prostate treatment

7/31/2019 Prostate Treatment

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http://www.prostate-cancer.com/

Prostate cancer is a disease in which malignant (cancer) cells form in the tissues of the prostate.

Theprostate is a gland in the male reproductive system located just below thebladder(theorgan

that collects and empties urine) and in front of therectum (the lower part of the intestine). It isabout the size of a walnut and surrounds part of the urethra (the tube that empties urine from the

bladder). The prostate gland makes fluid that is part of the semen.

Enlarge

Anatomy of the male reproductive and urinary systems, showing the prostate, testicles, bladder,

and other organs.

Prostate canceris found mainly in older men. As men age, the prostate may get bigger and block

the urethra or bladder. This may cause trouble urinating or sexual problems. The condition iscalledbenign prostatic hyperplasia (BPH), and although it is not cancer, surgery may be needed

to correct it. The symptomsof benign prostatic hyperplasia or of other problems in the prostatemay be like symptoms of prostate cancer.
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Enlarge

Normal prostate and benign prostatic hyperplasia (BPH). A normal prostate does not block the

flow of urine from the bladder. An enlarged prostate presses on the bladder and urethra and

blocks the flow of urine.

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

These and other symptoms may be caused by prostate cancer. Other conditions may cause thesame symptoms. Check with your doctor if you have any of the following problems:

Weak or interrupted flow of urine.

Frequent urination (especially at night).

Trouble urinating. Pain or burning during urination.

Blood in the urine or semen.

A pain in the back, hips, orpelvis that doesn't go away.

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:
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Digital rectal exam (DRE): An exam of the rectum. The doctor ornurseinserts a

lubricated, gloved finger into the rectum and feels the prostate through the rectal wall for

lumps orabnormal areas.

Enlarge

Digital rectal exam (DRE). The doctor inserts a gloved, lubricated finger into the rectumand feels the prostate to check for anything abnormal.

Prostate-specific antigen (PSA) test: A test that measures the level of PSA in the blood.

PSA is a substance made by the prostate that may be found in an increased amount in theblood of men who have prostate cancer. PSA levels may also be high in men who have an

infection orinflammationof the prostate or BPH (an enlarged, but noncancerous,

prostate).
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Transrectal ultrasound: A procedure in which aprobe that is about the size of a finger is

inserted into the rectum to check the prostate. The probe is used to bounce high-energy

sound waves (ultrasound) off internal tissues or organs and make echoes. The echoesform a picture of body tissues called a sonogram. Transrectal ultrasound may be used

during abiopsy procedure.

Enlarge

Transrectal ultrasound. An ultrasound probe is inserted into the rectum to check theprostate. The probe bounces sound waves off body tissues to make echoes that form a

sonogram (computer picture) of the prostate.

Biopsy: The removal ofcellsor tissues so they can be viewed under a microscopeby apathologist. The pathologist will check the biopsy sample to see if there are cancer cellsand find out the Gleason score. The Gleason score ranges from 2-10 and describes how

likely it is that a tumorwill spread. The lower the number, the less likely the tumor is to

spread. There are 2 types of biopsy procedures used to diagnose prostate cancer:

o Transrectal biopsy: The removal of tissue from the prostate by inserting a thin

needle through the rectum and into the prostate. This procedure is usually done
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using transrectal ultrasound to help guide the needle. A pathologist views the

tissue under a microscope to look for cancer cells.

Enlarge

Transrectal biopsy. An ultrasound probe is inserted into the rectum to show where

the tumor is. Then a needle is inserted through the rectum into the prostate to

remove tissue from the prostate.

o Transperineal biopsy: The removal of tissue from the prostate by inserting a thin

needle through the skin between the scrotum and rectum and into the prostate. A

pathologist views the tissue under a microscope to look for cancer cells.

Certain factors affect prognosis (chance of recovery) and treatment options.

Theprognosis(chance ofrecovery) and treatment options depend on the following:

The stageof the cancer (whether it affects part of the prostate, involves the wholeprostate, or has spread to other places in the body).

The patients age and health.
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Whether the cancer has just been diagnosed or has recurred (come back).

Prognosis also depends on the Gleason score and the level of PSA.

There are different types of treatment for patients with prostate cancer.

Different types of treatment are available for patients withprostate cancer. Some treatments arestandard (the currently used treatment), and some are being tested in clinical trials. A treatment

clinical trial is a research study meant to help improve current treatments or obtain information

on new treatments for patients withcancer. When clinical trials show that a new treatment is

better than the standard treatment, the new treatment may become the standard treatment.Patients may want to think about taking part in a clinical trial. Some clinical trials are open only

to patients who have not started treatment.

Six types of standard treatment are used:

Watchful waiting or active surveillance

Watchful waiting is closely monitoring a patients condition without giving any treatment untilsymptoms appear or change.

Active surveillance is closely following a patient's condition without giving any treatment unless

there are changes in test results. It is used to find early signs that the condition is getting worse.

In active surveillance, patients are given certain exams and tests, includingbiopsies, on a regularschedule.

