Prostate Cancer Treatment (PDQ®)
[Back to top]General Information About Prostate Cancer
Key Points:Prostate cancer is a disease in which malignant (cancer) cells
form in the tissues of the prostate.
The prostate is a
gland in the male
reproductive system located just
below the bladder (the organ that
collects and empties urine) and in
front of the rectum (the lower part
of the intestine). It is about the
size of a walnut and surrounds part of the urethra (the tube that empties urine from the
bladder). The prostate gland produces fluid that makes up part of the semen.
Anatomy of the male reproductive and urinary systems; drawing shows front and side views of ureters, lymph nodes, rectum, bladder, prostate gland, vas deferens, penis, testicles, urethra, seminal vesicle, and ejaculatory duct.
Prostate cancer is found
mainly in older men. As men age, the prostate may get bigger and block the
urethra or bladder. This may cause difficulty in urination or can interfere
with sexual function. The condition is called benign prostatic hyperplasia (BPH), and although
it is not cancer, surgery may be
needed to correct it. The symptoms
of benign prostatic hyperplasia or of other problems in the prostate may be
similar to symptoms of prostate cancer.
Two-panel drawing shows normal male reproductive and urinary anatomy and benign prostatic hyperplasia (BPH). Panel on the left shows the normal prostate and flow of urine from the bladder through the urethra. Panel on the right shows an enlarged prostate pressing on the bladder and urethra, blocking 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 the same symptoms. A doctor should be consulted if any of the following problems
occur:
- 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, or
pelvis 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:
- Digital rectal
exam (DRE): An exam of the rectum. The doctor or nurse inserts a lubricated, gloved finger into the rectum and feels the prostate through the rectal wall for lumps or abnormal areas.
Digital rectal exam; drawing shows a side view of the male reproductive and urinary anatomy, including the prostate, rectum, and bladder; also shows a gloved and lubricated finger inserted into the rectum to feel the prostate.
- 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 the blood of men who have prostate cancer. PSA levels may also be high in men who have an infection or inflammation of the prostate or BPH (an enlarged, but noncancerous, prostate).
- Transrectal
ultrasound: A procedure in which a probe 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 echoes form a picture of body tissues called a sonogram. Transrectal ultrasound may be used during a biopsy procedure.
Transrectal ultrasound; drawing shows a side view of the male reproductive and urinary anatomy including the prostate, anus, rectum, and bladder; also shows an ultrasound probe inserted into the rectum to check the prostate. Inset shows patient lying on back on a table having a transrectal ultrasound procedure.
- Biopsy: The removal of cells or tissues so they can be viewed under a microscope by a pathologist. The pathologist will
examine the biopsy sample to check for cancer cells and determine the
Gleason score. The Gleason score
ranges from 2-10 and describes how likely it is that a
tumor will 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:
- 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 using transrectal ultrasound to help guide the needle. A pathologist views the tissue under a microscope to look for cancer cells.
Transrectal biopsy; drawing shows a side view of the prostate, bladder, and rectum. Drawing also shows an ultrasound probe with a needle inserted into the rectum to remove a tissue sample from the prostate.
- 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.
The prognosis (chance of recovery) and treatment options depend on the following:
- The stage of the cancer (whether it affects part of
the prostate, involves the whole prostate, or has spread to other places in the
body).
- The patient’s age and health.
- Whether the cancer has just been diagnosed or has recurred (come back).
Prognosis also depends on the Gleason score and the level of PSA.
[Back to top]Stages of Prostate Cancer
Key Points:After prostate cancer has been diagnosed, tests are done to
find out if cancer cells have spread within the prostate or to other parts of
the body.
The process used to find out if cancer has spread within the
prostate or to other parts of the
body is called staging. The information gathered from the
staging process determines the stage of the disease. It is
important to know the stage in order to plan treatment. The following tests and procedures may be used in the staging process:
The stage of the cancer is based on the results of the staging and diagnostic tests, including
the original tumorbiopsy. The biopsy is used to determine the Gleason score. The Gleason score ranges from 2-10 and describes how different the cancer cells look from normal cells and how likely it is that the tumor will spread. The lower the number, the less likely the tumor is to spread.
There are three ways that cancer spreads in the body.
The three ways that cancer spreads in the body are:
- Through tissue. Cancer invades the surrounding normal tissue.
- Through the lymph system. Cancer invades the lymph system and travels through the lymph vessels to other places in the body.
- Through the blood. Cancer invades the veins and capillaries and travels through the blood to other places in the body.
