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Prostate Cancer - Introduction

Approved by the Lineagotica Editorial Board, 03/2018

ON THIS PAGE: You will find some basic information about this disease and the parts of the body it may affect. This is the first page of Lineagotica’s Guide to Prostate Cancer. Use the menu to see other pages. Think of that menu as a roadmap for this complete guide.

About the prostate

The prostate is a walnut-sized gland located behind the base of a man’s penis, in front of the rectum, and below the bladder. It surrounds the urethra, the tube-like channel that carries urine and semen through the penis. The prostate's main function is to make seminal fluid, the liquid in semen that protects, supports, and helps transport sperm.

As men get older, the prostate continues to enlarge over time. This can lead to a condition called benign prostatic hypertrophy (BPH), which is when the urethra becomes blocked. BPH is a common condition associated with growing older, and it can cause symptoms similar to those of prostate cancer. BPH has not been associated with a greater risk of having prostate cancer.

About prostate cancer

Cancer begins when healthy cells in the prostate change and grow out of control, forming a tumor. A tumor can be cancerous or benign. A cancerous tumor is malignant, meaning it can grow and spread to other parts of the body. A benign tumor means the tumor can grow but will not spread.

Prostate cancer is somewhat unusual when compared with other types of cancer. This is because many prostate tumors do not spread quickly to other parts of the body. Some prostate cancers grow very slowly and may not cause symptoms or problems for years or ever. Even when prostate cancer has spread to other parts of the body, it often can be managed for a long time, allowing men even with advanced prostate cancer to live with good health and quality of life for many years. However, if the cancer cannot be well controlled with existing treatments, it can cause symptoms like pain and fatigue and can sometimes lead to death. An important part of managing prostate cancer is monitoring it for growth over time, to determine whether it is growing slowly or quickly. Based on the pattern of growth, your doctor can decide the best available treatment options and when to give them.

About prostate-specific antigen (PSA)

Prostate-specific antigen (PSA) is a protein produced by cells in the prostate gland and released into the bloodstream. PSA levels are measured using a blood test. Although there is no such thing as a “normal PSA” for any man at any given age, a higher-than-normal level of PSA can be found in men with prostate cancer. Other non-cancerous prostate conditions, such as BPH (see above) or prostatitis can also lead to an elevated PSA level. Prostatitis is the inflammation or infection of the prostate. In addition, some activities like ejaculation can temporarily increase PSA levels. This should be avoided before a PSA test to avoid falsely elevated tests. See the Screening section for more information.

Histology is how cancer cells look under a microscope. The most common histology found in prostate cancer is called adenocarcinoma. Other, less common histologic types include neuroendocrine prostate cancer and small cell prostate cancer. These rare variants tend to be more aggressive, produce much less PSA, and spread outside the prostate earlier. Read more about neuroendocrine tumors.

Looking for More of an Introduction?

If you would like more of an introduction, explore these related items. Please note that these links will take you to other sections on Lineagotica:

The next section in this guide is Statistics. It helps explain the number of men who are diagnosed with this disease and general survival rates. You may use the menu to choose a different section to read in this guide.

Prostate Cancer - Statistics

Approved by the Lineagotica Editorial Board, 01/2018

ON THIS PAGE: You will find information about the number of men who are diagnosed with prostate cancer each year. You will also read information on surviving the disease. Remember, survival rates depend on several factors. Use the menu to see other pages.

Prostate cancer is the most common cancer among men, except for skin cancer. This year, an estimated 164,690 men in the United States will be diagnosed with prostate cancer. The average age of diagnosis is 66; the disease rarely occurs before age 40. For unknown reasons, the risk of prostate cancer is 74% higher in black men than in non-Hispanic white men. Most prostate cancers (91%) are found when the disease is confined to the prostate and nearby organs. This is referred to as the local or regional stage.

The 5-year survival rate tells you what percent of men live at least 5 years after the cancer is found. Percent means how many out of 100. The 5-year survival rate for most men with local or regional prostate cancer is nearly 100%. Ninety-eight percent (98%) are alive after 10 years. For men diagnosed with prostate cancer that has spread to other parts of the body, the 5-year survival rate is 30%.

Prostate cancer is the second leading cause of cancer death in men in the United States. It is estimated that 29,430 deaths from this disease will occur this year. Although the number of deaths from prostate cancer continues to decline among all men, the death rate remains twice as high in black men than any other group. A man’s individual survival depends on the type of prostate cancer and the stage of the disease.

It is important to remember that statistics on the survival rates for men with prostate cancer are an estimate. The estimate comes from annual data based on the number of men with this cancer in the United States. Also, experts measure the survival statistics every 5 years. So the estimate may not show the results of better diagnosis or treatment available for less than 5 years. Men should talk with their doctor if they have any questions about this information. Learn more about understanding statistics.

Statistics adapted from the American Cancer Society's (ACS) publication, Cancer Facts and Figures 2018, and the ACS website.

The next section in this guide is Medical Illustrations. It offers drawings of body parts often affected by prostate cancer. Use the menu to choose a different section to read in this guide.

Prostate Cancer - Medical Illustrations

Approved by the Lineagotica Editorial Board, 03/2018

ON THIS PAGE: You will find a drawing of the main body parts affected by this disease. Use the menu to see other pages.

The illustration shows the male urinary tract. Two kidneys are located on either side of the spine near the bottom of the rib cage. Each kidney connects to a ureter through the renal pelvis and calyx. The ureters run down the body to connect to the bladder, which is located in the pelvic cavity in front of the rectum and directly above the prostate. The prostate is a walnut-sized gland located at the base of the penis. A cross-section of the bladder and prostate shows the 2 ureteric orifices where the ureters connect to the bladder and that the prostate is located directly under the bladder and surrounds the urethra, which allows urine and seminal fluid to exit the body through the penis. Under the prostate, layers of corpus spongiosum tissue and bulbospongiosus muscle surround the urethra. Copyright 2003 American Society of Clinical Oncology. Robert Morreale/Visual Explanations, LLC.

For medical illustrations showing the different stages of prostate cancer, please visit the Stages and Grades section.

The next section in this guide is Risk Factors and Prevention. It explains what factors may increase the chance of developing this disease and what men can do to lower their risk. You may use the menu to choose a different section to read in this guide. 

Prostate Cancer - Risk Factors and Prevention

Approved by the Lineagotica Editorial Board, 03/2018

ON THIS PAGE: You will find out more about the factors that increase the chance of developing this type of cancer. Use the menu to see other pages.

A risk factor is anything that increases a person’s chance of developing cancer. Although risk factors often influence the chance to develop cancer, most do not directly or by themselves cause cancer. Some people with several known risk factors never develop cancer, while others with no known risk factors do. Knowing your risk factors and talking about them with your doctor may help you make more informed lifestyle and health care choices.

The following factors may raise a man’s risk of developing prostate cancer:

  • Age. The risk of prostate cancer increases with age, especially after age 50. More than 80% of prostate cancers are diagnosed in men who are 65 or older. Older patients who are diagnosed with prostate cancer can face unique challenges, specifically with regard to cancer treatment. For more information, please visit Lineagotica’s section about aging and cancer.

  • Race/ethnicity. Black men have a higher risk of prostate cancer than white men. They are also more likely to develop prostate cancer at an earlier age and to have more aggressive tumors that grow quickly. The exact reasons for these differences are not known and may involve genetic, socioeconomic, or other factors. Hispanic men have a lower risk of developing prostate cancer and dying from the disease than non-Hispanic white men.

    Prostate cancer occurs most often in North America and northern Europe. It also appears that prostate cancer is increasing among Asian men living in urbanized environments, such as Hong Kong, Singapore, and North American and European cities, particularly among those who have a lifestyle with less physical activity and a less healthy diet.

  • Family history. Prostate cancer that runs in a family, called familial prostate cancer, occurs about 20% of the time. This type of prostate cancer develops because of a combination of shared genes and shared environmental or lifestyle factors.

    Hereditary prostate cancer, meaning the cancer is inherited from a relative, is rare and accounts for about 5% of all cases. Hereditary prostate cancer occurs when changes in genes, or mutations, are passed down within a family from 1 generation to the next. Hereditary prostate cancer may be suspected if a man’s family history includes any of the following characteristics:

    • 3 or more first-degree relatives with prostate cancer

    • Prostate cancer in 3 generations on the same side of the family

    • 2 or more close relatives, such as a father, brother, son, grandfather, uncle, or nephew, on the same side of the family diagnosed with prostate cancer before age 55

    If a man has a first-degree relative—meaning a father, brother, or son—with prostate cancer, his risk of developing prostate cancer is 2 to 3 times higher than the average risk. This risk increases even further with the number of relatives diagnosed with prostate cancer. 

  • Hereditary breast and ovarian cancer (HBOC) syndrome. HBOC is associated with DNA-repair mutations to the BRCA1 and/or BRCA2 genes. BRCA stands for “BReast CAncer.” HBOC is most commonly associated with an increased risk of breast and ovarian cancers in women. However, men with HBOC also have an increased risk of developing breast cancer and a more aggressive form of prostate cancer. Mutations in the BRCA1 and BRCA2 genes are thought to cause only a small percentage of familial prostate cancers. Men who have BRCA1 or BRCA2 mutations should consider screening for prostate cancer at an earlier age. Genetic testing may only be appropriate for families with prostate cancer that may also have HBOC. If you are concerned about this based on your own family history, please talk with a genetic counselor or doctor for more information.

  • Other genetic changes. Other genes that may carry an increased risk of developing prostate cancer include HPC1, HPC2, HPCX, CAPB, ATM, and FANCA. However, none of them has been directly shown to cause prostate cancer or be specific to this disease. Research to identify genes associated with an increased risk of prostate cancer is ongoing, and researchers are constantly learning more about how specific genetic changes can influence the development of prostate cancer. At present, there are no genetic tests available to determine a man's chance of developing prostate cancer.

  • Agent Orange exposure. The U.S. Department of Veterans Affairs lists prostate cancer as a disease associated with exposure to Agent Orange, a chemical used during the Vietnam War. If you are a veteran who may have been exposed to Agent Orange, please talk to your doctor in the VA system. Learn more about the link with Agent Orange on the Department of Veterans Affairs’ website.

  • Eating habits. No study has proven that diet and nutrition can directly cause or prevent the development of prostate cancer. However, many studies that look at links between certain eating behaviors and cancer suggest there may be a connection. For example, obesity is associated with many cancers, including prostate cancer, and a healthy diet to avoid weight gain is recommended (See “Dietary Changes” below).

Prevention

Different factors cause different types of cancer. Researchers continue to look into what factors cause this type of cancer. Although there is no proven way to completely prevent this disease, you may be able to lower your risk. Talk with your doctor for more information about your personal risk of cancer.

Chemoprevention

A class of drugs called 5-alpha-reductase inhibitors (5-ARIs), which includes dutasteride (Avodart) and finasteride (Proscar), are often used to treat BPH. They may also lower a man’s risk of developing prostate cancer. While some previous clinical trials implied that 5-ARIs were linked to more aggressive prostate cancers, newer studies have suggested that this isn’t true. Interestingly, according to the results of a long-term follow-up study published in 2013, 78% of men either taking finasteride or a placebo were still alive 15 years later. These results suggest that taking finasteride does not decrease the risk of death for men with prostate cancer. This subject remains controversial, and the U.S. Food and Drug Administration (FDA) has not approved these drugs for prostate cancer prevention. However, a 5-ARI is FDA approved for the treatment of lower urinary tract symptoms associated with BPH. Because the decision to take a 5-ARI is different for each patient, any men considering taking this class of medication should discuss the possible benefits and side effects with their doctor.

Dietary changes

There is not enough information right now to make clear recommendations about the exact role eating behaviors play in prostate cancer. Dietary changes may need to be made many years earlier in a man’s life to reduce the risk of developing prostate cancer.

Here is a brief summary of the current research

  • Regularly eating foods high in fat, especially animal fat, may increase prostate cancer risk. However, no prospective studies, meaning studies that look at men who follow either high-fat or low-fat diets and then measure the total number of men in each group diagnosed with prostate cancer, have yet shown that diets high in animal fat raise the risk of prostate cancer.

  • A diet high in vegetables, fruits, and legumes, such as beans and peas, may decrease the risk of prostate cancer. It is unclear which nutrients are directly responsible. Although lycopene, the nutrient found in tomatoes and other vegetables, has been shown to be associated with a lower risk of prostate cancer, the data so far have not proven a relationship.

  • Currently no specific vitamins, minerals, or other supplements have been conclusively shown in clinical trials to prevent prostate cancer. Men should talk with their doctors before taking any supplements to prevent prostate cancer.

  • Specific changes to eating behaviors may not stop or slow the development of prostate cancer. It is possible such changes would need to be made early in life to have an effect.