Surgery

Patients in good health are usually offeredsurgery as treatment for prostate cancer. The

following types of surgery are used:

Pelvic lymphadenectomy: A surgical procedure to remove thelymph nodesin thepelvis.

Apathologist views the tissue under a microscope to look for cancercells. If the lymph

nodes contain cancer, the doctor will not remove theprostate and may recommend other

treatment.

Radical prostatectomy: A surgical procedure to remove the prostate, surrounding tissue,

andseminal vesicles. There are 2 types of radical prostatectomy:

o Retropubic prostatectomy: A surgical procedure to remove the prostate through an

incision (cut) in the abdominalwall. Removal of nearby lymph nodes may bedone at the same time.

o Perineal prostatectomy: A surgical procedure to remove the prostate through an

incision (cut) made in theperineum (area between thescrotumandanus). Nearby

lymph nodes may also be removed through a separate incision in the abdomen.
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Enlarge

Two types of radical prostatectomy. In a retropubic prostatectomy, the prostate isremoved through an incision in the wall of the abdomen. In a perineal prostatectomy, the

prostate is removed through an incision in the area between the scrotum and the anus.

Transurethral resection of the prostate (TURP): A surgical procedure to remove tissuefrom the prostate using a resectoscope (a thin, lighted tube with a cutting tool) inserted

through the urethra. This procedure is sometimes done to relieve symptoms caused by a

tumorbefore other cancer 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.
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Enlarge

Transurethral resection of the prostate (TURP). Tissue is removed from the prostate using

a resectoscope (a thin, lighted tube with a cutting tool at the end) inserted through the

urethra. Prostate tissue that is blocking the urethra is cut away and removed through theresectoscope.

Impotence and leakage ofurinefrom thebladderorstool from therectum 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 thenerves that control erection. However, men with large tumorsor tumors that are very close to the nerves may not be able to have this surgery.

Thepenis may be 1 to 2 centimeters shorter after a radical prostatectomy. The exact reason for

this is not known.

Inguinal hernia is bulging of fat or part of the small intestinethrough weak muscles into the

groin. Inguinal hernia may occur more often in men treated with radical prostatectomy than inmen who have some other types of prostate surgery, radiation therapy, or prostatebiopsy alone.

It is most likely to occur within the first 2 years after radical prostatectomy.

Radiation therapy
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Radiation therapy is a cancer treatment that uses high-energy x-raysor other types ofradiation to

kill cancer cells or keep them from growing. There are two types of radiation therapy. External

radiation therapy uses a machine outside the body to send radiation toward the cancer. Internalradiation therapy uses a radioactive substance sealed in needles, seeds, wires, orcatheters that

are placed directly into or near the cancer. The way the radiation therapy is given depends on the

type and stage of the cancer being treated.

There is an increased risk ofbladder cancerand/orrectal cancerin men treated with radiationtherapy.

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

Hormone therapy

Hormone therapyis a cancer treatment that removes hormonesor blocks their action and stops

cancer cells from growing. Hormones are substances made byglands in the body and circulated

in the bloodstream. In prostate cancer, male sex hormones can cause prostate cancer to grow.Drugs, surgery, or other hormones are used to reduce the amount of male hormones or block

them from working.

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

Luteinizing hormone-releasing hormone agonists can prevent thetesticlesfrom making

testosterone. Examples are leuprolide, goserelin, andbuserelin.

Antiandrogens can block the action ofandrogens(hormones that promote male sexcharacteristics). Examples areenzalutamide,flutamide, and nilutamide.

Drugs that can prevent theadrenal glandsfrom making androgens include ketoconazole

andaminoglutethimide. Orchiectomy is a surgical procedure to remove one or both testicles, the main source of

male hormones, to decrease the amount of hormone being made.

Estrogens (hormones that promote female sex characteristics) can prevent the testicles

from making testosterone. However, estrogens are seldom used today in the treatment ofprostate cancer because of the risk of serious side effects.

Hot flashes, impaired sexual function, loss of desire for sex, and weakened bones may occur in

men treated with hormone therapy. Other side effects include diarrhea,nausea, andpruritus

(itching).

SeeDrugs Approved for Prostate Cancerfor more information.

Chemotherapy

Chemotherapy is a cancer treatment that uses drugs to stop the growth of cancer cells, either by

killing the cells or by stopping them from dividing. When chemotherapy is taken by mouth or

injected into a vein or muscle, the drugs enter the bloodstream and can reach cancer cellsthroughout the body (systemic chemotherapy). When chemotherapy is placed directly into the
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cerebrospinal fluid, an organ, or a body cavity such as the abdomen, the drugs mainly affect

cancer cells in those areas (regional chemotherapy). The way the chemotherapy is given depends

on the type and stage of the cancer being treated.


Biologic therapy

Biologic therapyis a treatment that uses the patientsimmune systemto fight cancer. Substances

made by the body or made in a laboratory are used to boost, direct, or restore the bodys natural

defenses against cancer. This type of cancer treatment is also called biotherapy orimmunotherapy. Sipuleucel-T is a type of biologic therapy used to treat prostate cancer that has

metastasized(spread to other parts of the body).


New types of treatment are being tested in clinical trials.