When cancer cells break away from the primary (original) tumor and travel through the lymph or blood to other places in the body, another (secondary) tumor may form. This process is called metastasis. The secondary (metastatic) tumor is the same type of cancer as the primary tumor. For example, if breast cancer spreads to the bones, the cancer cells in the bones are actually breast cancer cells. The disease is metastatic breast cancer, not bone cancer.
The following stages are used for prostate cancer:
Prostate cancer staging; five panel drawing showing a side view of normal male anatomy and closeup views of Stage I, Stage II, Stage III, and Stage IV showing cancer growing from within the prostate to nearby tissue and then to lymph nodes or other parts of the body.
Stage I
In stage I, cancer is
found in the prostate only. It cannot be felt during a digital rectal exam and is not visible by imaging. It is usually found accidentally during
surgery for other reasons, such as
benign prostatic hyperplasia. The Gleason score is low. Stage
I prostate cancer may also be called stage A1 prostate cancer.
Stage II
In stage II, cancer is
more advanced than in stage I, but has not spread outside the prostate. The Gleason score can range from 2-10. Stage II prostate
cancer may also be called stage A2, stage B1, or stage B2 prostate
cancer.
Stage III
In stage III, cancer
has spread beyond the outer layer of the prostate to nearby
tissues. Cancer may be found in the
seminal vesicles. The Gleason score can range from 2-10. Stage III prostate cancer
may also be called stage C prostate cancer.
Stage IV
In stage IV, cancer
has metastasized (spread) to lymph nodes near or far from the prostate or to other
parts of the body, such as the bladder, rectum, bones, liver, or lungs. Metastatic prostate cancer
often spreads to the bones. The Gleason score can range from 2-10. Stage IV prostate cancer may also be called stage
D1 or stage D2 prostate cancer.
[Back to top]Recurrent Prostate Cancer
Recurrentprostate cancer is cancer that has recurred (come back) after
it has been treated. The cancer may come back in the prostate or
in other parts of the body.
[Back to top]Treatment Option Overview
Key Points:There are different types of treatment for patients with prostate cancer.
Different types of treatment are available for patients with
prostate cancer. Some treatments are standard (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
with cancer. 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.
Four types of standard treatment are used:
Watchful waiting
Watchful waiting is closely monitoring a patient’s condition without giving any treatment until symptoms appear or change. This is
usually used in older men with other medical problems and early-stage disease.
Surgery
Patients in good health are
usually offered surgery as treatment
for prostate cancer. The following types of surgery are used:
- Pelvic lymphadenectomy: A surgical procedure to remove the lymph nodes in the pelvis. A pathologist views the tissue under a microscope to look for cancer cells. If the lymph nodes contain cancer,
the doctor will not remove the prostate and may recommend other
treatment.
- Radical
prostatectomy: A surgical procedure to remove the prostate, surrounding tissue, and seminal vesicles. There are 2 types of radical prostatectomy:
- Retropubic
prostatectomy: A surgical procedure to remove the prostate through an incision (cut) in the abdominal wall. Removal of nearby lymph nodes may be done at the same time.
- Perineal
prostatectomy: A surgical procedure to remove the prostate through an incision (cut) made in the perineum (area between the scrotum and anus). Nearby lymph nodes may also be removed through a separate incision in the abdomen.
Two panel drawing showing two ways of doing a radical prostatectomy; in the first panel, dotted line shows where incision is made through the wall of the abdomen for a retropubic prostatectomy; in the second panel, dotted line shows where incision is made in area between the scrotum and the anus for a perineal prostatectomy.
- Transurethral resection of the
prostate (TURP): A surgical procedure to remove tissue from 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 tumor before 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.
Transurethral resection of the prostate; drawing shows removal of tissue from the prostate using a resectoscope (a thin, lighted tube with a cutting tool at the end) inserted through the urethra.
Impotence and leakage of urine from the bladder or stool from the rectum 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 the nerves that control erection. However, men with
large tumors or tumors that are very close to the nerves may not be able to
have this surgery.
Radiation therapy
Radiation therapy is a cancer treatment that uses high-energy x-rays or other types of radiation 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. Internal radiation therapy uses a radioactive substance sealed in needles, seeds, wires, or catheters 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.
Impotence and urinary problems may occur in men treated with
radiation therapy.
Hormone therapy
Hormone therapy is a cancer treatment that removes hormones or blocks their action and stops cancer cells from growing. Hormones are substances produced by glands 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 production of male hormones or block them from working.
