PROSTATE CANCER

DEFINITIONTHE PROSTATE IS THE WALNUT –SHAPED GLAND PRODUCING THE SEMINAL FLUID, THEAT NOURISHES AND TRANSPORTS SPERM

PROATATE CANCER IS A VERY PREVELANT FORM OF CANCER

PROSTATE CANCER IS SLOW FORMING

USUALLY REMAINS CONFINED INSIDE THE PROSTATE GLAND

WITH EARLY DISCOVERY-YOUR TREATMENT HAS A BETTER SUCCESS RATE

Symptoms of Prostate Cancer

In the early stages, men may have no symptoms. Later, symptoms can include:

Frequent urination, especially at night

Difficulty starting or stopping urination

Weak or interrupted urinary stream

Painful or burning sensation during urination or ejaculation

Blood in urine or semen

Pelvic discomfort

Pain in bones

SOME OF THE FACTORS THAT INCREASE YOUR RISK OF PROSTATE CANCER INCLUDE :

AGE-PROSTATE CANCER’S RISK INCREASES WITH AGE. ITS

MORE COMMON AMONG PEOPLE AGE 65+.

AFRO-AMERICANS-BLACK MEN ARE AT GREATER RISK. THEIR

CANCER IS MORE LIKELY TO BE AGGRESSIVE.

FAMILY HISTORY-WHEN FAMILY MEMBERS HAVE HAD IT YOUR

RISK FACTOR INCREASES

OBESITY-OBESE MEN ARE MORE LIKELY TO HAVE ADVANCED

DISEASE & ARE MUCH MORE DIFFICULT TO TREAT

RISK FACTORS

Questions to Ask Your Doctor How aggressive is my cancer? What is the Gleason score of my prostate tumor?

What are the results of my PSA and other tests?

How much time do I have to decide on an option?

Do my other health problems make any one option better for me?

Who else should I talk to about watchful waiting? Prostate surgery? Radiation? Hormone treatment?

What are my risks with this option?

What is the chance that my cancer will come back after treatment?

Which option will give me the least problems with erections? Leaking urine? Bowel urgency?

What is the chance I will be able to have a sex life after treatment?

How many treatments do you do a year?

Is there help for any side effects I might have?

What kind of follow-up care will I get

Enlarged Prostate or Prostate Cancer?

The prostate can grow larger as men age,

sometimes pressing on the bladder or

urethra and causing symptoms similar to

prostate cancer.

This is called benign prostatic hyperplasia

(BPH).

It's not cancer and can be treated if

symptoms become bothersome.

A third problem that can cause urinary

symptoms is prostatitis.

This inflammation or infection may also

cause a fever and in many cases is

treated with medicine.

What is screening?Screening is looking for cancer before a person has any symptoms.

This can help find cancer at an early stage. When abnormal tissue or cancer is found

early, it may be easier to treat.

By the time symptoms appear, cancer may have begun to spread.

Scientists are trying to better understand which people are more likely to get certain

types of cancer.

They also study the things we do and the things around us to see if they cause cancer.

This information helps doctors recommend who should be screened for cancer, which

screening tests should be used, and how often the tests should be done.

It is important to remember that your doctor does not necessarily think you have

cancer if he or she suggests a screening test.

Screening tests are given when you have no cancer symptoms.

Screening tests may be repeated on a regular basis.

If a screening test result is abnormal, you may need to have more tests done to find

out if you have cancer.

These are called diagnostic tests.

The United States Preventive Services Task Force (USPSTF) recommended

against PSA screening in healthy men finding that the potential risks outweigh

the potential benefits.

Guidelines from the American Urological Association, and the American

Cancer Society recommend that men be informed of the risks and benefits of

screening.

The American Society of Clinical Oncology recommends screening be

discouraged in those who are expected to live less than ten years, while in

those with a life expectancy of greater than ten years a decision should be

made by the person in question based on the potential risks and benefits.

In general, they conclude that based on recent research, "it is uncertain

whether the benefits associated with PSA testing for prostate cancer screening

are worth the harms associated with screening and subsequent unnecessary

treatment."

There is no standard or routine screening test for prostate cancer.

What Is Prostate Cancer?

Prostate cancer develops in a man's

prostate, the walnut-sized gland just

below the bladder that produces some of

the fluid in semen.

It's the most common cancer in men after

skin cancer.

Prostate cancer often grows very slowly

and may not cause significant harm.

But some types are more aggressive and

can spread quickly without treatment.