This summary section describes treatments that are being studied in clinical trials. It may notmention every new treatment being studied. Information about clinical trials is available from the

NCI Web site.

Cryosurgery

Cryosurgery is a treatment that uses an instrument to freeze and destroy prostate cancer cells.This type of treatment is also called cryotherapy.

Impotence and leakage of urine from the bladder or stool from the rectum may occur in mentreated with cryosurgery.

High-intensity focused ultrasound

High-intensity focused ultrasoundis a treatment that uses ultrasound (high-energy sound waves)to destroy cancer cells. To treat prostate cancer, an endorectal probe is used to make the sound

waves.

Proton beam radiation therapy

Proton beam radiation therapy is a type of high-energy, external radiation therapy that targetstumors with streams ofprotons(small, positively charged particles). This type of radiation

therapy is being studied in the treatment of prostate cancer.

Patients may want to think about taking part in a clinical trial.
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For some patients, taking part in a clinical trialmay be the best treatment choice. Clinical trials

are part of the cancer research process. Clinical trials are done to find out if new cancer

treatments are safe and effective or better than the standard treatment.

Many of today's standard treatments for cancer are based on earlier clinical trials. Patients who

take part in a clinical trial may receive the standard treatment or be among the first to receive anew treatment.

Patients who take part in clinical trials also help improve the way cancer will be treated in thefuture. Even when clinical trials do not lead to effective new treatments, they often answer

important questions and help move research forward.

Patients can enter clinical trials before, during, or after starting their cancer treatment.

Some clinical trials only include patients who have not yet received treatment. Other trials test

treatments for patients whose cancer has not gotten better. There are also clinical trials that test

new ways to stop cancer fromrecurring (coming back) or reduce the side effectsof cancertreatment.

Clinical trials are taking place in many parts of the country. See the Treatment Options sectionthat follows for links to current treatment clinical trials. These have been retrieved fromNCI's

listing of clinical trials.

Follow-up tests may be needed.

Some of the tests that were done to diagnose the cancer or to find out thestageof the cancer may

be repeated. Some tests will be repeated in order to see how well the treatment is working.

Decisions about whether to continue, change, or stop treatment may be based on the results ofthese tests. This is sometimes called re-staging.

Some of the tests will continue to be done from time to time after treatment has ended. The

results of these tests can show if yourcondition has changed or if the cancer has recurred(comeback). These tests are sometimes called follow-up tests or check-ups.

Treatment

1. Patients with a life expectancy of less than 10 years maybe candidates for

active surveillance

a. Primary hormone therapy is an option for patients not suitable fordefinitive local therapy

2. Eradication of the cancer is the goal of therapy in patients with a life

expectancy greater than 10 years

a. Radical prostatectomy
http://www.cancer.gov/Common/PopUps/popDefinition.aspx?id=45961&version=Patient&language=Englishhttp://www.cancer.gov/Common/PopUps/popDefinition.aspx?id=45961&version=Patient&language=Englishhttp://www.cancer.gov/Common/PopUps/popDefinition.aspx?id=44930&version=Patient&language=Englishhttp://www.cancer.gov/Common/PopUps/popDefinition.aspx?id=46556&version=Patient&language=Englishhttp://www.cancer.gov/Common/PopUps/popDefinition.aspx?id=46556&version=Patient&language=Englishhttp://www.cancer.gov/Common/PopUps/popDefinition.aspx?id=46580&version=Patient&language=Englishhttp://www.cancer.gov/Common/PopUps/popDefinition.aspx?id=46580&version=Patient&language=Englishhttp://www.cancer.gov/Common/PopUps/popDefinition.aspx?id=44267&version=Patient&language=Englishhttp://www.cancer.gov/Common/PopUps/popDefinition.aspx?id=46450&version=Patient&language=Englishhttp://www.cancer.gov/Common/PopUps/popDefinition.aspx?id=45885&version=Patient&language=Englishhttp://www.cancer.gov/Common/PopUps/popDefinition.aspx?id=45885&version=Patient&language=Englishhttp://www.cancer.gov/Common/PopUps/popDefinition.aspx?id=45885&version=Patient&language=Englishhttp://www.cancer.gov/Common/PopUps/popDefinition.aspx?id=651193&version=Patient&language=Englishhttp://www.cancer.gov/Common/PopUps/popDefinition.aspx?id=651193&version=Patient&language=Englishhttp://www.cancer.gov/Common/PopUps/popDefinition.aspx?id=46556&version=Patient&language=Englishhttp://www.cancer.gov/Common/PopUps/popDefinition.aspx?id=46556&version=Patient&language=Englishhttp://www.cancer.gov/Common/PopUps/popDefinition.aspx?id=44671&version=Patient&language=Englishhttp://www.cancer.gov/Common/PopUps/popDefinition.aspx?id=45961&version=Patient&language=Englishhttp://www.cancer.gov/Common/PopUps/popDefinition.aspx?id=44930&version=Patient&language=Englishhttp://www.cancer.gov/Common/PopUps/popDefinition.aspx?id=46556&version=Patient&language=Englishhttp://www.cancer.gov/Common/PopUps/popDefinition.aspx?id=46580&version=Patient&language=Englishhttp://www.cancer.gov/Common/PopUps/popDefinition.aspx?id=44267&version=Patient&language=Englishhttp://www.cancer.gov/Common/PopUps/popDefinition.aspx?id=46450&version=Patient&language=Englishhttp://www.cancer.gov/Common/PopUps/popDefinition.aspx?id=45885&version=Patient&language=Englishhttp://www.cancer.gov/Common/PopUps/popDefinition.aspx?id=651193&version=Patient&language=Englishhttp://www.cancer.gov/Common/PopUps/popDefinition.aspx?id=46556&version=Patient&language=Englishhttp://www.cancer.gov/Common/PopUps/popDefinition.aspx?id=44671&version=Patient&language=English


