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PROSTATE CANCER
Comprehensive, oncologist-
approved cancer information
from the American Society
of Clinical Oncology (ASCO)
www.cancer.net
The best cancer care starts with the best cancer information.
Well-informed patients are their own best advocates and
invaluable partners for physicians. ASCO’s patient education
materials are available both in print and online to provide
trusted, authoritative information for people living with cancer
and those who care for and about them.
TABLE OF CONTENTS
Overview..................................................................................2
About the prostate gland......................................................2
Types of prostate cancer........................................................2
Statistics...................................................................................3
Symptoms.................................................................................7
Diagnosis..................................................................................7
Staging.....................................................................................9
Cancer stage grouping........................................................10
Prognostic factors............................................................... 11
Treatment............................................................................... 12
Active surveillance (watchful waiting)................................... 13
Surgery............................................................................... 13
Radiation therapy................................................................14
Hormone therapy................................................................15
Chemotherapy.................................................................... 17
Advanced prostate cancer...................................................18
Side Effects.............................................................................20
After Treatment......................................................................21
Current Research.....................................................................22
The ideas and opinions expressed in the Guide to Prostate Cancer do not
necessarily reflect the opinions of ASCO or The ASCO Cancer Foundation.
The information in this guide is not intended as medical or legal advice, or
as a substitute for consultation with a physician or other licensed health
care provider. Patients with health care-related questions should call or
see their physician or other health care provider promptly, and should
not disregard professional medical advice, or delay seeking it, because of
information encountered here. The mention of any product, service, or
treatment in this guide should not be construed as an ASCO endorsement.
ASCO is not responsible for any injury or damage to persons or property
arising out of or related to any use of ASCO’s patient education materials,
or to any errors or omissions.
1
OVERVIEW
Cancer begins when normal cells in the prostate begin to
change and grow uncontrollably, forming a mass called a tumor.
A tumor can be benign (noncancerous) or malignant (cancerous,
meaning it can spread to other parts of the body).
Anatomical and staging illustrations for many types of cancer are available at
www.cancer.net.
2 OVERVIEW
cancer tends to spread earlier but usually does not make
prostate-specific antigen (PSA), a tumor marker discussed later
in the Risk Factors and Prevention section. Read more about
neuroendocrine tumors at www.cancer.net/neuroendocrine.
STATISTICS
Prostate cancer is the most common cancer and the second
leading cause of cancer death in men. Although the number
of deaths from prostate cancer is declining among all men, the
death rate remains more than twice as high in black men than
in white men.
More than 90% of all prostate cancers are found when the
disease is located only in the prostate and nearby organs. Nearly
all men who develop prostate cancer are expected to live at
least five years after diagnosis. The 10-year and 15-year relative
survival rates (the percentage of people who survive at least 10
or 15 years after the cancer is detected, excluding those who
die from other diseases) are 91% and 76%, respectively. These
survival rates are a combination of early-stage and later-stage
prostate cancers; a man’s individual survival depends on the
type of prostate cancer and the stage of the disease.
Find out more about basic cancer terms used in this section at www.cancer.net/
dictionaryresources.
SYMPTOMS
Often, prostate cancer is found through a PSA test or DRE (see
Risk Factors and Prevention) in otherwise healthy men who
have not had any symptoms or signs. When prostate cancer
does cause symptoms or signs, they may include the following:
• Frequent urination
• Weak or interrupted urine flow
• Blood in the urine
• The urge to urinate frequently at night
• Blood in the seminal fluid
• Pain or burning during urination (much less common)
DIAGNOSIS
Doctors use many tests to diagnose cancer and find out if
it has metastasized. Some tests may also determine which
treatments may be the most effective. For most types of
cancer, a biopsy is the only way to make a definitive diagnosis
of cancer. If a biopsy is not possible, the doctor may suggest
other tests that will help make a diagnosis, but this situation
is rare for prostate cancer. For example, a biopsy may not be
If the PSA or DRE test results are abnormal, the following tests
can confirm a diagnosis of cancer:
8 DIAGNOSIS
vein. It collects in areas of the bone and is detected by a special
camera. Healthy bone appears gray to the camera, and areas of
injury, such as those caused by cancer, appear dark.