The next section in this guide is Screening. It explains how tests may find cancer before signs or symptoms appear. You may use the menu to choose a different section to read in this guide.

Prostate Cancer - Screening

Approved by the Lineagotica Editorial Board, 03/2018

ON THIS PAGE: You will find out more about screening for this type of cancer. You will also learn the risks and benefits of screening. Use the menu to see other pages.

Screening is used to look for cancer before you have any symptoms or signs. When cancer is found earlier, it is often at an earlier stage. This means that there is a better chance of successfully treating the cancer. Scientists have developed, and continue to develop, tests that can be used to screen a person for specific types of cancer. The overall goals of cancer screening are to:

  • Lower the number of people who die from the disease, or eliminate deaths from cancer altogether

  • Lower the number of people who develop the disease

Learn more about the basics of cancer screening.

Screening information for prostate cancer

Screening for prostate cancer is done to find evidence of cancer in otherwise healthy men. Two tests are commonly used to screen for prostate cancer:

  • Digital rectal examination (DRE). A DRE is a test in which the doctor inserts a gloved, lubricated finger into a man’s rectum and feels the surface of the prostate through the bowel wall for any irregularities.

  • PSA blood test. There is controversy about using the PSA test to look for prostate cancer in men with no symptoms of the disease. On the one hand, the PSA test is useful for detecting early-stage prostate cancer, especially in men with many risk factors, which helps some men get the treatment they need before the cancer grows and spreads. On the other hand, PSA screening finds conditions that are not cancer, such as BPH, in addition to very-slow-growing prostate cancers that would never threaten a man’s life. As a result, screening for prostate cancer with PSA may mean that some men have surgery and other treatments that may not be needed, which can cause side effects and seriously affect a man’s quality of life.

ASCO recommends that men with no symptoms of prostate cancer not receive PSA screening if they are expected to live less than 10 years. For men expected to live longer than 10 years, ASCO recommends that they talk with their doctors to find out if the test is appropriate for them.

Other organizations have different recommendations for screening:

  • The U.S. Preventive Services Task Force (USPSTF) had previously concluded that the potential risks of PSA screening in healthy men outweigh the potential benefits. The latest USPSTF final recommendation statement on prostate cancer screening states that men between 55 and 69 should discuss the pros and cons of PSA screening with their clinician before making a decision about screening. Men who are 70 and older should not have routine PSA screenings for prostate cancer.

  • Both the American Urological Association and the American Cancer Society recommend that men be told the risks and benefits of testing before PSA screening occurs and then make an informed decision in consultation with their doctor.

  • The National Comprehensive Lineagoticawork considers a patient’s age, PSA value, DRE results, and other factors in their recommendations.

It is not easy to predict which tumors will grow and spread quickly and which will grow slowly. Every man should discuss his situation and personal risk of prostate cancer with his doctor so they can work together to make an informed decision.

The next section in this guide is Symptoms and Signs. It explains what body changes or medical problems this disease can cause. You may use the menu to choose a different section to read in this guide.

Prostate Cancer - Symptoms and Signs

Approved by the Lineagotica Editorial Board, 03/2018

ON THIS PAGE: You will find out more about body changes and other things that can signal a problem that may need medical care. Use the menu to see other pages.

Often, early-stage prostate cancer has no symptoms or signs. It is usually found through a PSA test or DRE, a process called screening. If a PSA test or DRE indicates that prostate cancer may be present, more monitoring and testing is needed to diagnose prostate cancer. When prostate cancer does cause symptoms or signs, it is usually diagnosed in a later stage. These symptoms and signs may include:  

  • Frequent urination

  • Weak or interrupted urine flow or the need to strain to empty the bladder

  • The urge to urinate frequently at night

  • Blood in the urine

  • Blood in the seminal fluid

  • New onset of erectile dysfunction

  • Pain or burning during urination, which is much less common

  • Discomfort or pain when sitting, caused by an enlarged prostate

Sometimes men with prostate cancer do not have any of these changes. Other noncancerous conditions of the prostate, such as BPH or an enlarged prostate, can cause similar symptoms. Or, the cause of a symptom may be a different medical condition that is not cancer. Urinary symptoms also can be caused by an infection of the bladder or other conditions.

If cancer has spread outside of the prostate gland, a man may experience:

  • Pain in the back, hips, thighs, shoulders, or other bones

  • Swelling or fluid buildup in the legs or feet

  • Unexplained weight loss

  • Fatigue

  • Change in bowel habits

If you are concerned about any changes you experience, please talk with your doctor. Your doctor will ask how long and how often you have been experiencing the symptom(s), in addition to other questions. This is to help figure out the cause of the problem, called a diagnosis.

If cancer is diagnosed, relieving symptoms remains an important part of cancer care and treatment. This may also be called symptom management, palliative care, or supportive care. Be sure to talk with your health care team about the symptoms you experience, including any new symptoms or a change in symptoms.

The next section in this guide is Diagnosis. It explains what tests may be needed to learn more about the cause of the symptoms. You may use the menu to choose a different section to read in this guide.

Prostate Cancer - Diagnosis

Approved by the Lineagotica Editorial Board, 03/2018

ON THIS PAGE: You will find a list of common tests, procedures, and scans that doctors use to find the cause of a medical problem. Use the menu to see other pages.

Doctors use many tests to find, or diagnose, cancer. They also do tests to learn if cancer has spread to another part of the body from where it started. If this happens, it is called metastasis. For example, imaging tests can show if the cancer has spread. Imaging tests show pictures of the inside of the body. Doctors may also do tests to learn which treatments could work best.

For most types of cancer, a biopsy is the only sure way for the doctor to know whether an area of the body has cancer. In a biopsy, the doctor takes a small sample of tissue for testing in a laboratory. 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 done when a patient has another medical problem that makes it difficult to do a biopsy, or when a person has a very high PSA level and a bone scan that indicates cancer.

This list describes options for diagnosing this type of cancer. Not all tests listed below are commonly used for every person. Your doctor may consider these factors when choosing a diagnostic test:

  • The type of cancer suspected

  • Your signs and symptoms

  • Your age and medical condition

  • The results of earlier medical tests

Preliminary tests

In addition to a physical examination, the following tests may be used to diagnose prostate cancer:

  • PSA test. As described in the Introduction and Screening sections, PSA is a type of protein released by prostate tissue that is found in higher levels in a man's blood. Levels can be raised when there is abnormal activity in the prostate, including prostate cancer, BPH, or inflammation of the prostate. Doctors can look at features of the PSA value, such as absolute level, change over time (also known as “PSA velocity”), and level in relation to prostate size, to decide if a biopsy is needed.

    • Free PSA test. There is a version of the PSA test that allows the doctor to measure a specific component, called the “free” PSA. Free PSA is found in the bloodstream and is not bound to proteins. A standard PSA test measures total PSA, which includes both PSA that is and is not bound to proteins. The free PSA test measures the ratio of free PSA to total PSA. Knowing this ratio can sometimes help find out if an elevated PSA level is caused by a malignant condition like prostate cancer.
  • DRE. A doctor uses a DRE to find abnormal parts of the prostate by feeling the area using a finger. It is not very precise and not every doctor has expertise in the technique; therefore, DRE does not usually detect early prostate cancer. See the Screening section for more information.

  • Biomarker tests. A biomarker is a substance that is found in the blood, urine, or body tissues of a person with cancer. It is made by the tumor or by the body in response to the cancer. A biomarker may also be called a tumor marker. Biomarker tests for prostate cancer include the 4Kscore, which predicts the chances a man will develop high-risk prostate cancer, and the Prostate Health Index (PHI), which predicts the chances a man will develop prostate cancer.

Confirming the diagnosis

If the PSA or DRE test results are abnormal, then the following tests can help confirm a diagnosis of cancer:

  • PCA3 test. The Prostate CAncer gene 3 (PCA3) assay looks for the PCA3 gene in a man’s urine. Unlike PSA, which can be found in anyone with a prostate, the PCA3 gene is greatly expressed in men with prostate cancer. Using a urine test, a doctor can find out whether this gene is present in the body. This test does not replace PSA. It is used along with a PSA test to help decide if a prostate biopsy is needed.

  • Transrectal ultrasound (TRUS). A doctor inserts a probe into the rectum that takes a picture of the prostate using sound waves that bounce off the prostate. A TRUS is usually done at the same time as a biopsy.

  • Biopsy. A biopsy is the removal of a small amount of tissue for examination under a microscope. Other tests can suggest that cancer is present, but only a biopsy can make a definite diagnosis. To get a tissue sample, a surgeon most often uses TRUS and a biopsy tool to take very small slivers of prostate tissue. Biopsy specimens will be taken from several areas of the prostate. This is done to ensure that a good sample is taken for examination. Most men will have 12 to 14 pieces of tissue removed, and the procedure can take 20 to 30 minutes to complete.

    A person usually can have this procedure done at the hospital or doctor’s office without needing to stay overnight. The patient is given local anesthesia beforehand to numb the area and usually receives antibiotics before the procedure to prevent infection.

    A pathologist then analyzes the sample(s) under a microscope. A pathologist is a doctor who specializes in interpreting laboratory tests and evaluating cells, tissues, and organs to diagnose disease.

    Ask to review the results of the pathology report with your health care team.

  • MRI fusion biopsy. An MRI fusion biopsy combines an MRI scan (see below) with TRUS. Evaluation with a prostate MRI scan has become a routine procedure in clinical practice. The patient first receives an MRI scan to identify suspicious areas of the prostate that require further evaluation. The patient then has an ultrasound of the prostate. Computer software combines these images to produce a 3D image that helps target the precise area where to perform the biopsy. Although it may not eliminate the need for repeat biopsies, an MRI fusion biopsy can better identify areas that are more likely to be cancerous than other methods. An MRI fusion biopsy should only be performed by someone with expertise in the procedure.

Finding out if the cancer has spread

To find out if cancer has spread outside of the prostate, doctors may perform the imaging tests listed below. Doctors are able to estimate the risk of spread, called metastasis, based on PSA levels, tumor grade, and other factors, but an imaging test can confirm this. Men with low-risk early-stage prostate cancer who do not have any symptoms do not need to receive a CT scan or bone scan to figure out the stage of the disease. Learn more about when these tests are recommended to find out if the cancer has spread.

  • Whole-body bone scan. A bone scan uses a radioactive tracer (Technetium-99) to look at the inside of the bones. The tracer is injected into a patient’s vein. It collects in areas of the bone where metabolic activity has occurred. Healthy bone appears gray to the camera, and areas of injury, such as those caused by cancer, appear dark. It is important to know that structural changes to the bone, such arthritis or bone scars like old fractures, can also be interpreted as abnormal and need to be evaluated by a doctor to make sure they are not cancer.

  • Computed tomography (CT or CAT) scan. A CT scan creates a 3D picture of the inside of the body using x-rays taken from different angles. A computer combines these images into a detailed, cross-sectional view that shows any abnormalities or tumors. A CT scan can be used to measure the tumor’s size. Sometimes, a special dye called a contrast medium is given before the scan to provide better detail on the image. This dye can be injected into a patient’s vein or given as a liquid to swallow.

  • Positron emission tomography (PET) or PET-CT scan. A PET scan is usually combined with a CT scan (see above), called a PET-CT scan. However, you may hear your doctor refer to this procedure just as a PET scan. A PET scan is a way to create pictures of organs and tissues inside the body. A small amount of a radioactive substance is injected into the patient’s body. This substance is taken up by cells that use the most energy. Because cancer tends to use energy actively, it absorbs more of the radioactive substance. A scanner then detects this substance to produce images of the inside of the body. For many types of cancer, a PET-CT scan uses fluorodeoxyglucose (FDG) as the substance that is imaged; however, FDG is not a useful substance for imaging in prostate cancer and should not be used.

    Researchers are actively investigating using different substances with PET scans to find prostate cancer. For example, sodium fluoride is absorbed by bones, and its use in a PET scan may improve the chances of finding prostate cancer that has spread to the bone. Other substances being studied include choline acetate, fluciclovine, and prostate specific membrane antigen (PSMA).

  • Magnetic resonance imaging (MRI). An MRI scan uses magnetic fields, not x-rays, to produce detailed images of the body. An MRI can be used to measure the tumor’s size. A special dye called contrast medium is given before the scan to create a clearer picture. This dye can be injected into a patient’s vein or given as a liquid to swallow.

After diagnostic tests are done, your doctor will review all of the results with you. If the diagnosis is cancer, these results also help the doctor describe the cancer. This is called staging.

The next section in this guide is Stages and Grades. It explains the system doctors use to describe the extent of the disease and how the cancer cells look under a microscope. You may use the menu to choose a different section to read in this guide.

Prostate Cancer - Stages and Grades

Approved by the Lineagotica Editorial Board, 03/2018

ON THIS PAGE: You will learn about how doctors describe a cancer’s growth or spread, as well as what the cancer cells look like under a microscope. This is called the stage and grade. Use the menu to see other pages.