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i. Surgical removal of the prostate

ii. May be done with

Retropubic

Perineal

Laparoscopic

iii. Most common side effects are impotence and incontinence

b. External beam radiation

i. Radiation to the prostate from outside the body

ii. Evidence that higher doses are associated with better efficacy

iii. SE: impotence and rectal irritation

c. Brachytherapy

i. Radiation implants placed directly into the prostate under

ultrasound or ct guidance

ii. Very high dose radiation to the prostate with little radiation

outside the prostatic bed

iii. SE: acute urinary symptoms

iv. Procedure completed in one day

Treatment

On This Page

Clinical Trials

Complementary and Alternative Medicine

Which Treatment Is Right for Me?

Different types of treatment are available for prostate cancer. You and your doctor will decide

which treatment is right for you. Some common treatments are

Active surveillance (watchful waiting): This consists of closely monitoring the patient'sprostate cancer by performing the PSA and DRE tests regularly, and treating it only if

and when the prostate cancer causes symptoms or shows signs of growing.
http://www.cdc.gov/cancer/prostate/basic_info/treatment.htm#ahttp://www.cdc.gov/cancer/prostate/basic_info/treatment.htm#bhttp://www.cdc.gov/cancer/prostate/basic_info/treatment.htm#bhttp://www.cdc.gov/cancer/prostate/basic_info/treatment.htm#ahttp://www.cdc.gov/cancer/prostate/basic_info/treatment.htm#bhttp://www.cdc.gov/cancer/prostate/basic_info/treatment.htm#b


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Surgery (radical prostatectomy): Prostatectomy is surgery to remove the prostate

completely. Radical prostatectomy removes the prostate as well as the surrounding tissue.

Radiation therapy: Radiation destroys cancer cells, or prevents them from growing, bydirecting high-energy X-rays (radiation) at the prostate. There are two types of radiation

therapy

o

External radiation therapy: A machine outside the body directs radiation at thecancer cells.

o Internal radiation therapy (brachytherapy): Radioactive seeds or pellets are

surgically placed into or near the cancer to destroy the cancer cells.

Hormone therapy: This treatment uses drugs, surgery, or other hormones to remove

male sex hormones or block them from working, which prevents cancer cells from

growing.

Other therapies used in the treatment of prostate cancer that are still under investigation include

Cryotherapy: Placing a special probe inside or near the prostate cancer to freeze and killthe cancer cells.

Chemotherapy: Using special drugs to shrink or kill the cancer. The drugs can be pillsyou take or medicines given through an intravenous (IV) tube, or, sometimes, both.

Biological therapy: This treatment works with your body's immune system to help it

fight cancer or to control side effects from other cancer treatments. Side effects are howyour body reacts to drugs or other treatments. Biological therapy is different from

chemotherapy, which attacks cancer cells directly.

High-intensity focused ultrasound: This therapy directs high-energy sound waves(ultrasound) at the cancer to kill cancer cells.

http://www.cdc.gov/cancer/prostate/basic_info/treatment.htm

What does this guide cover?

This guide can help you work with your doctor to treat localized prostate cancer. Theinformation comes from a government-funded review of research about treatments for localized

prostate cancer. It covers research about four common prostate cancer treatments and their side

effects.

Watchful waitingcarefully watching the cancer over time with regularcheckups.

Prostate surgeryalso called radical prostatectomy (PRAHS-tah-TEK-toe-mee).

Radiationone kind called external beam and another called brachytherapy(BRAKE-ee-THAYR-uh-pee) or "seeding."

Hormone treatment.
http://www.cdc.gov/cancer/prostate/basic_info/treatment.htmhttp://www.cdc.gov/cancer/prostate/basic_info/treatment.htm


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What is not covered in this guide?

This guide does not cover how to prevent prostate cancer. It also does not talk about othertreatments, like ultrasound treatment, cryotherapy (freezing treatment), laparoscopic surgery

(also called bandaid or keyhole surgery), or robotic surgery. These are newer treatments. There

isnt enough research yet to tell us how well they work compared with other treatments. Thisguide also does not cover herbal products (like green tea) or vitamins and minerals (like

selenium). It does not include treatments, like chemotherapy, for prostate cancer that has already

spread outside the prostate gland.

How Is Prostate Cancer Found?

Most men with localized prostate cancer have few or no symptoms at all. These cancers are

usually found during a routine exam or through screening tests. The most common tests are adigital rectal exam and a blood test called PSA (prostate specific antigen).