Learn more about what to expect when having common tests, procedures, and
scans at www.cancer.net/tests.
Find out more about common terms used during a diagnosis of cancer at
www.cancer.net/dictionaryresources.
STAGING
Staging is a way of describing
a cancer, such as where it is
located, if or where it has spread,
and if it is affecting the functions
of other organs in the body.
Doctors use diagnostic tests to
determine the cancer’s stage,
so staging may not be complete
until all of the tests are finished.
Staging for prostate cancer also involves reviewing test results
to determine if the cancer has spread from the prostate to other
parts of the body. Knowing the stage helps the doctor decide
what kind of treatment is best and can help predict a patient’s
prognosis (chance of recovery). There are different stage
descriptions for different types of cancer.
One tool that doctors use to describe the stage is the TNM
system, developed by the American Joint Committee on Cancer
STAGING 9
(AJCC) and the Union International Contre le Cancer (UICC).
This system is most commonly used in the United States and
uses three criteria to judge the stage of the cancer: the tumor
itself, the lymph nodes around the tumor, and if the tumor has
spread to other parts of the body. The results are combined
to determine the stage of cancer for each person. There are
four stages: stages I through IV (one through four). The stage
provides a common way of describing the cancer, so doctors
can work together to plan the best treatments.
Tumor. Using the TNM system, the “T” plus a letter or number
(0 to 4) is used to describe the size and location of the tumor.
Some stages are also divided into smaller groups that help
describe the tumor in even more detail.
Nodes. The “N” in the TNM staging system stands for lymph
nodes, the tiny, bean-shaped organs that help fight infection.
Lymph nodes near the prostate in the pelvic region are called
regional lymph nodes. Lymph nodes in other parts of the body
are called distant lymph nodes.
Stage IIA and IIB: This stage describes a tumor that is too small
to be felt or seen on imaging tests. Or, it describes a slightly
larger tumor that can be felt during a DRE. The cancer has not
10 STAGING
spread outside of the prostate gland, but the cells are usually
more abnormal and may tend to grow more quickly. It has not
spread to lymph nodes or distant organs.
Stage III: The cancer has spread beyond the outer layer of
the prostate into nearby tissues. It may also have spread to the
seminal vesicles, the glands in men that help make semen.
Stage IV: This stage describes any tumor that has spread to
other areas of the body, such as the bladder, rectum, bone, liver,
lungs, or lymph nodes.
Anatomical and staging illustrations for many types of cancer are available at
www.cancer.net.
Prognostic Factors
In addition to stage, doctors use other prognostic factors
to help plan the best treatment and predict how successful
treatment will be. Below are prognostic factors for patients with
prostate cancer.
STAGING 11
scores are added to come up with an overall score between
2 and 10. The interpretation of the Gleason score by doctors
has changed recently. Originally, there was a broader spread,
with doctors using a range of scores. Today, doctors tend to
describe a score of 6 as a low-grade cancer, 7 as medium-
grade, and 8, 9, or 10 as high-grade cancer. A lower-grade
cancer grows more slowly and is less likely to spread than a
cancer with a higher grade.
TREATMENT
The treatment of prostate cancer depends on the size and
location of the tumor, whether the cancer has spread, and
the man’s overall health. In many cases, a team of doctors will
work with the patient to determine the best treatment plan.
It is important to discuss
the goals and possible
side effects of treatment
with your doctor before
treatment begins,
including the likelihood of
success of that treatment,
the potential side effects
of therapy (including
possible urinary, bowel,
sexual, and hormone-
related side effects), and
the patient’s preferences.