Staging is a way of describing where the cancer is located, if or where it has spread, and whether it is affecting other parts of the body.

Doctors use diagnostic tests to find out the cancer's stage, so staging may not be complete until all of the tests are finished. Staging for prostate cancer also involves looking at test results to find out if the cancer has spread from the prostate to other parts of the body. Knowing the stage helps the doctor to decide what kind of treatment is best and can help predict a patient's prognosis, which is the chance of recovery. There are different stage descriptions for different types of cancer.

There are 2 types of staging for prostate cancer:

  • Clinical staging. This is based on the results of DRE, PSA testing, and Gleason score (see “Gleason score for grading prostate cancer” below). These test results will help determine whether x-rays, bone scans, CT scans, or MRI are also needed. If scans are needed, they can add more information to help the doctor figure out the clinical stage.

  • Pathologic staging. This is based on information found during surgery, plus the laboratory results, referred to as pathology, of the prostate tissue removed during surgery. The surgery often includes the removal of the entire prostate and some lymph nodes. Examination of the removed lymph nodes can provide more information for pathologic staging.

TNM staging system

One tool that doctors use to describe the stage is the TNM system. Doctors use the results from diagnostic tests and scans to answer these questions:

  • Tumor (T): How large is the primary tumor? Where is it located?

  • Node (N): Has the tumor spread to the lymph nodes? If so, where and how many?

  • Metastasis (M): Has the cancer metastasized to other parts of the body? If so, where and how much?

The results are combined to determine the stage of cancer for each person. There are 5 stages: stage 0 (zero) and stages I through IV (1 through 4). The stage provides a common way of describing the cancer, so doctors can work together to plan the best treatments.

Here are more details about each part of the TNM system for prostate cancer.

Tumor (T)

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. Specific tumor stage information is listed below. If the tumor is staged clinically, it is often written as cT. If pathologic staging is used, it is written as pT.

Clinical T

TX: The primary tumor cannot be evaluated.

T0 (T plus zero): There is no evidence of a tumor in the prostate.

T1: The tumor cannot be felt during a DRE and is not seen during imaging tests. It may be found when surgery is done for another reason, usually for BPH or an abnormal growth of noncancerous prostate cells.

  • T1a: The tumor is in 5% or less of the prostate tissue removed during surgery.

  • T1b: The tumor is in more than 5% of the prostate tissue removed during surgery.

  • T1c: The tumor is found during a needle biopsy, usually because the patient has an elevated PSA level.

T2: The tumor is found only in the prostate, not other parts of the body. It is large enough to be felt during a DRE.

  • T2a: The tumor involves one-half of 1 side of the prostate.

  • T2b: The tumor involves more than one-half of 1 side of the prostate but not both sides.

  • T2c: The tumor has grown into both sides of the prostate.

T3: The tumor has grown through the prostate on 1 side and into the tissue just outside the prostate.

  • T3a: The tumor has grown through the prostate either on 1 or both sides of the prostate. This called extraprostatic extension (EPE).

  • T3b: The tumor has grown into the seminal vesicle(s), the tube(s) that carry semen.

T4: The tumor is fixed, or it is growing into nearby structures other than the seminal vesicles, such as the external sphincter, the part of the muscle layer that helps to control urination; the rectum; the bladder; levator muscles; or the pelvic wall.

Pathological T

There is no TX, T0, or T1 classification for pathologic staging of prostate cancer.

T2: The tumor is found only in the prostate.

T3: There is EPE. The tumor has grown through the prostate on 1 or both sides of the prostate.

  • T3a: There is EPE or the tumor has invaded the neck of the bladder.

  • T3b: The tumor has grown into the seminal vesicle(s).

T4: The tumor is fixed, or it is growing into nearby structures other than the seminal vesicles, such as the external sphincter, the part of the muscle layer that helps to control urination; the rectum; the bladder; levator muscles; or the pelvic wall.

Node (N)

The “N” in the TNM staging system stands for lymph nodes. These tiny, bean-shaped organs 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.

NX: The regional lymph nodes cannot be evaluated.

N0 (N plus zero): The cancer has not spread to the regional lymph nodes.

N1: The cancer has spread to the regional (pelvic) lymph node(s).

Metastasis (M)

The "M" in the TNM system indicates whether the prostate cancer has spread to other parts of the body, such as the lungs or the bones. This is called distant metastasis.

MX: Distant metastasis cannot be evaluated.

M0 (M plus zero): The disease has not metastasized.

M1: There is distant metastasis.

  • M1a: The cancer has spread to nonregional, or distant, lymph node(s).

  • M1b: The cancer has spread to the bones.

  • M1c: The cancer has spread to another part of the body, with or without spread to the bone.

Gleason score for grading prostate cancer

Prostate cancer is also given a grade called a Gleason score. This score is based on how much the cancer looks like healthy tissue when viewed under a microscope. Less aggressive tumors generally look more like healthy tissue. Tumors that are more aggressive are likely to grow and spread to other parts of the body. They look less like healthy tissue.

The Gleason scoring system is the most common prostate cancer grading system used. The pathologist looks at how the cancer cells are arranged in the prostate and assigns a score on a scale of 3 to 5 from 2 different locations. Cancer cells that look similar to healthy cells receive a low score. Cancer cells that look less like healthy cells or look more aggressive receive a higher score. To assign the numbers, the pathologist determines the main pattern of cell growth, which is the area where the cancer is most obvious and looks for another area of growth. The doctor then gives each area a score from 3 to 5. The scores are added together to come up with an overall score between 6 and 10.

Gleason scores of 5 or lower are not used. The lowest Gleason score is 6, which is a low-grade cancer. A Gleason score of 7 is a medium-grade cancer, and a score of 8, 9, or 10 is a high-grade cancer. A lower-grade cancer grows more slowly and is less likely to spread than a high-grade cancer.

Doctors look at the Gleason score in addition to stage to help plan treatment. For example, active surveillance (see Treatment Options) may be an option for a patient with a small tumor, low PSA level, and a Gleason score of 6. Patients with a higher Gleason score may need treatment that is more intensive, even if the cancer is not large or has not spread.

  • Gleason X: The Gleason score cannot be determined.

  • Gleason 6 or lower: The cells are well differentiated, meaning they look similar to healthy cells.

  • Gleason 7: The cells are moderately differentiated, meaning they look somewhat similar to healthy cells.

  • Gleason 8, 9, or 10: The cells are poorly differentiated or undifferentiated, meaning they look very different from healthy cells.

Gleason scores are often grouped into simplified Grade Groups:

  • Grade Group 1 = Gleason 6

  • Grade Group 2 = Gleason 3 + 4 = 7

  • Grade Group 3 = Gleason 4 + 3 = 7

  • Gleason Group 4 = Gleason 8

  • Gleason Group 5 = Gleason 9 or 10

Cancer stage grouping

Doctors assign the stage of the cancer by combining the T, N, and M classifications. Staging also includes the PSA level (see Screening) and Grade Group.

Stage I: Cancer in this early stage is usually slow growing. The tumor cannot be felt and involves one-half of 1 side of the prostate or even less than that. PSA levels are low. The cancer cells are well differentiated, meaning they look like healthy cells (cT1a–cT1c or cT2a or pT2, N0, M0, PSA level is less than 10, Grade Group 1).

Stage II: The tumor is found only in the prostate. PSA levels are medium or low. Stage II prostate cancer is small but may have an increasing risk of growing and spreading.

  • Stage IIA: The tumor cannot be felt and involves half of 1 side of the prostate or even less than that. PSA levels are medium, and the cancer cells are well differentiated (cT1a–cT1c or cT2a, N0, M0, PSA level is between 10 and 20, Grade Group 1). This stage also includes larger tumors confined to the prostate as long as the cancer cells are still well differentiated (cT2b–cT2c, N0, M0, PSA level is less than 20, Group 1).

  • Stage IIB: The tumor is found only inside the prostate, and it may be large enough to be felt during DRE. The PSA level is medium. The cancer cells are moderately differentiated (T1–T2, N0, M0, PSA level less than 20, Grade Group 2).

  • Stage IIC: The tumor is found only inside the prostate, and it may be large enough to be felt during DRE. The PSA level is medium. The cancer cells may be moderately or poorly differentiated (T1–T2, N0, M0, PSA level is less than 20, Grade Group 3–4).

Stage III: PSA levels are high, the tumor is growing, or the cancer is high grade. These all indicate a locally advanced cancer that is likely to grow and spread.

  • Stage IIIA: The cancer has spread beyond the outer layer of the prostate into nearby tissues. It may also have spread to the seminal vesicles. The PSA level is high. (T1–T2, N0, M0, PSA level is 20 or more, Grade Group 1–4).

  • Stage IIIB: The tumor has grown outside of the prostate gland and may have invaded nearby structures, such as the bladder or rectum (T3­–T4, N0, M0, any PSA, Grade Group 1–4).

  • Stage IIIC: The cancer cells across the tumor are poorly differentiated, meaning they look very different from healthy cells (any T, N0, M0, any PSA, Grade Group 5).

Stage IV: The cancer has spread beyond the prostate.

  • Stage IVA: The cancer has spread to the regional lymph nodes (any T, N1, M0, any PSA, any Grade Group).

  • Stage IVB: The cancer has spread to distant lymph nodes, other parts of the body, or to the bones (any T, N0, M1, any PSA, any Grade Group).

Recurrent: Recurrent prostate cancer is cancer that has come back after treatment. It may come back in the prostate area again or in other parts of the body. If the cancer does return, there will be another round of tests to learn about the extent of the recurrence. These tests and scans are often similar to those done at the time of the original diagnosis.

Used with permission of the American College of Surgeons, Chicago, Illinois. The original and primary source for this information is the AJCC Cancer Staging Manual, Eighth Edition (2017), published by Springer International Publishing.

Prostate cancer risk groups

In addition to stage, doctors use other prognostic factors to help plan the best treatment and predict how successful treatment will be. Two such risk assessment methods come from the National Comprehensive Lineagoticawork (NCCN) and the University of California, San Francisco (UCSF).

NCCN

The NCCN developed 4 risk-group categories based on PSA level, prostate size, needle biopsy findings, and the stage of cancer. The lower your risk, the lower the chance that the prostate cancer will grow and spread.

  • Very low risk. The tumor cannot be felt during a DRE and is not seen during imaging tests but was found during a needle biopsy (T1c). PSA is less than 10 ng/mL. The Gleason score is 6 or less. Cancer was found in fewer than 3 samples taken during a core biopsy. The cancer was found in half or less of any core.

  • Low risk. The tumor is classified as T1a, T1b, T1c, or T2a (see above). PSA is less than 10 ng/mL. The Gleason score is 6 or less.

  • Intermediate risk. The tumor has 2 or more of these characteristics:

    • Classified as T2b or T2c (see above)

    • PSA is between 10 and 20 ng/mL

    • Gleason score of 7

  • High risk. The tumor has 2 or more of these characteristics:

    • Classified as T3a (see above)

    • PSA level is higher than 20 ng/mL

    • Gleason score is between 8 and 10

  • Very high risk. The tumor is classified as T3b or T4 (see above). The histologic grade is 5 for the main pattern of cell growth, or more than 4 biopsy cores have Gleason scores between 8 and 10.

Source: Risk group information is adapted from the NCCN.

UCSF Cancer of the Prostate Risk Assessment (UCSF-CAPRA) score

The UCSF-CAPRA score predicts a man’s chances of having the cancer spread and of dying. This score can be used to help make decisions about the treatment plan. Points are assigned according to a person’s age at diagnosis, PSA level at diagnosis, Gleason score of the biopsy, T classification from the TNM system, and the percentage of biopsy cores involved with cancer. These categories are then used to assign a score between 0 and 10.

  • CAPRA score 0 to 2 indicates low risk.

  • CAPRA score 3 to 5 indicates intermediate risk.

  • CAPRA score 6 to 10 indicates high risk.   

Information about the cancer’s stage and other prognostic factors will help the doctor recommend a specific treatment plan. The next section in this guide is Treatment Options. You may use the menu to choose a different section to read in this guide.

Prostate Cancer - Types of Treatment

Approved by the Lineagotica Editorial Board, 03/2018

ON THIS PAGE: You will learn about the different treatments doctors use for men with prostate cancer. Use the menu to see other pages.

This section tells you the treatments that are the standard of care for this type of cancer. “Standard of care” means the best treatments known. When making treatment plan decisions, patients are encouraged to consider clinical trials as an option. A clinical trial is a research study that tests a new approach to treatment. Doctors want to learn whether the new treatment is safe, effective, and possibly better than the standard treatment. Clinical trials can test a new drug, a new combination of standard treatments, or new doses of standard drugs or other treatments. Your doctor can help you consider all your treatment options. To learn more about clinical trials, see the About Clinical Trials and Latest Research sections.