What is the prostate?

The prostate is a gland about the size of a walnut. It is found only in men. It makes

and stores the liquid that carries sperm. The prostate is located near the bladder

and rectum (the last part of the bowel before the anus). It is just below the bladder

and surrounds the urethra (the tube that drains urine from the bladder).

Digital Rectal Exam

The doctor or nurse feels the prostate gland through the rectum with a finger. This is done to

check the shape of the prostate and to check for hard spots.


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PSA Blood Test

PSA is a protein made by the prostate gland. A blood test tells how much PSA is in the blood.Many men with prostate cancer have PSA levels that are higher than normal or have increased

over time.

When a digital rectal exam or PSA blood test is not normal, more testing may be done. This

might include a biopsy of the prostate.

Biopsy

A biopsy is when the doctor takes out tiny pieces of the prostate gland with a needle. The pieces

are examined under a microscope to look for cancer cells. If the biopsy shows prostate cancer,the lab gives it a Gleason score.

Gleason scores range from 2 to 10. They give an idea of how fast the cancer may grow. A lower

Gleason score (2 to 5) means the cancer is slower to grow. A higher score (8 to 10) means thecancer is more "aggressive" and more likely to spread. Most men with prostate cancer have ascore in the middle (6 to 7).

Surviving prostate cancer is more likely with lower Gleason scores. This is true with any prostate

cancer treatment or watchful waiting.

The charts below show that surviving prostate cancer is more likely with lower

Gleason scores. "Age" means the age when the cancer was found. The men in this

research study used watchful waiting or hormone treatment. Keep in mind that

some men who survived prostate cancer died of other causes.

Age 55 to 59


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Age 60 to 64

Age 65 to 69

Age 70 to 74

What Are Your Options?

Options for localized prostate cancer include watchful waiting, prostate surgery, radiation, andhormone treatment.

Deciding can be a challenge because there is a lot to think about. Research cant tell us which

option is best. All the active treatments can have long-lasting side effects.

Many prostate cancers grow slowly over a lifetime. That means men can take time to learn aboutthe cancer, the options, and the side effects.


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Research Takes Time

This guide focuses on the long-term results of treatments. There isnt research yet that comparesthe effects over time of all four treatments. But there is research that compares a few of the

treatments to each other. Some treatments have been compared after 10 years and others after 5

years.

Most of the research so far started before PSA testing was common. Today, PSA testing iswidely used. It helps find the cancers earlier and when they are smaller. Research today includes

men whose prostate cancers are found by PSA testing. Not enough time has passed to know the

long-term results of this research.

Thinking About Your Options

The first thing to think about is whether to wait and watch the cancer or treat it right away.

Options might be different based on your overall health and lab results.

What was your Gleason score at the time the cancer was found?

A lower Gleason score means the cancer usually grows slowly.

Tumors with higher Gleason scores (8 to 10) are called aggressive. They are very likely to grow

and spread outside the prostate gland within 5 years. Men who have a higher Gleason score may

think they need to get an active treatment. But research cant tell us if watchful waiting or anactive treatment is better for men with higher Gleason scores.

How will your age or other health problems affect your treatment choices?

Age and some health problems can make surgery more risky. If you have serious heart or lung

problems, your doctor may talk to you about other options. If you have had radiation before, you

may not be able to have radiation for prostate cancer. Talk to your doctor about your options.

Watchful Waiting

Watchful waiting (also called active surveillance or expectant management) means seeing what

happens with the cancer over time.

Watchful waiting is not the same as doing nothing. It means that you keep a careful watch on the

cancer with regular checkups. When you visit your doctor or nurse, you might get a digital rectalexam, a PSA blood test, an ultrasound, or a biopsy to see if the cancer has grown.

How will watching and waiting affect your sense of well-being?

With watchful waiting, your cancer is not taken out or destroyed. You and your doctor will bechecking for changes over time. The cancer may not spread. But if it does, your doctor will talk

with you about your options for active treatment.


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What about the side effects?

The main benefit of watchful waiting is that you can avoid the side effects of active treatment,

like erectile dysfunction (ED) and urinary problems. Keep in mind that men who use watchfulwaiting may also get these problems. They can be caused by other health issues or medicines.

You and your doctor may decide on an active treatment instead of watchful waiting.

If so, think about which one would be best for you. The main benefit with an active

treatment is that there is a higher chance that the cancer can be taken out or

destroyed. The trade-off is that all active treatments can cause side effects. Some

side effects can be long-lasting.

Prostate Surgery

Prostate surgery (also called radical prostatectomy) is an operation to take out the prostate gland

and the cancer inside the gland. The urethra (tube that carries urine) is surrounded by the prostate

gland, so part of it has to be removed as well. The remaining urethra is reattached to the bladder.Other tissues around the prostate gland, like lymph nodes, may also be removed and checked for

cancer.

Nerves that are needed for a man to get an erection are next to the prostate gland. These nervescan be damaged during surgery, which causes problems in keeping an erection. If the cancer has

not spread near the nerves, they can be left alone and not taken out.