Men should talk with their
doctor about how the
various treatments affect
recurrence (the return of the cancer after treatment), survival,
and quality of life. In addition, the success of any treatment
often depends on the skill and expertise of the physician or
surgeon, so it is important to find doctors who have experience
treating prostate cancer.
12 TREATMENT
Active surveillance (watchful waiting)
for early-stage cancer
If a prostate cancer is in an early stage, growing slowly, and
treating the cancer would cause more discomfort than the
disease itself, a doctor may recommend watchful waiting,
also called active surveillance or watch-and-wait. The cancer
is monitored closely with periodic PSA tests, DRE tests, and
watching for symptoms. Treatment would begin only if the
tumor shows signs of becoming more aggressive or spreading,
causes pain, or blocks the urinary tract. This approach may
be used for much older patients, those with other serious or
life-threatening illnesses, or those who wish to delay active
treatment because of possible side effects. However, real
caution must be taken not to make errors of judgment about
the disease. In other words, doctors must collect as much
information as possible about the patient’s other illnesses and
potential life expectancy, so they don’t miss the chance to
detect an early, aggressive prostate cancer. For this reason,
many doctors recommend a repeat biopsy shortly after
diagnosis to confirm that the cancer is in an early stage and
growing slowly before considering active surveillance for an
otherwise healthy man. New information is becoming available
all the time, and it is important for men to discuss these issues
with their doctor to make the best decision about treatment.
Surgery
Surgery is used to try to cure cancer before it has spread outside
the prostate. A surgical oncologist is a doctor who specializes
in treating cancer using surgery. For prostate cancer, a urologist
or urologic oncologist is the surgical oncologist involved in
treatment. The type of surgery depends on the stage of the
disease, the man’s general health, and other factors.
TREATMENT 13
less pain, but sexual and urinary side effects can be similar to
an open radical prostatectomy. This procedure has not been
available for as long as open radical prostatectomy, so longer-
term follow-up information, including permanent cure rates,
are not yet certain. Talk with your doctor about whether your
treatment center offers this procedure and how it compares
with the results of the conventional open radical prostatectomy.
Radiation therapy
Radiation therapy is the use of high-energy rays to kill cancer
cells. A doctor who specializes in giving radiation therapy to
treat cancer is called a radiation oncologist. The most common
type of radiation treatment is called external-beam radiation
therapy, which is radiation given from a machine outside the
body. When radiation treatment is given using implants, it is
called internal radiation therapy or brachytherapy. A radiation
therapy regimen (schedule) usually consists of a specific number
of treatments given over a specific time.
14 TREATMENT
form a 3-D picture of the prostate before treatment. With IMRT,
high doses of radiation can be directed at the prostate without
increasing the risk of damaging nearby organs.
Hormone therapy
Because prostate cancer growth is driven by male sex hormones
known as androgens, lowering levels of these hormones can
help slow the growth of the cancer. Hormone treatment is
also called androgen ablation or androgen deprivation therapy.
The most common androgen is testosterone. The production
of testosterone can be lowered either surgically, with surgical
castration (removal of the testicles), or with drugs that turn off
the function of the testicles (see below).
TREATMENT 15
One important side effect of hormone therapy is the risk of
developing metabolic syndrome. Metabolic syndrome refers
to a set of conditions, such as high levels of blood cholesterol
and high blood pressure that increases a person’s risk of heart
disease, stroke, and diabetes. Currently, it is not certain how
often this happens or exactly why it happens, but it is quite clear
that patients who undergo a surgical or medical castration (even
a temporary medical castration) with hormone therapy have an
increased risk of developing metabolic syndrome. The risks and
benefits of castration should be carefully discussed with your
doctor. For men with metastatic prostate cancer, especially if it
is advanced and causing symptoms, most doctors believe that
the benefits of castration far outweigh the risks of metabolic
syndrome.
