care for it.
After surgery, some men may lose control of the flow of urine (urinary incontinence). Most men regain at least some bladder control after a few weeks.
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.
You may want to ask your doctor these questions before choosing 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:
Side effects depend mainly on the dose and type of radiation. You're likely to be very tired during radiation therapy, especially in the later weeks of treatment. Resting is important, but doctors usually advise patients to try to stay active, unless it leads to pain or other problems.
If you have external radiation, you may have diarrhea or frequent and uncomfortable urination. Some men have lasting bowel or urinary problems. Your skin in the treated area may become red, dry, and tender. You may lose hair in the treated area. The hair may not grow back.
Internal radiation therapy may cause incontinence. This side effect usually goes away.
Both internal and external radiation can cause impotence. You can talk with your doctor about ways to help cope with this side effect.
You may find it helpful to read the NCI booklet Radiation Therapy and You.
You may want to ask your doctor these questions before choosing radiation therapy:
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.
Hormone therapy causes side effects such as impotence, hot flashes, and loss of sexual desire. Also, any treatment that lowers hormone levels can weaken your bones. Your doctor can suggest medicines that may reduce your risk of bone fractures.
An LH-RH agonist may make your symptoms worse for a short time at first. This temporary problem is called "flare." To prevent flare, your doctor may give you an antiandrogen for a few weeks along with the LH-RH agonist.
An LH-RH agonist such as leuprolide can increase body fat, especially around the waist. The levels of sugar and cholesterol in your blood may increase too. Because these changes increase the risk of diabetes and heart disease, your health care team will monitor you for these side effects.
Antiandrogens (such as nilutamide) can cause nausea, diarrhea, or breast growth or tenderness. Rarely, they may cause liver problems (pain in the abdomen, yellow eyes, or dark urine). Some men who use nilutamide may have shortness of breath or develop heart failure. Some may have trouble adjusting to sudden changes in light.
If you receive total androgen blockade, you may have more side effects than if you have just one type of hormone treatment.
If used for a long time, ketoconazole may cause liver problems, and aminoglutethimide can cause skin rashes.
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.
You may want to ask your doctor these questions before choosing hormone therapy:
Chemotherapy may be used for prostate cancer that has spread and no longer responds to hormone therapy.
Chemotherapy uses drugs to kill cancer cells. The drugs for prostate cancer are usually given through a vein (intravenous). You may receive chemotherapy in a clinic, at the doctor's office, or at home. Some men need to stay in the hospital during treatment.
The side effects depend mainly on which drugs are given and how much. Chemotherapy kills fast-growing cancer cells, but the drugs can also harm normal cells that divide rapidly:
Other side effects include shortness of breath and a problem with your body holding extra water. Your health care team can give you medicine to protect against too much water building up in the body. Also, chemotherapy may cause a skin rash, tingling or numbness in your hands and feet, and watery eyes. Your health care team can suggest ways to control many of these problems. Most go away when treatment ends.