There is more research about prostate surgery than other active treatments.

How does prostate surgery compare with watchful waiting?

In general, men who have prostate surgery are in good health and are younger than men who usewatchful waiting or other active treatments. The risks from prostate surgery increase as you get

older. Up to 10 out of 100 men 65 years and older have heart and lung problems after surgery.

Men who have prostate surgery are more likely to survive their prostate cancer than men who

follow watchful waiting. One research study that compared prostate surgery with watchfulwaiting found:

90 out of 100 men who had prostate surgery survived their cancer for atleast 10 years.

85 out of 100 men who used watchful waiting survived their cancer for atleast 10 years.

This research study started before PSA testing was common.

What about combining hormone treatment with prostate surgery?


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Research tells us that using hormone treatment before prostate surgery does not work better than

having prostate surgery without the hormone treatment. Hormone treatment used before surgery

does not help men live longer and does not stop the cancer from coming back.

More experience means better results

Men who have prostate surgery from a surgeon and a hospital with more experience have fewer

problems from the surgery.

Men treated by surgeons who do more than 10 prostate surgeries a yearhave a lower chance of long-lasting side effects. They have fewer problems,like dribbling or leaking urine, than men treated by surgeons who do less.

Men treated in hospitals that do more than 43 prostate surgeries a year havefewer problems from the surgery. They are less likely to have bleeding orheart and lung problems.

Radiation

Radiation kills the cancer cells. The goal is to target the cancer and avoid hurting normal parts ofthe body. Radiation can be given in two waysexternal beam radiation or brachytherapy.

Sometimes the two kinds of radiation are used together.

External beam radiation uses radiation from a machine to target the prostate gland. This kind of

radiation takes place in a hospital or clinic. The radiation is given a few minutes a day for about6 to 8 weeks.

Brachytherapy (also called radiation "seeding") uses a needle to put small seeds of radiation

into the cancer inside the prostate gland. This usually requires a trip to the hospital or clinic. The

seeds inside the prostate gland slowly release radiation over time.

What do we know about radiation?

Men who get higher amounts of radiation are less likely to have their prostatecancer come back than men who get lower amounts of radiation.

Men who get higher amounts of external beam radiation are more likely tohave diarrhea and rectal pain.

Research cant tell us if men who get higher amounts of radiation live longer. Research cant tell us if external beam radiation or seeding works better for

localized prostate cancer.

How does radiation compare with other options?

Research cant tell us if men who have radiation live as long as men who use watchful waiting orhave prostate surgery.


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Hormone Treatment

Testosterone is a hormone made by the body. It causes prostate cancer cells to grow. Hormonetreatment lowers or blocks the bodys testosterone. This helps to slow or stop the growth of

cancer cells.

What do we know about hormone treatments?

Hormone treatments come in shots or pills. Most of the research about hormone medicines is onthese drugsleuprolide (Lupron, Viadur, Eligard), goserelin (Zoladex), flutamide

(Eulexin), and bicalutamide (Casodex). Hormone medicines are often combined with prostate

surgery or radiation. Hormone treatment can also be used by itself.

Most of the research is about combining hormone medicines with other types of prostate cancertreatments. There is less research about using hormone medicines on their own.

Bicalutamide (Casodex

) is a pill that does not work for localized prostate cancer. This is truewhether it is used by itself, with prostate surgery, or with external beam radiation.

Research cant tell us if using other hormone treatments on their own can stop localized prostate

cancer from spreading.

What about combining hormone treatment with radiation?

Men who combine hormone medicines with external beam radiation are more likely to survive

their prostate cancer than men who get only radiation. One research study that compared

radiation with and without hormone treatment found:

100 out of 100 men who combined hormone treatment along with externalbeam radiation survived their prostate cancer for at least 5 years.

94 out of 100 men who had only external beam radiation survived theirprostate cancer for at least 5 years.

This research study cant tell us if combining hormone treatment with external beam radiationcures the cancer. Longer research studies are needed to see all the effects of the treatments.

Side Effects of Treatment

All prostate cancer treatments can cause side effects. The most common side effects are sexual,urinary, and bowel problems. Some of these problems happen soon after treatment and others

develop over time. Talk to your doctor or nurse if you have any of these side effects. There may

be a way to help.

Erectile dysfunction (ED) means not being able to keep an erection for intercourse. ED is the

most common long-lasting side effect. It can happen with any treatment.


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Urinary problems are another long-lasting side effect. This can mean leaking or dribbling urine.

It can also mean sometimes not being able to hold your urine at all. Urinary problems are more

common after surgery than with other treatments.

Bowel problems can also be a long-lasting side effect. This can mean sometimes having "bowel

urgency" (needing to have a bowel movement right away and not being able to wait). Long-lasting bowel problems are more common after external beam radiation or hormone treatment

than after prostate surgery or with watchful waiting.

Hormone treatments can have other side effects. They can cause hot flashes, breast swelling,

and loss of sex drive. They can also cause tiredness, depression, and memory problems.

Hormone treatments can weaken bones and raise the chance they will break.

57 out of 100 men who take hormone medicines have hot flashes (suddenfeeling of warmth and sweating).