Treatment overview

In cancer care, different types of doctors—including medical oncologists, surgeons, and radiation oncologists—often work together to create an overall treatment plan that may combine different type of treatments to treat the cancer. This is called a multidisciplinary team. Cancer care teams include a variety of other health care professionals, such as palliative care experts, physician assistants, advanced nurse practitioners, oncology nurses, social workers, pharmacists, counselors, dietitians, physical therapists, and others.

Descriptions of the most common treatment options for prostate cancer are listed below. Treatment options and recommendations depend on several factors, including the type and stage of cancer, possible side effects, and the patient’s preferences and overall health. Your care plan may also include treatment for symptoms and side effects, an important part of cancer care.

More information on the specific effects of surgery, chemotherapy, and radiation therapy on older patients can be found in this article in another section of this website.

Take time to learn about your treatment options and be sure to ask questions if something is unclear. Talk with your doctor about the goals of each treatment, the likelihood that the treatment will work, what you can expect while receiving the treatment, and the possible urinary, bowel, sexual, and hormone-related side effects of treatment. Men should also discuss with their doctor how the various treatment options affect recurrence, 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. These types of talks with your doctor are called shared decision making. Shared decision making is when doctors and people with cancer work together to choose treatments that fit their goals of care. Shared decision making is particularly important for prostate cancer because there are many treatment options. Learn more about making treatment decisions.

Because most prostate cancers are found in the early stages when they are growing slowly, you usually do not have to rush to make treatment decisions. During this time, it is important to talk with your doctor about the risks and benefits of all your treatment options and when treatment should begin. This discussion should also address the current state of the cancer, such as:

  • Whether PSA levels are rising or steady

  • Whether the cancer has spread to the bones

  • Your health history

  • Any other medical conditions you may have

Although your treatment recommendations will depend on these factors, there are some general steps for treating early-stage and locally advanced prostate cancer. Treatment options for advanced and metastatic prostate cancer are described later in this section.

  • Early-stage prostate cancer (stages I and II). Early-stage prostate cancer usually grows very slowly and may take years to cause any symptoms or other health problems, if it ever does at all. As a result, active surveillance may be recommended. Radiation therapy (external-beam or brachytherapy) or surgery may also be suggested, as well as clinical trials. For men with a higher Gleason score, the cancer may be faster growing, so radical prostatectomy (see “Surgery” below) and radiation therapy are often appropriate. Your doctor will consider your age and general health before recommending a treatment option.

    ASCO, the American Urological Association, American Society of Radiation Oncology, and the Society of Urologic Oncology recommend that men with high-risk early-stage prostate cancer that has not spread to other areas of the body should receive radical prostatectomy or radiation therapy with androgen-deprivation therapy (ADT) as standard treatment options. Radical prostatectomy, radiation therapy, and ADT are described in detail below.

    Learn more about these recommendations for men with early-stage prostate cancer on a different ASCO website.

  • Locally advanced prostate cancer (stage III). Men with locally advanced prostate cancer who choose not to have surgery should not have systemic therapy with either ADT or chemotherapy before surgery. Men with locally advanced prostate cancer who choose radiation therapy should receive ADT as the standard of care.

    ADT given for 24 months is widely accepted as the least amount of time needed to control the disease, but 18 months may also be enough. Adjuvant or salvage radiation therapy is treatment that is given after radical prostatectomy. It is a standard of care for men with extraprostatic extension (pT3a or pT3b, see “Stages and Grades”), regardless of Gleason score and margin status (positive or negative). Having positive margins means that cancer cells were found in margins of the tissue removed during surgery that surrounded the prostate. Having positive margins does not necessarily mean that cancer was left behind during surgery. The significance of this finding needs to be discussed with your doctor. The role of adjuvant radiation therapy for men who have microscopic cancer in their lymph nodes is still being studied. 

    For older men who are not expected to live for a long time and whose cancer is not causing symptoms, or for those who have another, more serious illness, watchful waiting may be considered.

Active surveillance and watchful waiting

If prostate cancer is in an early stage, is growing slowly, and treating the cancer would cause more problems than the disease itself, a doctor may recommend active surveillance or watchful waiting.

  • Active surveillance. Prostate cancer treatments can cause side effects, such as erectile dysfunction, which is the inability to get and maintain an erection, and incontinence, which is the inability to control urine flow or bowel function. These treatments for prostate cancer may seriously affect a man’s quality of life. In addition, many prostate cancers grow slowly and cause no symptoms or problems. For this reason, many men may consider delaying cancer treatment rather than starting treatment immediately. This is called active surveillance. During active surveillance, the cancer is closely monitored for signs that it is worsening. If the cancer is found to be worsening, treatment will begin.

    Active surveillance is usually preferred for men with low-risk prostate cancer that can be treated with surgery or radiation therapy if it shows signs of getting worse. ASCO endorses recommendations from CancerCare Ontario concerning active surveillance, which recommend active surveillance for most patients with a Gleason score of 6 or below, with cancer that has not spread beyond the prostate. Sometimes, active surveillance may be an option for men with a Gleason score of 7. There is also growing use of genomic testing to help determine whether active surveillance is the best choice for a man with prostate cancer (see more in Latest Research).

    ASCO encourages the following testing schedule for active surveillance:

    • A PSA test every 3 to 6 months

    • A DRE at least once every year

    • Another prostate biopsy within 6 to 12 months, then a biopsy at least every 2 to 5 years

    A patient should receive treatment if the results of the tests done during active surveillance show signs of the cancer becoming more aggressive or spreading, causes pain, or blocks the urinary tract.

  • Watchful waiting. Watchful waiting may be an option for much older men and those with other serious or life-threatening illnesses who are expected to live less than 5 years. With watchful waiting, routine PSA tests, DRE, and biopsies are not usually performed. If a patient develops symptoms from the prostate cancer, such as pain or blockage of the urinary tract, then treatment may be recommended to relieve those symptoms. This may include ADT (see “Systemic treatments” below). Men who start on active surveillance who later have a shorter life expectancy may switch to watchful waiting at some point to avoid repeated tests and biopsies.

Doctors must be cautious in judging the disease. In other words, doctors must collect as much information as possible about the patient’s other illnesses and life expectancy to determine whether active surveillance or watchful waiting is appropriate for each patient. In addition, 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 decisions about treatment. Learn more about ASCO’s endorsement of recommendations for active surveillance on a separate ASCO website.

Local treatments

Local treatments get rid of cancer from a specific, limited area of the body. Such treatments include surgery and radiation therapy. For men diagnosed with early-stage prostate cancer, local treatments may get rid of the cancer completely. If the cancer has spread outside the prostate gland, other types of treatment called systemic treatments (see “Systemic treatments” below) may be needed to destroy cancer cells located in other parts of the body.

Surgery

Surgery involves the removal of the prostate and some surrounding healthy tissue during an operation. 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 overall health, and other factors.

Surgical options include:

  • Radical (open) prostatectomy. A radical prostatectomy is the surgical removal of the entire prostate and the seminal vesicles. Lymph nodes in the pelvic area may also be removed. This operation has the risk of affecting sexual function. Nerve-sparing surgery, when possible, increases the chance that a man can maintain his sexual function after surgery by avoiding surgical damage to the nerves that allow erections and orgasm to occur. Orgasm can occur even if some nerves are cut because these are 2 separate processes. Urinary incontinence is also a possible side effect of radical prostatectomy. To help resume normal sexual function, men can receive drugs, penile implants, or injections. Sometimes, another surgery can fix urinary incontinence.

  • Robotic or laparoscopic prostatectomy. This type of surgery is possibly much less invasive than a radical prostatectomy and may shorten recovery time. A camera and instruments are inserted through small keyhole incisions in the patient’s abdomen. The surgeon then directs the robotic instruments to remove the prostate gland and some surrounding healthy tissue. In general, robotic prostatectomy causes less bleeding and less pain, but the sexual and urinary side effects can be similar to those of a radical (open) prostatectomy. Talk with your doctor about whether your treatment center offers this procedure and how it compares with the results of the radical (open) prostatectomy.

  • Bilateral orchiectomy. Bilateral orchiectomy is the surgical removal of both testicles. It is described in detail in “Systemic treatments” below.

Before surgery, talk with your health care team about the possible side effects from the specific surgery you will have. Typically, younger or healthier men may benefit more from a prostatectomy. Younger men are also less likely to develop permanent erectile dysfunction and urinary incontinence after a prostatectomy than older men.

Learn more about the basics of cancer surgery.

Radiation therapy (Updated 10/2018)

Radiation therapy is the use of high-energy rays to destroy cancer cells. A doctor who specializes in giving radiation therapy to treat cancer is called a radiation oncologist. A radiation therapy regimen, or schedule, usually consists of a specific number of treatments given over a set period of time.

The types of radiation therapy used to treat prostate cancer include:

  • External-beam radiation therapy. External-beam radiation therapy is the most common type of radiation treatment. The radiation oncologist uses a machine located outside the body to focus a beam of x-rays on the area with the cancer. Some cancer centers use conformal radiation therapy (CRT), in which computers help precisely map the location and shape of the cancer. CRT reduces radiation damage to healthy tissues and organs around the tumor by directing the radiation therapy beam from different directions to focus the dose on the tumor.

    One method of EBRT used to treat prostate cancer is called hypofractionated radiation therapy. This is when a person receives a higher daily dose of radiation therapy given over a shorter period instead of lower doses given over a longer period.

    According to recommendations from ASCO, American Society for Radiation Oncology, and American Urological Association, hypofractionated radiation therapy may be an option for the following people with early-stage prostate cancer that has not spread to other parts of the body:

    • Men with low-risk prostate cancer who need or prefer treatment instead of active surveillance.

    • Men with intermediate or high-risk prostate cancer receiving EBRT to the prostate, but not including the pelvic lymph nodes.

    People who receive hypofractionated radiation therapy may have a slightly higher risk of some short-term side effects after treatment compared with those who receive regular EBRT. This can include gastrointestinal side effects. Based on current research, people who receive hypofractionated radiation therapy are not at a higher risk of side effects in the long term. Talk with your health care team if you have questions about your risk for side effects.

    Learn more about these recommendations for hypofractionated radiation therapy for prostate cancer on a different ASCO website.

  • Brachytherapy. Brachytherapy, or internal radiation therapy, is the insertion of radioactive sources directly into the prostate. These sources, called seeds, give off radiation just around the area where they are inserted and may be left for a short time (high-dose rate) or for a longer time (low-dose rate). Low-dose-rate seeds are left in the prostate permanently and work for up to 1 year after they are inserted. However, how long they work depends on the source of radiation. High-dose-rate brachytherapy is usually left in the body for less than 30 minutes, but it may need to be given more than once.

    Brachytherapy may be used with other treatments, such as external-beam radiation therapy and/or ADT. ASCO recommends the following brachytherapy options:

    • Men with low-risk prostate cancer who need or choose an active treatment may consider low-dose-rate brachytherapy. Other options include external-beam radiation therapy or a radical prostatectomy.

    • Men with intermediate-risk prostate cancer who choose external-beam radiation therapy (with or without ADT) should be offered either a low-dose-rate or high-dose-rate brachytherapy boost. For a brachytherapy boost, a lower dose of radiation is given for a shorter period of time. Some men with intermediate-risk prostate cancer may be able to receive only brachytherapy without external-beam radiation therapy or ADT.

    • Men with high-risk prostate cancer who are receiving external-beam radiation therapy and ADT should be offered a low-dose-rate or high-dose-rate brachytherapy boost.

    Read ASCO’s recommendations for brachytherapy for prostate cancer, found on a separate ASCO website.

  • Intensity-modulated radiation therapy (IMRT). IMRT is a type of external-beam radiation therapy that uses CT scans to form a 3D picture of the prostate before treatment. A computer uses this information about the size, shape, and location of the prostate cancer to determine how much radiation is needed to destroy it. With IMRT, high doses of radiation can be directed at the prostate without increasing the risk of damaging nearby organs.

  • Proton therapy. Proton therapy, also called proton beam therapy, is a type of external-beam radiation therapy that uses protons rather than x-rays. At high energy, protons can destroy cancer cells. Current research has not shown that proton therapy provides any more benefit to men with prostate cancer than traditional radiation therapy. It is also more expensive.

Radiation therapy may cause side effects during treatment, including increased urinary urge or frequency; problems with sexual function; problems with bowel function, including diarrhea, rectal discomfort or rectal bleeding; and fatigue. Most of these side effects usually go away after treatment.

To help resume normal sexual function, men can receive drugs, penile implants, or injections. While uncommon, some side effects of radiation therapy may not show up until years after treatment. See Follow-up Care for more information about long-term side effects.