16 TREATMENT
flare-up or increase in activity of the prostate cancer cells
that sometimes happens because of a temporary surge in
testosterone production by the testicles (in response to the
LHRH agonists). Major studies have not shown a big difference
in long-term survival from the use of combined androgen
blockade as permanent therapy; therefore, some doctors
prefer to give combined drug treatment only for the first two to
three months.
Chemotherapy
Chemotherapy is the use of drugs to kill cancer cells. Systemic
chemotherapy is delivered through the bloodstream, targeting
cancer cells throughout the body. Chemotherapy is given by a
medical oncologist, a doctor who specializes in treating cancer
with medication. Some people may receive chemotherapy in
their doctor’s office or outpatient clinic; others may go to the
hospital. A chemotherapy regimen (schedule) usually consists of
a specific number of cycles given over a specific time.
TREATMENT 17
The side effects of chemotherapy depend on the individual
and the dose used, but can include fatigue, risk of infection,
nausea and vomiting, loss of appetite, and diarrhea. These side
effects usually go away once treatment is finished.
18 TREATMENT
Because this treatment is tailored for each patient, it may not be
available in many areas.
Find out more about common terms used during cancer treatment at
www.cancer.net/dictionaryresources.
Learn more about clinical trials, including patient safety, phases of a clinical trial,
deciding to participate in a clinical trial, questions to ask the research team, and
links to find cancer clinical trials at www.cancer.net/clinicaltrials.
For specific topics being studied for prostate cancer, learn more in the Current
Research section.
SIDE EFFECTS
Cancer and its treatment can cause a variety of side effects.
However, doctors have made major strides in recent years in
reducing pain, nausea and vomiting, and other physical side
effects of cancer treatments. Many treatments used today are
less intensive but as effective as treatments used in the past.
Doctors also have many ways to provide relief to patients when
such side effects do occur.
20 SIDE EFFECTS
controlling side effects is a major focus of your health care
team. Before treatment begins, talk with your doctor about
possible side effects of the specific treatments you will be
receiving. The specific side effects that can occur depend on a
variety of factors, including the type of cancer, its location, the
individual treatment plan (including the length and dosage of
treatment), and the person’s overall health.
Ask your doctor which side effects are most likely to happen
(and which are not), when side effects are likely to occur, and
how they will be addressed by the health care team if they do
happen. Also, be sure to communicate with the doctor about
side effects you experience during and after treatment. Learn
more about the most common side effects of cancer and
different treatments, along with ways to prevent or control
them, at www.cancer.net/sideeffects.
AFTER TREATMENT
After treatment for prostate
cancer ends, talk with your
doctor about developing a
follow-up care plan. This plan
may include regular physical
examinations and/or medical
tests to monitor your recovery for
the coming months and years.
ASCO offers cancer treatment
summary forms at www.cancer.
net/treatmentsummaries to
help keep track of the cancer
treatment you received and
develop a survivorship care plan
once treatment is complete.
AFTER TREATMENT 21
Learn more about healthy living after cancer at www.cancer.net/features.
Find out more about coping with cancer, including important topics for men
with prostate cancer, such as self-image and cancer, fertility and cancer
treatment, and talking with your spouse or partner at www.cancer.net/coping.
Learn more about common terms used after cancer treatment is complete at
www.cancer.net/dictionaryresources.
CURRENT RESEARCH
Research for prostate cancer is ongoing. The following advances
may still be under investigation in clinical trials and may not be
approved or available at this time. Always discuss all diagnostic
and treatment options with your doctor.
22 CURRENT RESEARCH
Therapy for advanced prostate cancer. Researchers are
exploring different chemotherapy options for advanced prostate
cancer through a series of clinical trials. In addition, several other
immunotherapy options are being tested in clinical trials.
CURRENT RESEARCH 23
QUESTIONS TO ASK THE DOCTOR
Regular communication with your doctor is important in making
informed decisions about your health care. Consider asking the
following questions of your doctor:
Warmest regards,