25 out of 100 men who take hormone medicines have breast swelling.

The chart below shows research about long-lasting side effects 2 years after treatment. Erection

problems are common with all treatments. Bowel problems are more common with external

beam radiation. Urinary problems are more common with prostate surgery.

Comparing Side Effects 2 Years After Treatment

(number of men out of 100)

Watchful

Waiting

Prostate

Surgery

External Beam

Radiation

Hormone

Treatment

Erectile Dysfunction(no erections at all)

33 58 43 86

Urinary problems

(leaking urine)7 35 12 11

Bowel Problems (bowel

urgency)16 14 29 16

Early-stage prostate cancer means that cancer cells are found only in your prostate. Compared

with many other cancers, prostate cancer grows slowly. This means that it can take 10 to 30

years before a prostate tumor gets big enough to cause symptoms or for doctors to find it. Mostmen who have prostate cancer will die of something other than prostate cancer.

Prostate cancer is most common in men age 65 and older, although younger men can be

diagnosed with it as well.

By age 80, more than half of all men have some cancer in their prostate.

African American men tend to be diagnosed at younger ages and with faster-growing

prostate cancer than men of other races.


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Prostate cancer is most often found in early stages. When it is found early, there are a number of

treatment choices available.

Thinking About Treatment Choices

Active surveillance, surgery, and radiation therapy are the standard therapy choices for men withearly-stage prostate cancer (see Types of Treatment). Each has benefits (how treatments can

help) and risks (problems treatment may cause). There is seldom just one right treatment choice.

The choice of treatment depends on many factors:

Your prostate cancer risk group. Doctors use details about your cancerto place you into a low-, medium-, or high-risk group.

o Low-riskprostate cancer is not likely to grow or spread for manyyears.

o Medium-riskprostate cancer is not likely to grow or spread for a few

years.o High-riskprostate cancer may grow or spread within a few years.

Doctors define low-, medium-, and high-risk groups as follows:

Low-Risk Medium-Risk High-Risk

PSA Level* Less than 10 ng/ml**10 to

20 ng/mlMore than 20 ng/ml

Gleason Score

(see Medical Tests)6 or lower 7 8 or higher

Tumor Stage

(seeTumor Stages)T1 or T2a T2b T2c

*PSA stands for prostate-specific antigen (seeMedical Tests)**ng/ml stands for nanograms per milliliter of blood

Reprinted with permission from:

1. Macmillan Publishers Ltd: Mazhar & Waxman. (2008) Nature Clinical Practice Urology 5: 486-493.2. The American Medical Association: DAmico, et al. (1998) JAMA 280 (11):969-974. Copyright 1998 American

Medical Association. All rights reserved.

Health problems other than prostate cancer. Having heart problems,diabetes, or other illnesses may affect your treatment options.

If you have already had surgery for an enlarged prostate. If you havehad prostate surgery, this may affect the treatment choices you have.

Age. The benefits and risks of different treatments may vary with age. Type of care available to you. The skills and experience of specialists and

types of treatment available in your area may vary. You will need to ask
http://www.cancer.gov/Common/PopUps/popDefinition.aspx?id=CDR0000616060&version=Patient&language=Englishhttp://www.cancer.gov/Common/PopUps/popDefinition.aspx?id=CDR0000044971&version=Patient&language=Englishhttp://www.cancer.gov/Common/PopUps/popDefinition.aspx?id=CDR0000044930&version=Patient&language=Englishhttp://www.cancer.gov/cancertopics/treatment/prostate/understanding-prostate-cancer-treatment/page3#typeshttp://www.cancer.gov/cancertopics/treatment/prostate/understanding-prostate-cancer-treatment/page3#medicalhttp://www.cancer.gov/cancertopics/treatment/prostate/understanding-prostate-cancer-treatment/page3#tumorhttp://www.cancer.gov/cancertopics/treatment/prostate/understanding-prostate-cancer-treatment/page3#medicalhttp://www.cancer.gov/cancertopics/treatment/prostate/understanding-prostate-cancer-treatment/page3#medicalhttp://www.cancer.gov/cancertopics/treatment/prostate/understanding-prostate-cancer-treatment/page3#medicalhttp://www.cancer.gov/Common/PopUps/popDefinition.aspx?id=CDR0000616060&version=Patient&language=Englishhttp://www.cancer.gov/Common/PopUps/popDefinition.aspx?id=CDR0000044971&version=Patient&language=Englishhttp://www.cancer.gov/Common/PopUps/popDefinition.aspx?id=CDR0000044930&version=Patient&language=Englishhttp://www.cancer.gov/cancertopics/treatment/prostate/understanding-prostate-cancer-treatment/page3#typeshttp://www.cancer.gov/cancertopics/treatment/prostate/understanding-prostate-cancer-treatment/page3#medicalhttp://www.cancer.gov/cancertopics/treatment/prostate/understanding-prostate-cancer-treatment/page3#tumorhttp://www.cancer.gov/cancertopics/treatment/prostate/understanding-prostate-cancer-treatment/page3#medical


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tough questions to make sure you receive the best possible care. See AskingQuestions.