Learn more about the basics of radiation therapy.

Focal therapies

Focal therapies are less-invasive treatments that destroy small prostate tumors without treating the rest of the prostate gland. These treatments use heat, cold, and other methods to treat cancer, primarily for men with low-risk or intermediate-risk prostate cancer. They are being studied and most have not been endorsed as standard treatment options. Focal therapies are usually done as part of clinical trials.

Cryosurgery, also called cryotherapy or cryoablation, is a type of focal therapy. It is the freezing of cancer cells with a metal probe inserted through a small incision in the area between the rectum and the scrotum, the skin sac that contains the testicles. It is not an established therapy or standard of care for men newly diagnosed with prostate cancer. Cryosurgery has not been compared with radical prostatectomy or radiation therapy, so doctors do not know if it is a comparable treatment option. Its effects on urinary and sexual function are also not well known.

High-intensity focused ultrasound (HIFU) is a heat-based type of focal therapy. During HIFU treatment, an ultrasound probe is inserted into the rectum and then sound waves are directed at cancerous parts of the prostate gland. This treatment is designed to destroy cancer cells while limiting damage to the rest of the prostate gland. The FDA approved HIFU for the treatment of prostate tissue in 2015. HIFU may be an attractive option for some patients, but knowing who may benefit most from this treatment is still unknown. Similarly, HIFU should only be performed by a specialist with extensive expertise. You will need to carefully discuss with your doctor if HIFU is the best treatment for you.

Systemic treatments

Doctors use treatments such as ADT, chemotherapy, and novel agents to reach cancer cells throughout the body. This is called systemic treatment.

Androgen deprivation therapy (ADT)

Because prostate cancer growth is driven by male sex hormones called androgens, lowering levels of these hormones can help slow the growth of the cancer. The most common androgen is testosterone. Testosterone levels in the body can be lowered either by surgically removing the testicles, known as surgical castration, or by taking drugs that turn off the function of the testicles, called medical castration. Which ADT method is used is less important than the main goal of lowering testosterone levels.

ADT is used to treat prostate cancer in different situations, including locally advanced, recurrent prostate cancer, and metastatic prostate cancer. Some of the situations in which ADT may be used include:

  • Men with NCCN-based intermediate-risk and high-risk prostate cancer who are having definitive therapy with radiation therapy are candidates for ADT. Definitive therapy is a treatment given with the intent to cure the cancer. Men with intermediate-risk prostate cancer should receive ADT for at least 4 to 6 months. Those with high-risk prostate cancer should receive ADT for 24 to 36 months.

  • ADT may also be given to men who have had surgery and microscopic cancer cells were found in the removed lymph nodes. ADT is done to eliminate any remaining cancer cells and reduce the chance the cancer will return. This is known as adjuvant therapy. Although the use of adjuvant ADT is controversial, some specific patients appear to benefit from this approach.

Specific types of ADT

  • Bilateral orchiectomy. Bilateral orchiectomy is the surgical removal of both testicles. It was the first treatment used for metastatic prostate cancer more than 70 years ago. Even though this is an operation, it is considered an ADT because it removes the main source of testosterone production, the testicles. The effects of this surgery are permanent and cannot be reversed.

  • LHRH agonists. LHRH stands for luteinizing hormone-releasing hormone. Medications known as LHRH agonists prevent the testicles from receiving messages sent by the body to make testosterone. By blocking these signals, LHRH agonists reduce a man’s testosterone level just as well as removing his testicles. Unlike surgical castration, the effects of LHRH agonists are often reversible, so testosterone production usually begins again once a patient stops treatment. However, testosterone recovery can take any time from 6 months to 24 months, and for a small proportion of patients, testosterone production does not return.

    LHRH agonists are injected or placed as small implants under the skin. Depending on the drug used, they may be given once a month or once a year. When LHRH agonists are first given, testosterone levels briefly increase before falling to very low levels. This effect is known as a “flare.” Flares occur because the testicles temporarily release more testosterone in response to the way LHRH agonists work in the body. This flare may increase the activity of prostate cancer cells and cause symptoms and side effects, such as bone pain in men with cancer that has spread to the bone.

  • LHRH antagonist. This class of drugs, also called a gonadotropin-releasing hormone (GnRH) antagonist, stops the testicles from producing testosterone like LHRH agonists, but they reduce testosterone levels more quickly and do not cause a flare. The FDA has approved degarelix (Firmagon), given by monthly injection, to treat advanced prostate cancer. One side effect of this drug is that it may cause a severe allergic reaction.

  • Anti-androgens. While LHRH agonists and antagonists lower testosterone levels in the blood, anti-androgens block testosterone from binding to so-called “androgen receptors,” which are chemical structures in cancer cells that allow testosterone and other male hormones to enter the cells. These drugs include bicalutamide (Casodex), flutamide (Eulexin), and nilutamide (Nilandron) and are taken as pills. Anti-androgens are usually given to men who have “hormone-sensitive” prostate cancer, which means that the prostate cancer still responds to testosterone suppression therapy. Anti-androgens are not usually used by themselves to treat prostate cancer.

  • Combined androgen blockade. Sometimes anti-androgens are combined with bilateral orchiectomy or LHRH agonist treatment to maximize the blockade of male hormones. This is because even after the testicles are no longer producing hormones, the adrenal glands still make small amounts of androgens. Many doctors also feel that this combined approach is the safest way to start ADT, as it prevents the possible flare that sometimes happens in response to LHRH agonist treatment. Some, but not all, research has shown that combined androgen blockade can help patients live longer than treatment with just ADT, surgery, or LHRH agonists or antagonists. Therefore, some doctors prefer to give combined drug treatment, while others may only give the combination early in the treatment to prevent the flare.

  • Intermittent ADT. Traditionally, ADT was given for the patient’s lifetime or until it stopped controlling the cancer, and then other treatment options were considered. During the past 2 decades, researchers have studied the use of intermittent ADT, which is ADT that is given for specific times (most commonly 6 months) and then stopped temporarily to allow for testosterone levels to recover. For these patients, ADT is restarted when the PSA begins to rise again. When to restart therapy (that is, at which PSA levels) remains controversial. Using ADT in this way may lower the side effects related to the lack of testosterone and improve a patient’s quality of life. This approach most benefits patients who have no evidence of metastases. Intermittent ADT has not been shown to be as effective as or better than lifelong ADT in men with metastatic disease.

Side effects of ADT

ADT will cause side effects that generally go away after treatment has finished, except in men who have had an orchiectomy. General side effects of ADT include:

  • Erectile dysfunction

  • Loss of sexual desire

  • Hot flashes with sweating

  • Gynecomastia, which is growth of breast tissue that sometimes can lead to discomfort

  • Depression

  • Cognitive dysfunction and memory loss

  • Weight gain

  • Loss of muscle mass

  • Osteopenia or osteoporosis, which is thinning of bones

Although testosterone levels may recover after stopping ADT, some men who have had medical castration with LHRH agonists for many years may continue to have hormonal effects, even if they are no longer taking these drugs.

Another serious side effect of ADT is the risk of developing metabolic syndrome. Metabolic syndrome is a set of conditions, such as obesity, 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 receive a surgical or medical castration with ADT have an increased risk of developing metabolic syndrome. The risk is increased even if the medical castration is temporary. Find out more about the symptoms of hormone deprivation and how to manage them.

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 side effects. Aggressive management of side effects is very important for patients receiving ADT. These include getting regular exercise, quitting smoking, eating a balanced diet, making sure to get enough vitamin D and calcium, and receiving aggressive, preventive cardiovascular follow-up care.

Chemotherapy

Chemotherapy is the use of drugs to destroy cancer cells, usually by ending their ability to grow and divide. Chemotherapy is usually given by a medical oncologist, a doctor who specializes in treating cancer with medication.

Systemic chemotherapy gets into the bloodstream to reach cancer cells throughout the body. Chemotherapy for prostate cancer is given through an intravenous (IV) tube placed into a vein using a needle. It may help patients with advanced or castration-resistant prostate cancer. A chemotherapy regimen, or schedule, usually consists of a specific number of cycles given over a set period of time.

There are several standard drugs used for prostate cancer. In general, standard chemotherapy begins with docetaxel (Docefrez, Taxotere) combined with a steroid called prednisone (multiple brand names).

The FDA has also approved another drug, cabazitaxel (Jevtana), based on research that showed it improved survival when compared with mitoxantrone for patients whose disease progressed after having docetaxel. In clinical trials, cabazitaxel was compared with docetaxel in patients who had not received chemotherapy. In these patients, treatment with cabazitaxel was not better than treatment with the standard docetaxel. Another study compared the standard dose with a lower dose of cabazitaxel in people whose tumors grew after treatment with docetaxel. In addition of fewer side effects, this study also found that the lower dose also helped patients live longer.

Recent research shows that adding chemotherapy after the completion of 2 years of ADT for men with high-risk prostate cancer who are having definitive radiation therapy is an effective approach to reduce recurrence and improve survival. Although these results are interesting, further study is needed to see if this treatment helps people with prostate cancer.

In general, the side effects of chemotherapy depend on the individual, the type of chemotherapy received, the dose used, and the length of treatment, but they can include fatigue, sores in the mouth and throat, diarrhea, nausea and vomiting, constipation, blood disorders, nervous system effects, changes in thinking and memory, sexual and reproductive issues, appetite loss, pain, and hair loss. The side effects of chemotherapy usually go away after treatment has finished. However, some side effects may continue, come back, or develop later. Ask your doctor which side effects you may experience, based on your treatment plan. Your health care team will work with you to manage or prevent many of these side effects.

Learn more about the basics of chemotherapy and preparing for treatment. The medications used to treat cancer are continually being evaluated. Talking with your doctor is often the best way to learn about the medications prescribed for you, their purpose, and their potential side effects or interactions with other medications. Learn more about your prescriptions by using searchable drug databases.

Advanced prostate cancer (stage IV)

If cancer spreads to another part in the body from where it started, doctors call it metastatic cancer. High-risk or locally advanced prostate cancers pose a higher chance of becoming metastatic cancer. If prostate cancer has a high risk of becoming metastatic or is already metastatic, it is a good idea to talk with doctors who have experience in treating it. Doctors can have different opinions about the best standard treatment plan. Also, clinical trials might be an option. Learn more about getting a second opinion before starting treatment, so you are comfortable with your chosen treatment plan.

For most patients, a diagnosis of metastatic cancer is very stressful and, at times, difficult to bear. Patients and their families are encouraged to talk about the way they are feeling with doctors, nurses, social workers, or other members of the health care team. It may also be helpful to talk with other patients, including through a support group.

There is no cure for metastatic prostate cancer, but it is often treatable for quite some time. Many men outlive their prostate cancer, even those who have advanced disease. Often, the prostate cancer grows slowly, and there are now effective treatment options that extend life even further.  In this way, it can be like living with a chronic disease like heart disease or diabetes, requiring ongoing treatment to minimize symptoms and maintain well-being.

Researchers are using other methods to better understand metastatic prostate cancer and identify new treatment approaches. For example, the Metastatic Prostate Cancer Project allows people with metastatic prostate cancer to enroll themselves. Please note that the link above takes you to another, independent website.

Biochemical recurrence

Many men treated with surgery or radiation therapy are cured. However, some will develop a biochemical recurrence (BCR). The primary signs of BCR are rising PSA levels and no metastases in scans. This is why BCR is also called “rising PSA syndrome.” The exact definition of BCR depends on the initial treatment a patient has received.

For men who receive a radical prostatectomy, BCR is defined as a rising PSA level that reaches a value of 0.2 ng/mL or more. Radiation therapy may be a treatment option for certain patients with BCR after surgery; this treatment option is called “salvage radiation therapy.” Several factors are considered when deciding who can be treated with salvage radiation therapy, including Gleason score, pathologic stage, how long it took for BCR to occur, PSA value after surgery, and changes in PSA over time, also known as “PSA doubling time.” Men who receive radiation therapy to treat BCR should receive systemic treatment as well. There are currently 2 options:

  • 2 years of hormonal therapy with an androgen receptor blocker called bicalutamide (Casodex)

  • 6 months of testosterone suppression with standard ADT

For men who received radiation therapy as the main local definitive treatment for prostate cancer, BCR is defined as a normal testosterone level (for men who received ADT) and a PSA value more than 2.0 ng/mL plus the lowest PSA value achieved after the treatment with radiation therapy (this is called “nadir PSA”). Treating BCR after radiation therapy is more difficult. Treatment options for these men can include surgery, called “salvage radical prostatectomy,” or cryosurgery, called “salvage cryotherapy” (see “Focal therapies” above). Patients are encouraged to discuss treatment options with their health care team.

BCR is considered advanced cancer, so treatment with ADT may be recommended, especially if other local treatments are not options. ADT remains the most important treatment strategy for men with advanced prostate cancer. For men with BCR, there is still no exact recommendation for which type of ADT to use, when to start it, and for how long to give it.