Hormone therapy used in the treatment of prostate cancer may
include the following:
Hot flashes, impaired sexual function, loss of desire for sex, and weakened bones
may occur in men treated with hormone therapy.
New types of treatment are being tested in clinical
trials.
This summary section describes treatments that are being studied in clinical trials. It may not mention 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 men treated with cryosurgery.
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 cells throughout the body (systemic chemotherapy). When chemotherapy is placed directly into the spinal column, 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 therapy is a treatment that uses the patient’s immune system to fight cancer. Substances made by the body or made in a laboratory are used to boost, direct, or restore the body’s natural defenses against cancer. This type of cancer treatment is also called biotherapy or immunotherapy.
High-intensity focused ultrasound
High-intensity focused ultrasound is 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.
Patients may want to think about taking part in a clinical trial.
For some patients, taking part in a clinical trial may 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 a new treatment.
Patients who take part in clinical trials also help improve the way cancer will be treated in the future. 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 from recurring (coming back) or reduce the side effects of cancer treatment.
Clinical trials are taking place in many parts of the country. See the Treatment Options section that follows for links to current treatment clinical trials. These have been retrieved from NCI's clinical trials database.
Follow-up tests may be needed.
Some of the tests that were done to diagnose the cancer or to find out the stage of 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 of these 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 your condition has changed or if the cancer has recurred (come back). These tests are sometimes called follow-up tests or check-ups.
[Back to top]Treatment Options by Stage
A link to a list of current clinical trials is included for each treatment section. For some types or stages of cancer, there may not be any trials listed. Check with your doctor for clinical trials that are not listed here but may be right for you.
[Back to top]Stage I Prostate Cancer
Treatment of stage I prostate
cancer may include the following:
Check for U.S. clinical trials from NCI's PDQ Cancer Clinical Trials Registry that are now accepting patients with stage I prostate cancer. For more specific results, refine the search by using other search features, such as the location of the trial, the type of treatment, or the name of the drug. General information about clinical trials is available from the NCI Web site.
[Back to top]Stage II Prostate Cancer
Treatment of stage II prostate
cancer may include the following:
Check for U.S. clinical trials from NCI's PDQ Cancer Clinical Trials Registry that are now accepting patients with stage II prostate cancer. For more specific results, refine the search by using other search features, such as the location of the trial, the type of treatment, or the name of the drug. General information about clinical trials is available from the NCI Web site.
[Back to top]Stage III Prostate Cancer
Treatment of stage III prostate
cancer may include the following:
Check for U.S. clinical trials from NCI's PDQ Cancer Clinical Trials Registry that are now accepting patients with stage III prostate cancer. For more specific results, refine the search by using other search features, such as the location of the trial, the type of treatment, or the name of the drug. General information about clinical trials is available from the NCI Web site.
[Back to top]Stage IV Prostate Cancer
Treatment of stage IV prostate
cancer may include the following:
Check for U.S. clinical trials from NCI's PDQ Cancer Clinical Trials Registry that are now accepting patients with stage IV prostate cancer. For more specific results, refine the search by using other search features, such as the location of the trial, the type of treatment, or the name of the drug. General information about clinical trials is available from the NCI Web site.
[Back to top]Treatment Options for Recurrent Prostate Cancer
Treatment of recurrentprostatecancer may include the following:
Check for U.S. clinical trials from NCI's PDQ Cancer Clinical Trials Registry that are now accepting patients with recurrent prostate cancer. For more specific results, refine the search by using other search features, such as the location of the trial, the type of treatment, or the name of the drug. General information about clinical trials is available from the NCI Web site.
[Back to top]To Learn More About Prostate Cancer
For more information from the National Cancer Institute about prostate cancer, see the following:
For general cancer information and other resources from the National Cancer Institute, see the following:
[Back to top]Changes to This Summary (05/23/2008)
The PDQcancer information summaries are reviewed regularly and updated as new information becomes available. This section describes the latest changes made to this summary as of the date above.
Several enhancements have been made to this summary to better explain certain medical concepts and to help readers find information about clinical trials. The following changes were made:
- Text describing the way cancer spreads in the body was added to the Stages section.
- Information about patients taking part in clinical trials and about follow-up tests was added to the Treatment Option Overview section.
- Links to ongoing clinical trials listed in NCI's PDQ Cancer Clinical Trials Registry were added to the Treatment Options section.
- A new section called "To Learn More" was added. It includes links to more information about this type of cancer and about cancer in general.
- The "Get More Information from NCI" section (originally called "To Learn More") was revised.