Thinking about what you value most. Your unique experiences in lifeshape your feelings and thoughts about how to deal with prostate cancer.Keeping in mind what is important to you will help guide your decision.

Many men may ask their doctor, What would you do, if you were me? Try toremember, the doctor isnt you, and his or her personal values may be different from

yours.

Here are some things to think about:

o How do you view the benefits and risks of the treatment choices thathave been offered to you?

o Can you cope with knowing cancer is in your body?o Would you rather have treatment to remove or shrink the cancer,

knowing that there could be side effects?

o Do you know other men who have had prostate cancer? If so, theirexperiences may help you make your decision.

Spouse or partner. Even though the treatment choice is yours, involvingyour spouse, partner, or other loved ones can help you sort out what is mostimportant to you and your family.

Medical Tests

By now you may have had many tests and exams to find out details about your cancer. As we

discussed in the section above, your doctor will take into account your general health, the results

of your tests and exams, and the Gleason score of your cancer when talking with you about your

treatment choices. What are these tests? What do their results mean?

Prostate-Specific Antigen (PSA) test. PSA is a protein that is made byboth normal prostate cells and prostate cancer cells. PSA is found in theblood and can be measured with a blood test. Because the amount of PSA inthe blood often rises with prostate cancer, doctors may check your PSA levelover time. If you have a score of 4ng/ml (which stands for nanograms permilliliter of blood) or higher, your doctor may want to do other tests, such asa prostate biopsy.

Gleason score of your cancer. When you have a biopsy, samples aretaken from many areas of your prostate. A doctor called a pathologist uses amicroscope to check the samples for cancer. He or she assigns a Gleason

score on a scale of 2 to 10 to your cancer. This score tells how different theprostate cancer tissue looks from normal prostate tissue and how likely it isthat the cancer will grow or spread. Most men with early-stage prostatecancer have a Gleason score of 6 or 7.

Digital Rectal Exam (DRE). In this exam, your doctor feels your prostate byinserting a gloved and lubricated finger into your rectum.
http://www.cancer.gov/cancertopics/treatment/prostate/understanding-prostate-cancer-treatment/page5#questionshttp://www.cancer.gov/cancertopics/treatment/prostate/understanding-prostate-cancer-treatment/page5#questionshttp://www.cancer.gov/Common/PopUps/popDefinition.aspx?id=CDR0000045164&version=Patient&language=Englishhttp://www.cancer.gov/cancertopics/treatment/prostate/understanding-prostate-cancer-treatment/page5#questionshttp://www.cancer.gov/cancertopics/treatment/prostate/understanding-prostate-cancer-treatment/page5#questionshttp://www.cancer.gov/Common/PopUps/popDefinition.aspx?id=CDR0000045164&version=Patient&language=English


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Stages of Early Prostate Cancer

The clinical stage of your cancer is important in choosing a treatment. The clinical stage tellshow much the cancer may have grown within the prostate and whether it has spread to other

tissues or organs. If you decide to have surgery, your prostate, nearby lymph nodes, and seminal

vesicles will be removed and samples of them studied under a microscope. This exam gives thepathologist the information he or she needs to find out thepathological stage to your cancer.

Your doctor may do one or more of the following tests or exams to help figure out the stage of

your cancer:

DRE Prostate biopsy Bone scan MRI CT scan Biopsy of the lymph nodes in the pelvis Biopsy of the seminal vesicles

Tumor Stages

T1 means that the cancer is so small it cant be felt during a DRE. T1a and T1b cancer is mostoften found by accident, when men have surgery to relieve symptoms of BPH (which stands for

benign prostatic hyperplasia).

T1c is most often found when a prostate biopsy is done because of a PSA test result that showed

a high PSA blood level. This is the most commonly diagnosed stage of prostate cancer.

A stage of T2 means that prostate cancer can be felt during a DRE, but is still only in theprostate. Your doctor may also assign a, b, or c to the stage, depending on the cancers size and

whether it is in 1 or more lobes of the prostate.
http://www.cancer.gov/Common/PopUps/popDefinition.aspx?id=CDR0000686244&version=Patient&language=Englishhttp://www.cancer.gov/Common/PopUps/popDefinition.aspx?id=CDR0000045762&version=Patient&language=Englishhttp://www.cancer.gov/Common/PopUps/popDefinition.aspx?id=CDR0000046576&version=Patient&language=Englishhttp://www.cancer.gov/Common/PopUps/popDefinition.aspx?id=CDR0000046576&version=Patient&language=Englishhttp://www.cancer.gov/Common/PopUps/popDefinition.aspx?id=CDR0000686253&version=Patient&language=Englishhttp://www.cancer.gov/Common/PopUps/popDefinition.aspx?id=CDR0000046509&version=Patient&language=Englishhttp://www.cancer.gov/Common/PopUps/popDefinition.aspx?id=CDR0000686244&version=Patient&language=Englishhttp://www.cancer.gov/Common/PopUps/popDefinition.aspx?id=CDR0000045762&version=Patient&language=Englishhttp://www.cancer.gov/Common/PopUps/popDefinition.aspx?id=CDR0000046576&v

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