Metastatic hormone-sensitive prostate cancer

Prostate cancer that has spread to other parts of the body and still responds to ADT is called metastatic hormone-sensitive prostate cancer. ASCO recommends that men with this type of cancer consider receiving ADT plus 1 of the 2 following options. The best option for each man depends on his health and the extent of the cancer. It is important for men to talk with their health care team about the risks and benefits of these treatment options.

  • Docetaxel. Chemotherapy with the drug docetaxel is an option, along with ADT for men newly diagnosed with widespread metastatic hormone-sensitive prostate cancer. Docetaxel is given by IV every 3 weeks for a total of 6 doses. The side effects of docetaxel may include low levels of blood cells, infection, nausea and vomiting, muscle aches, and hair and nail changes. It may also cause peripheral neuropathy, which is a type of nerve damage that causes a tingling or burning feeling in the hands and/or feet.

  • Abiraterone acetate (Zytiga) plus prednisone. Abiraterone acetate is an option, along with ADT for men who are newly diagnosed with metastatic hormone-sensitive prostate cancer. Although the testicles are the main producers of testosterone, other cells in the body can still make small amounts of androgens that may drive cancer growth. Abiraterone acetate prevents certain cells from making hormones that are known to help prostate cancer grow. Abiraterone acetate is taken each day as 4 pills along with a small dose of prednisone. Prednisone is used to help prevent some of the side effects of abiraterone.

    Abiraterone acetate may cause serious side effects, such as high blood pressure, low blood potassium levels, fatigue, and fluid retention. Other possible side effects include weakness, joint swelling or pain, swelling in the legs or feet, hot flushes, diarrhea, vomiting, shortness of breath, and anemia.

In addition to the above treatment options, treatment to relieve a patient’s symptoms and side effects continues to be an important part of the overall treatment plan.

Read ASCO’s recommendations on treatment of metastatic hormone-sensitive prostate cancer, found on ASCO’s website.

Non-metastatic castration-resistant prostate cancer (updated 07/2018)

Prostate cancer that is no longer stopped by low testosterone levels (less than 50 ng/mL) is called “castration resistant.” Castration-resistant prostate cancer is defined by a rising PSA level and/or worsening symptoms and/or growing cancer verified by scans. If the cancer has not spread to other parts of the body, it is called “non-metastatic castration-resistant prostate cancer.” 

ASCO recommends that men who develop castration-resistant prostate cancer should continue treatment that lowers testosterone levels. This may include a permanent treatment, such as surgery to remove the testicles (called orchiectomy), or it may include continuing treatment with medicines that lower hormone levels.

Apalutamide (Erleada) in an anti-androgen medication called a nonsteroidal anti-androgen (NSAA). It is approved by the FDA for the treatment of non-metastatic castration-resistant prostate cancer. In the SPARTAN research study, apalutamide prevented metastasis that could be found with imaging scans for a median of over 2 years. The median is the midpoint, so this means that half of the men who received apalutamide had metastasis delayed for less than 2 years, and the other half had metastasis delayed for more than 2 years.  

In the PROSPER study, enzalutamide (Xtandi) was given to men with non-metastatic castration-resistant prostate cancer. Treatment with enzalutamide was found to delay metastasis for a median of about 36 months compared with nearly 15 months for men who received ADT alone with a placebo. The median is the midpoint. The FDA approved enzalutamide for the treatment of non-metastatic castration-resistant prostate cancer in July 2018.

Second-line ADT may be an option for men who have not already received chemotherapy and who have a high risk of developing metastatic prostate cancer. It is not recommended for men who have not had chemotherapy and have a low risk of developing metastatic disease. Talk with your doctor about your personal risk level.

PSA testing and/or imaging tests may be done periodically to check whether the cancer has worsened or spread. For men with a low risk of developing metastatic disease, ASCO recommends PSA testing every 4 to 6 months. For men with a high risk of metastatic disease, ASCO recommends PSA testing every 3 months. Imaging tests, such as a bone scan, CT scan, or MRI, may be done if a man has symptoms or signs that the cancer is worsening.

Metastatic castration-resistant prostate cancer

If the cancer is no longer stopped by low testosterone levels (less than 50 ng/mL) and has spread to other parts of the body, it is called “metastatic castration-resistant prostate cancer.” Castration-resistant prostate cancer is defined by a rising PSA level and/or worsening symptoms and/or growing cancer verified by scans. For men with metastatic castration-resistant prostate cancer, ASCO recommends PSA testing every 3 months. Imaging tests may also be done.

Metastatic castration-resistant prostate cancer can be difficult to treat. ASCO recommends that men with metastatic castration-resistant prostate cancer continue treatment that lowers androgen levels. ASCO has treatment recommendations for hormone therapy for advanced cancer and for the treatment of metastatic castration-resistant prostate cancer.  

Treatment options for metastatic castration-resistant prostate cancer are listed below. Treatment in a clinical trial may also be an option.

  • Abiraterone acetate (Zytiga) plus prednisone. Abiraterone acetate is a drug that blocks an enzyme called CYP17 and prevents these cells from making certain hormones, including adrenal androgens. Although the testicles are the main producers of testosterone, other cells in the body can still make small amounts of testosterone that may drive cancer growth. These include the adrenal glands and some prostate cancer cells themselves. Abiraterone acetate is taken in the form of a pill. Men take 4 pills per day along with prednisone twice a day. Abiraterone acetate has been approved by the FDA as a treatment for progressive, metastatic castration-resistant prostate cancer.

    Abiraterone acetate may cause serious side effects, such as high blood pressure, low blood potassium levels, and fluid retention. Other common side effects include weakness, joint swelling or pain, swelling in the legs or feet, hot flushes, diarrhea, vomiting, shortness of breath, and anemia.

  • Enzalutamide (Xtandi). Enzalutamide is a nonsteroidal anti-androgen that is approved by the FDA for men who have metastatic castration-resistant prostate cancer. Several large clinical trials (called the STRIVE, TERRAIN, and PREVAIL studies) have shown that enzalutamide helped men live longer than treatment with other drugs.

    Enzalutamide may cause serious side effects, such as headaches, confusion, loss of vision, and seizures. Other common side effects include weakness, back pain, decreased appetite, constipation, joint pain, diarrhea, hot flashes, upper respiratory tract infection, swelling, weight loss, high blood pressure, dizziness, and vertigo.

  • Chemotherapy. Doctors may recommend chemotherapy for patients with this type of prostate cancer, especially those with bone pain or cancer-related symptoms. Research studies of chemotherapy treatment plans that include docetaxel have been shown to lengthen life by several months. Cabazitaxel can be used after docetaxel stops working.

  • Immunotherapy. For some men with castration-resistant metastatic prostate cancer who have no or very few cancer symptoms and generally have not had chemotherapy, vaccine therapy with sipuleucel-T (Provenge) may be an option. Sipuleucel-T is an immunotherapy. Immunotherapy is designed to boost the body’s natural defenses to fight the cancer. It uses materials made either by the body or in a laboratory to improve, target, or restore immune system function.

  • Sipuleucel-T is adapted for each patient. Before treatment, blood is removed from the patient in a process called leukapheresis. Special immune cells are separated from the patient’s blood, modified in the laboratory, and then put back into the patient. At this point, the patient’s immune system may recognize and destroy prostate cancer cells. When this treatment is used, it is difficult to know if the treatment is working to treat the cancer because treatment with sipuleucel-T does not lead to PSA reductions, shrinking of the tumor, or keeping the cancer from getting worse. However, results from clinical trials have shown that treatment with sipuleucel-T can increase survival by about 4 months in men with metastatic castration-resistant prostate cancer with few or no symptoms.

    Different types of immunotherapy can cause different side effects. Talk with your doctor about possible side effects for the immunotherapy recommended for you. Learn more about the basics of immunotherapy.

  • Radiopharmaceuticals. Radium-223 (Xofigo) is a radioactive substance used to treat men with castration-resistant prostate cancer that has spread to the bone. Radium-223 is an alpha-emitter radionucleotide that mimics calcium and targets areas in the bone where destruction and remodeling has occurred (this is often seen when prostate cancer spreads to bone). This treatment delivers radiation particles directly to tumors found in the bone, limiting damage to healthy tissue, including the bone marrow, where normal blood cells are made. Radium-223 is given by intravenous injection (IV) once a month for 6 months. This treatment is given by a radiation oncologist or a nuclear medicine doctor. Your medical oncologist should continue to follow your progress during this treatment to make sure you are benefiting from treatment and that any potential side effects are managed in a timely manner. Treatment with radium-233 has small effects on PSA, so patients should not expect to see big decreases in PSA levels during treatment.

    Some people should not receive this treatment, especially those who need fast treatment of symptoms and men with prostate cancer that has spread to the liver and/or lungs. Discuss with your doctor whether this medication is best for your situation. 

  • Palliative/supportive care. Treatment to relieve a patient’s symptoms and avoid side effects continues to be an important part of the overall treatment plan. This can include ways to help patients cope with stress, anxiety, and depression. Relieving pain as much as possible is very important in the management of metastatic prostate cancer. Psychosocial support and discussion of goals can be another important part of this care. Early involvement with a palliative care team has been shown to help prevent some symptoms of prostate cancer, leading to better quality of life in patients.

Getting care for symptoms and side effects

Cancer and its treatment often cause side effects. In addition to treatments intended to slow, stop, or eliminate the cancer, an important part of cancer care is relieving a person’s symptoms and side effects. This approach is called palliative or supportive care, and it includes supporting the patient with his physical, emotional, and social needs.

Palliative or supportive care is any treatment that focuses on reducing symptoms, improving quality of life, and supporting patients and their families. Any person, regardless of age or type and stage of cancer, may receive palliative care. It works best when palliative care is started as early as needed in the cancer treatment process. People often receive treatment for the cancer at the same time that they receive treatment to ease side effects. In fact, patients who receive both at the same time often have less severe symptoms, better quality of life, and report they are more satisfied with treatment.

Palliative treatments vary widely and often include medication, nutritional changes, relaxation techniques, emotional support, and other therapies. You may also receive palliative treatments similar to those meant to eliminate the cancer, such as chemotherapy, surgery, or radiation therapy. Talk with your doctor about the goals of each treatment in your treatment plan.

Urinary blockage

  • Transurethral resection of the prostate (TURP). TURP is most often used to relieve symptoms of a urinary blockage, not to treat prostate cancer. In this procedure, with the patient under full anesthesia, which is medication to block the awareness of pain, a surgeon inserts a narrow tube with a cutting device called a cystoscope into the urethra and then into the prostate to remove prostate tissue.

Bone pain and weakness

  • Strontium and samarium. These radioactive substances (beta-emitters) are given by injection and absorbed near the area of bone pain. The radiation that is released helps relieve the pain, probably by causing the tumor in the bone to shrink. Neither substance helps patients live longer.

  • Radium-223. This treatment is used to relieve bone pain in men with castration-resistant prostate cancer that has spread to the bone. Read more in “Treatments for metastatic castration-resistant prostate cancer” above.

  • Bone-modifying drugs. Bone health is an important aspect in the life of men with prostate cancer. Osteopenia and osteoporosis are bone conditions that can be caused by low testosterone. Therefore, preventing bone loss in men receiving ADT is important because it lowers the risk of bone loss. Bone-modifying drugs like denosumab (Prolia, Xgeva) and zoledronic acid (Reclast, Zometa) can be given to prevent bone loss. Both of these drugs have unique side effects, so patients should discuss with their doctor when to take the medication and which drug would be best, based on their situation.

In metastatic castration-resistant prostate cancer, bone-modifying drugs have been shown to reduce the risk of skeletal-related events. Skeletal-related events are complications caused by prostate cancer that has spread to the bone, such as fractures and spinal cord compression. They are treated with orthopedic surgery and palliative radiation therapy for pain control.

Bone-modifying drugs have not been shown to help in the treatment of non-metastatic castration-resistant prostate cancer.

A possible condition associated with bone-modifying drugs is osteonecrosis of the jaw. It is an uncommon but serious condition. The symptoms of osteonecrosis of the jaw include pain, swelling, and infection of the jaw; loose teeth; and exposed bone. It is important for all dental work to be finished before starting these drugs. If a patient taking these drugs needs dental work, treatment should be stopped until the dental work is completed and the patient has healed.

Palliative treatment for metastatic cancer

As mentioned above and in Coping with Treatment, palliative care is important to help relieve symptoms and side effects. This includes people with metastatic prostate cancer. Palliative care options include:

  • TURP to manage symptoms such as bleeding or urinary obstruction.

  • Bone-modifying drugs, such as denosumab or zoledronic acid, may be used to strengthen bones and reduce the risk of skeletal-related events for men with prostate cancer that has spread to the bone.

  • Intravenous radiation therapy with radium-223, strontium, and samarium can also help relieve bone pain.

  • Palliative radiation therapy to specific bone areas can be used to reduce bone pain when medications don’t help.

Before treatment begins, talk with your health care team, including your dentist, about the possible side effects of your specific treatment plan and palliative care options. During and after treatment, be sure to tell your doctor or another health care team member if you are experiencing a problem so it can be addressed as quickly as possible. Learn more about palliative care.

Remission and the chance of recurrence

A remission is when cancer cannot be detected in the body and there are no symptoms. This may also be called having “no evidence of disease” or NED.

A remission can be temporary or permanent. This uncertainty causes many people to worry that the cancer will come back. Although there are treatments to help prevent a recurrence, such as ADT and radiation therapy, which are described above, it is important to talk with your doctor about the possibility of the cancer returning. There are tools your doctor can use, called nomograms, to estimate a person’s risk of recurrence. Understanding your risk of recurrence and the treatment options may help you feel more prepared if the cancer does return. Learn more about coping with the fear of recurrence.

In general, following surgery or radiation therapy, the PSA level in the blood usually drops. If the PSA level starts to rise again, it may be a sign that the cancer has come back. If the cancer does return after the original treatment, it is called recurrent cancer.

When this occurs, a new cycle of testing will begin again to learn as much as possible about the recurrence, including where the recurrence is located. The cancer may come back in the prostate (called a local recurrence), in the tissues or lymph nodes near the prostate (a regional recurrence), or in another part of the body, such as the bones, lungs, or liver (a distant or metastatic recurrence). Sometimes the doctor cannot find a tumor even though the PSA level has increased. This is known as a PSA-only or biochemical recurrence.

After this testing is done, you and your doctor will talk about your treatment options. The choice of treatment plan is based on the type of recurrence and the treatment(s) you have already received and may include the treatments described above, such as radiation therapy, prostatectomy for men first treated with radiation therapy, or ADT. Your doctor may suggest clinical trials that are studying new ways to treat this type of recurrent cancer.

Whichever treatment plan you choose, palliative care will be important for relieving symptoms and side effects. Palliative care usually includes pain medication, external-beam radiation therapy, brachytherapy with radium-223, strontium, or samarium, or other treatments to reduce bone pain.

People with recurrent cancer often experience emotions such as disbelief or fear. Patients are encouraged to talk with their health care team about these feelings and ask about support services to help them cope. Learn more about dealing with cancer recurrence.

If treatment doesn’t work

Recovery from cancer is not always possible. If the cancer cannot be cured or controlled, the disease may be called advanced or terminal.

This diagnosis is stressful, and for many people, advanced cancer may be difficult to discuss. However, it is important to have open and honest conversations with your doctor and health care team to express your feelings, preferences, and concerns. The health care team is there to help, and many team members have special skills, experience, and knowledge to support patients and their families. Making sure a person is physically comfortable and free from pain is extremely important.

Patients who have advanced cancer and who are expected to live less than 6 months may want to consider a type of palliative care called hospice care. Hospice care is designed to provide the best possible quality of life for people who are near the end of life. You and your family are encouraged to talk with the health care team about hospice care options, which include hospice care at home, a special hospice center, or other health care locations. Nursing care and special equipment, including a hospital bed, can make staying at home a workable option for many families. Learn more about advanced cancer care planning.

After the death of a loved one, many people need support to help them cope with the loss. Learn more about grief and loss.

The next section in this guide is About Clinical Trials. It offers more information about research studies that are focused on finding better ways to care for people with cancer. You may use the menu to choose a different section to read in this guide.

Prostate Cancer - About Clinical Trials

Approved by the Lineagotica Editorial Board, 03/2018

ON THIS PAGE: You will learn more about clinical trials, which are the main way that new medical approaches are tested to see how well they work. Use the menu to see other pages.

What are clinical trials?

Doctors and scientists are always looking for better ways to care for men with prostate cancer. To make scientific advances, doctors create research studies involving volunteers, called clinical trials. In fact, every FDA-approved drug was tested in clinical trials.

Many clinical trials focus on new treatments. Researchers want to learn if a new treatment is safe, effective, and possibly better than the treatment doctors use now. These types of studies evaluate new drugs, different combinations of existing treatments, new approaches to radiation therapy or surgery, and new methods of treatment. Patients who participate in clinical trials can be some of the first to get a treatment before it is available to the public. However, there are some risks with a clinical trial, including possible side effects and that the new treatment may not work. People are encouraged to talk with their health care team about the pros and cons of joining a specific study.

Some clinical trials study new ways to relieve symptoms and side effects during treatment. Others study ways to manage the late effects that may happen a long time after treatment. Talk with your doctor about clinical trials for symptoms and side effects. There are also clinical trials studying ways to prevent cancer.

Deciding to join a clinical trial

Patients decide to participate in clinical trials for many reasons. For some patients, a clinical trial is the best treatment option available. Because standard treatments are not perfect, patients are often willing to face the added uncertainty of a clinical trial in the hope of a better result. Other patients volunteer for clinical trials because they know that these studies are a way to contribute to the progress in treating prostate cancer. Even if they do not benefit directly from the clinical trial, their participation may benefit future men with prostate cancer.

Insurance coverage of clinical trials costs differs by location and by study. In some programs, some of the patient’s expenses from participating in the clinical trial are reimbursed. In others, they are not. It is important to talk with the research team and your insurance company first to learn if and how your treatment in a clinical trial will be covered. Learn more about health insurance coverage of clinical trials.

Sometimes people have concerns that, in a clinical trial, they may receive no treatment by being given a placebo or a “sugar pill.” Placebos are usually combined with standard treatment in most cancer clinical trials. When a placebo is used in a study, it is done with the full knowledge of the participants. Find out more about placebos in cancer clinical trials.

Patient safety and informed consent

To join a clinical trial, patients participate in a process known as informed consent. During informed consent, the doctor should:

  • Describe all of the patient’s options, so that the person understands how the new treatment differs from the standard treatment.

  • List all of the risks of the new treatment, which may or may not be different from the risks of standard treatment.

  • Explain what will be required of each patient in order to participate in the clinical trial, including the number of doctor visits, tests, the schedule of treatment, and the costs they may need to pay.

Clinical trials also have certain rules called “eligibility criteria” that help structure the research and keep patients safe. You and the research team will carefully review these criteria together.

Patients who participate in a clinical trial may stop participating at any time for any personal or medical reason. This may include that the new treatment is not working or there are serious side effects. Clinical trials are also closely monitored by experts who watch for any problems with each study. It is important that patients participating in a clinical trial talk with their doctor and researchers about who will be providing their treatment and care during the clinical trial, after the clinical trial ends, and/or if the patient chooses to leave the clinical trials before it ends.

Finding a clinical trial

Research through clinical trials is ongoing for all types of cancer. For specific topics being studied for prostate cancer, learn more in the Latest Research section.

Lineagotica offers a lot of information about cancer clinical trials in other areas of the website, including a complete section on clinical trials and places to search for clinical trials for a specific type of cancer.

PRE-ACT, Preparatory Education About Clinical Trials

In addition, this website offers free access to a video-based educational program about cancer clinical trials, located outside of this guide.

The next section in this guide is Latest Research. It explains areas of scientific research currently going on for this type of cancer. You may use the menu to choose a different section to read in this guide.

Prostate Cancer - Latest Research

Approved by the Lineagotica Editorial Board, 03/2018

ON THIS PAGE: You will read about the scientific research being done now to learn more about this type of cancer and how to treat it. Use the menu to see other pages.

Doctors are working to learn more about prostate cancer, ways to prevent it, how to best treat it, and how to provide the best care to people diagnosed with this disease. The following areas of research may include new options for patients through clinical trials. Always talk with your doctor about the best diagnostic and treatment options for you.

  • Finding causes of prostate cancer. Researchers continue to explore the link between nutrition and lifestyle factors and the development of prostate cancer.

  • Early detection. Researchers are trying to develop a better PSA test, either a more specific and precise test or a different test. With improved testing, more healthy men could be screened for prostate cancer, so more prostate cancers could be found and treated early.

  • Genomic tests. Genomics is the study of how genes behave. Genomic tests look at the genes in prostate cancer to help predict how quickly the cancer may grow and spread. The information from these tests can help the cancer care team make decisions about the treatment plan, such as whether active surveillance is an option for men with low-risk prostate cancer or by helping the health care team make a prognosis after surgery and choose the best adjuvant treatments. Some of the genomic tests available now include Decipher, Oncotype DX, ProstaVysion, and the Prolaris Test.

    NCCN recently updated their guidelines to include details about genomic testing in men with prostate cancer. They recommend that men with metastatic castration-resistant prostate cancer receive testing for inherited and tumor mutations, which could help direct treatment. 

  • Advanced imaging scans. Research is ongoing to use different molecules in PET-CT scans (see Diagnosis) to gather important information about a prostate cancer diagnosis, such whether there is distant spread (metastasis). One of those molecules, prostate-specific membrane antigen (PSMA), may be very effective at finding BCR and allowing early treatment.

  • Improved surgical techniques. Better techniques for nerve-sparing surgery can decrease the risk of urinary and sexual side effects for men who need a radical prostatectomy.

  • Shorter radiation therapy schedules. With better, more precise external-beam radiation therapy, researchers are exploring much shorter and more convenient treatment schedules. Instead of 40 treatments, researchers are evaluating using 28, 12, or only 5 treatments.

  • Tests to evaluate the success of treatment. Research continues to evaluate biomarkers that are found in the blood. These biomarkers can help determine the effectiveness of a treatment and be used to better assess the cancer’s response to treatment. Blood tests measuring circulating tumor cells (CTCs) are 1 such test. CTCs are cells that have broken free from the tumor.

  • Improved therapy for advanced prostate cancer. Researchers are exploring different treatment options for advanced prostate cancer in clinical trials, including special targeted drugs, chemotherapy, ADT, and immunotherapy. Researchers are evaluating another class of drugs, called PARP inhibitors, for prostate cancer. These drugs act on DNA-repair genes in cancer cells, making it difficult for them to replicate. In the TOPAR study, men with metastatic castration-resistant prostate cancer were treated with olaparib (Lynparza). Olaparib worked well in men who had defects in DNA-repair genes. Multiple studies are currently evaluating this class of agents.

  • Palliative care. Clinical trials are underway to find better ways of reducing symptoms and side effects of current prostate cancer treatments to improve patients’ comfort and quality of life.

Looking for More About the Latest Research?

If you would like additional information about the latest areas of research regarding prostate cancer, explore these related items that take you outside of this guide:

  • To find clinical trials specific to your diagnosis, talk with your doctor or search online clinical trial databases now.

  • Visit the Lineagotica Blog to read reviews of recent research in prostate cancer and to listen to podcasts with expert perspectives on the topic.

  • Visit the website of ASCO’s Conquer Cancer Foundation to find out how to help support cancer research. Please note that this link takes you to a separate ASCO website. 

The next section in this guide is Coping with Treatment. It offers some guidance in how to cope with the physical, emotional, and social changes that cancer and its treatment can bring. You may use the menu to choose a different section to read in this guide.

Prostate Cancer - Coping with Treatment

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ON THIS PAGE: You will learn more about coping with the physical, emotional, social, and financial effects of cancer and its treatment. This page includes several links outside of this guide to other sections of this website. Use the menu to see other pages.

Every cancer treatment can cause side effects or changes to your body and how you feel. For many reasons, people don’t experience the same side effects even when they are given the same treatment for the same type of cancer. This can make it hard to predict how you will feel during treatment.

As you prepare to start cancer treatment, it is normal to fear treatment-related side effects. It may help to know that your health care team will work to prevent and relieve side effects. Doctors call this part of cancer treatment “palliative care.” It is an important part of your treatment plan, regardless of your age or the stage of disease.

Coping with physical side effects

Common physical side effects from each treatment option for prostate cancer are described in the Treatment Options section. Learn more about side effects of cancer and its treatment, along with ways to prevent or control them. Changes to your physical health depend on several factors, including the cancer’s stage, the length and dose of treatment, and your general health. Any discussion of side effects should also cover fertility, sexual health and function, and bladder function.

Sometimes, physical side effects can last after treatment ends. Doctors call these long-term side effects. They call side effects that occur months or years after treatment late effects. Treating long-term side effects and late effects is an important part of survivorship care. Learn more by reading the Follow-up Care section of this guide or talking with your doctor.

Coping with emotional and social effects

You can have emotional and social effects as well as physical effects after a cancer diagnosis. This may include dealing with difficult emotions, such as sadness, anxiety, or anger, or managing your stress level. Sometimes, patients have problems expressing how they feel to their loved ones, or people don’t know what to say in response.

Patients and their families are encouraged to share their feelings with a member of their health care team. You can also find coping strategies for emotional and social effects in a separate section of this website. This section includes many resources for finding support and information to meet your needs.

Coping with financial effects

Cancer treatment can be expensive. It is often a big source of stress and anxiety for people with cancer and their families. In addition to treatment costs, many people find they have extra, unplanned expenses related to their care. For some people, the high cost stops them from following or completing their cancer treatment plan. This can put their health at risk and may lead to higher costs in the future. Patients and their families are encouraged to talk about financial concerns with a member of their health care team. Learn more about managing financial considerations in a separate part of this website.

Caring for a loved one with cancer

Family members and friends often play an important role in taking care of a person with prostate cancer. This is called being a caregiver. Caregivers can provide physical, practical, and emotional support to the patient, even if they live far away.

Caregivers may have a range of responsibilities on a daily or as-needed basis. Below are some of the responsibilities caregivers take care of:

  • Providing support and encouragement

  • Giving medications

  • Helping manage symptoms and side effects

  • Coordinating medical appointments

  • Providing a ride to appointments

  • Assisting with meals

  • Helping with household chores

  • Handling insurance and billing issues

Learn more about caregiving.

Talking with your health care team about side effects

Before starting treatment, talk with your doctor about possible side effects. Ask:

  • Which side effects are most likely?

  • When are they are likely to happen?

  • What can we do to prevent or relieve them?

Be sure to tell your health care team about any side effects that happen during treatment and afterward, too. Tell them even if you don’t think the side effects are serious. This discussion should include physical, emotional, and social effects of cancer.

Also, ask how much care you may need at home and with daily tasks during and after treatment. This can help you make a caregiving plan.

The next section in this guide is Follow-up Care. It explains the importance of checkups after cancer treatment is finished. You may use the menu to choose a different section to read in this guide.

Prostate Cancer - Follow-Up Care

Approved by the Lineagotica Editorial Board, 03/2018

ON THIS PAGE: You will read about your medical care after cancer treatment is completed and why this follow-up care is important. Use the menu to see other pages.

Care for men diagnosed with prostate cancer doesn’t end when active treatment has finished. Your health care team will continue to check to make sure the cancer has not returned, manage any side effects, and monitor your overall health. This is called follow-up care.

Your follow-up care may include regular physical examinations, medical tests, or both. Doctors want to keep track of your recovery in the months and years ahead. Learn more about the importance of follow-up care.

Watching for recurrence

One goal of follow-up care is to check for a recurrence. Cancer recurs because small areas of cancer cells may remain undetected in the body. Over time, these cells may increase in number until they show up on test results or cause signs or symptoms. During follow-up care, a doctor familiar with your medical history can give you personalized information about your risk of recurrence. Your doctor will ask specific questions about your health. Some people may have blood tests or imaging tests done as part of regular follow-up care, but testing recommendations depend on several factors, including the type and stage of cancer originally diagnosed and the types of treatment given.

The anticipation before having a follow-up test or waiting for test results can add stress to you or a family member. This is sometimes called “scan-xiety.” Learn more about how to cope with this type of stress.

Managing long-term and late side effects

Most people expect to experience side effects when receiving treatment. However, it is often surprising to survivors that some side effects may linger beyond the treatment period. These are called long-term side effects. Other side effects called late effects may develop months or even years afterwards. Long-term and late effects can include both physical and emotional changes.

Talk with your doctor about your risk of developing late effects based on the stage of cancer, your individual treatment plan, and your overall health. If you had a treatment known to cause specific late effects, you may have certain physical examinations, scans, or blood tests to help find and manage them. Learn more about self-image and cancer, fertility and cancer treatment, sexual health, and talking with your spouse or partner.

Keeping personal health records

You and your doctor should work together to develop a personalized follow-up care plan. Be sure to discuss any concerns you have about your future physical or emotional health. ASCO offers forms to help create a treatment summary to keep track of the cancer treatment you received and develop a survivorship care plan when treatment is completed.

This is also a good time to decide who will lead your follow-up care. Some survivors continue to see their oncologist, while others transition back to the care of their family doctor or another health care professional. This decision depends on several factors, including the type and stage of cancer, side effects, health insurance rules, and your personal preferences.

If a doctor who was not directly involved in your cancer care will lead your follow-up care, be sure to share your cancer treatment summary and survivorship care plan forms with him or her and with all future health care providers. Details about your cancer treatment are very valuable to the health care professionals who will care for you throughout your lifetime.

The next section in this guide is Survivorship. It describes how to cope with challenges in everyday life after a cancer diagnosis. You may use the menu to choose a different section to read in this guide.

Prostate Cancer - Survivorship

Approved by the Lineagotica Editorial Board, 03/2018

ON THIS PAGE: You will read about how to cope with challenges in everyday life after a cancer diagnosis. Use the menu to see other pages.

What is survivorship?

The word “survivorship” means different things to different people. Common definitions include:

  • Having no signs of cancer after finishing treatment.

  • Living with, through, and beyond cancer. According to this definition, cancer survivorship begins at diagnosis and includes people who continue to have treatment over the long term, either to reduce the risk of recurrence or to manage chronic disease.

Survivorship is one of the most complicated parts of having cancer. This is because it is different for everyone.  

Survivors may experience a mixture of strong feelings, including joy, concern, relief, guilt, and fear. Some people say they appreciate life more after a cancer diagnosis and have gained a greater acceptance of themselves. Others become very anxious about their health and uncertain about coping with everyday life.

Survivors may feel some stress when their frequent visits to the health care team end after completing treatment. Often, relationships built with the cancer care team provide a sense of security during treatment, and people miss this source of support. This may be especially true when new worries and challenges surface over time, such as any late effects of treatment, emotional challenges including fear of recurrence, sexual and fertility concerns, and financial and workplace issues.

Every survivor has individual concerns and challenges. With any challenge, a good first step is being able to recognize your fears and talk about them. Effective coping requires:

  • Understanding the challenge you are facing

  • Thinking through solutions

  • Asking for and allowing the support of others

  • Feeling comfortable with the course of action you choose

Many survivors find it helpful to join an in-person support group or an online community of survivors. This allows you to talk with people who have had similar first-hand experiences. Other options for finding support include talking with a friend or member of your health care team, individual counseling, or asking for assistance at the learning resource center of the place where you received treatment.

Changing role of caregivers

Family members and friends may also go through periods of transition. A caregiver plays a very important role in supporting a person diagnosed with cancer, providing physical, emotional, and practical care on a daily or as-needed basis. Many caregivers become focused on providing this support, especially if the treatment period lasts for many months or longer.

However, as treatment is completed, the caregiver's role often changes. Eventually, the need for caregiving related to the cancer diagnosis will become much less or come to an end. Caregivers can learn more about adjusting to life after caregiving in this article.

A new perspective on your health

For many people, survivorship serves as a strong motivator to make positive lifestyle changes.

Men recovering from prostate cancer are encouraged to follow established guidelines for good health, such as not smoking, limiting alcohol, eating well, and managing stress. Regular physical activity can help rebuild your strength and energy level. Your health care team can help you create an appropriate exercise plan based upon your needs, physical abilities, and fitness level. Learn more about making healthy lifestyle choices.

It is important to have recommended medical checkups and tests (see Follow-up Care) to take care of your health. Cancer rehabilitation may be recommended, and this could mean any of a wide range of services such as physical therapy, career counseling, pain management, nutritional planning, and/or emotional counseling. The goal of rehabilitation is to help people regain control over many aspects of their lives and remain as independent and productive as possible.

Talk with your doctor to develop a survivorship care plan that is best for your needs.

Looking for More Survivorship Resources?

For more information about cancer survivorship, explore these related items. Please note that these links will take you to other sections of Lineagotica:

  • ASCO Answers Cancer Survivorship Guide: Get this 44-page booklet that helps people transition into life after treatment. It includes blank treatment summary and survivorship care plan forms. The booklet is available as a PDF, so it is easy to print out.

  • Lineagotica Patient Education Video: View a short video led by an ASCO expert that provides information about what comes next after finishing treatment.

  • Survivorship Resources: Lineagotica offers an entire area of this website with resources to help survivors, including those in different age groups.

The next section offers Questions to Ask the Health Care Team to help start conversations with your cancer care team. You may use the menu to choose a different section to read in this guide.

Prostate Cancer - Questions to Ask the Health Care Team

Approved by the Lineagotica Editorial Board, 03/2018

ON THIS PAGE: You will find some questions to ask your doctor or other members of your health care team to help you better understand your diagnosis, treatment plan, and overall care. Use the menu to see other pages.

Talking often with the health care team is important to make informed decisions about your health care. These suggested questions are a starting point to help you learn more about your cancer care and treatment. You are also encouraged to ask additional questions that are important to you. You may want to print this list and bring it to your next appointment, or download Lineagotica’s free mobile app for an e-list and other interactive tools to manage your care.

Questions to ask about prostate cancer risk and screening

  • What type of prostate cancer screening schedule do you recommend for me, based on my individual medical profile and family history?

  • Are there any changes I can make to my diet that can help lower my risk of prostate cancer?

Questions to ask after getting a diagnosis

  • What type of prostate cancer do I have, and how aggressive is it?

  • Can you explain my pathology report (laboratory test results) to me?

  • What stage is my prostate cancer, and what does this mean?

  • What is the Gleason score of my prostate cancer? What does this mean?

Questions to ask about choosing a treatment and managing side effects

  • How much experience do you have treating this type of cancer?

  • What are my treatment options?

  • What clinical trials are available for me? Where are they located, and how do I find out more about them?

  • Does this prostate cancer need to be treated? What would happen if I choose not to start treatment now?

  • What treatment plan do you recommend? Why?

  • What is the goal of each treatment? Is it to eliminate the cancer, help me feel better, or both?

  • What are the possible side effects of each treatment, both in the short term and the long term?

  • Who will be part of my health care team, and what does each member do?

  • Who will be leading my overall treatment?

  • How will this treatment affect my daily life? Will I be able to work, exercise, and perform my usual activities?

  • Will I have difficulty controlling my bladder or bowel function after treatment?

  • Could this treatment affect my sex life? If so, how and for how long?

  • Could this treatment affect my ability to have children? If so, should I talk with a fertility specialist before cancer treatment begins? Should I consider sperm banking?

  • If I’m worried about managing the costs of cancer care, who can help me?

  • What support services are available to me? To my family?

  • Whom should I call with questions or problems?

Questions to ask about having surgery

  • What type of surgery will I have? Will lymph nodes be removed?

  • How long will the operation take?

  • How long will I be in the hospital?

  • Can you describe what my recovery from surgery will be like?

  • What are the possible long-term effects of having this surgery?

Questions to ask about having radiation therapy

  • What type of treatment is recommended?

  • Where will the radiation be focused?

  • What is the goal of this treatment?

  • How long will it take to give this treatment?

  • What side effects can I expect during treatment?

  • What are the possible long-term effects of having this treatment?

  • What can be done to relieve the side effects?

Questions to ask about having ADT

  • What type of ADT do you recommend?

  • What is the goal of this treatment?

  • How will this treatment be given?

  • How long will I need to continue this treatment?

  • What side effects can I expect during treatment?

  • What are the possible long-term effects of having this treatment?

  • What can be done to relieve the side effects?

Questions to ask about having chemotherapy or immunotherapy

  • What type of treatment do you recommend?

  • What is the goal of this treatment?

  • How will this treatment be given?

  • How long will it take to give this treatment?

  • What side effects can I expect during treatment?

  • What are the possible long-term effects of having this treatment?

  • What can be done to relieve the side effects?

Questions to ask about planning follow-up care

  • What is the chance that the cancer will come back? Should I watch for specific signs or symptoms?

  • What long-term side effects or late effects are possible based on the cancer treatment I received?

  • What follow-up tests will I need, and how often will I need them?

  • How do I get a treatment summary and survivorship care plan to keep in my personal records?

  • Who will be leading my follow-up care?

  • What survivorship support services are available to me? To my family?

The next section in this guide is Additional Resources. It offers some more resources on this website beyond this guide that may be helpful to you. You may use the menu to choose a different section to read in this guide.

Prostate Cancer - Additonal Resources

Approved by the Lineagotica Editorial Board, 03/2018

ON THIS PAGE: You will find some helpful links to other areas of Lineagotica that provide information about cancer care and treatment. This is the final page of Lineagotica’s Guide to Prostate Cancer. Use the menu to go back and see other pages.

Lineagotica includes many other sections about the medical and emotional aspects of cancer for the person diagnosed and their family members and friends. This website is meant to be a resource for you and your loved ones from the time of diagnosis, through treatment, and beyond.

Beyond this guide, here are a few links to help you explore other parts of Lineagotica:

This is the end of Lineagotica’s Guide to Prostate Cancer. You may use the menu to choose a different section to read in this guide.