STAGES OF PROSTATE CANCERTHE CAUSE OF PROSTATE CANCER ISN’T CLEAR TO PHYSICIANS

WHEN THE PROCESS HAPPENS IT FORMS IN STAGES

STAGE I

THIS IS WHEN THE CELLS IN THE PROSTATE BECOME ABNORMAL

STAGE II

THE ABNORMAL CELLS & MUTATED DNA CAUSE THE CELL TO GROW RAPIDLY

STAGE III

THE CELL SURVIVE & A TUMOR IS FORMED THAT INVADE NEARBY TISSUE

STAGE IV

WHEN SOME OF THE ABNORMAL CELLS MIGHT METASTISIZE (MOVE TO OTHER BODY PARTS)

Prostate-specific antigen test A prostate-specific antigen (PSA) test is a test

that measures the level of PSA in the blood.

PSA is a substance made mostly by the prostate that may be found in an increased amount in the blood of men who have prostate cancer.

The level of PSA may also be high in men who have an infection or inflammation of the prostate or benign prostatic hyperplasia (BPH; an enlarged, but noncancerous, prostate).

If a man has a high PSA level and a biopsy of the prostate does not show cancer, a prostate cancer gene 3 (PCA3) test may be done.

This test measures the amount of PCA3 in the urine. If the PCA3 level is high, another biopsy may help diagnose prostate cancer.

Scientists are studying the combination of PSA testing and digital rectal exam as a way to get more accurate results from the screening tests.

Digital rectal exam

Digital rectal exam (DRE) is an exam of the rectum. The doctor or nurse inserts a lubricated, gloved finger into the lower part of the rectum to feel the prostate for lumps or anything else that seems unusual.

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

Types of standard treatment are

used:

Watchful waiting or active surveillance

Watchful waiting is closely monitoring a patient’s condition

without giving any treatment until symptoms appear or

change.

Active surveillance is closely following a patient's

condition without giving any treatment unless there

are changes in test results.

It is used to find early signs that the condition is getting

worse. In active surveillance, patients are given certain

exams and tests, including biopsies, on a regular schedule.

What Are the Advantages of Laparoscopy?

As is the case with other minimally invasive procedures, laparoscopic prostate removal has significant advantages over traditional surgery:

Laparoscopy can shorten your hospital stay to one or two days. About 50% of men are discharged one day after surgery. (The length of stay depends on how quickly you recover and the extent of the surgery).

There is much less bleeding during the operation.

You are less likely to need prescription painkillers after you leave the hospital. Patients often need nothing more than Tylenol.

At your follow-up appointment one week after surgery, the tube, or catheter, draining your bladder will be removed if there are no signs of other problems. Occasionally, the catheter remains in place for another week, as with conventional surgery.

About 90% of patients can return to work or resume full activity in only two to three weeks.

RadiationRadiation kills the cancer cells. The goal is to target the cancer and avoid hurting normal parts of the body. Radiation can be given in two ways—external beam radiation or brachytherapy. Sometimes the two kinds of radiation are used together. External beam radiation uses radiation from a machine to target the prostate gland. This kind of radiation takes place in a hospital or clinic. The radiation is given a few minutes a day for about 6 to 8 weeks. Brachytherapy (also called radiation “seeding”) uses a needle to put small seeds of radiation into the cancer inside the prostate gland. This usually requires a trip to the hospital or clinic. The seeds inside the prostate gland slowly release radiation over time.

Hormone Treatment Testosterone is a hormone made by the body. It causes prostate cancer cells to grow. Hormone treatment lowers or blocks the body’s testosterone. This helps

to slow or stop the growth of cancer cells. What do we know about hormone treatments?Hormone treatments come in shots or pills. Most of the research

about hormone medicines is on these drugs—leuprolide (Lupron®, Viadur®, Eligard®), goserelin(Zoladex®), flutamide (Eulexin®), and bicalutamide (Casodex®). Hormone medicines are often

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

Most of the research is about combining hormone medicines with other types of prostate cancer treatments.

There is less research about using hormone medicines on their own.

Bicalutamide (Casodex®) is a pill that does not work for localized prostate cancer.

This is true whether it is used by itself, with prostate surgery, or with external beam radiation.

Research can’t tell us if using other hormone treatments on their own can stop localized prostate cancer from spreading.

LATEST CLINICAL TRIALS

TREATMENTS

NEW NON-INVASIVE

ALTERNATE TREATMENT WITH ALBATHERIN HIFU

CURRENTELY AT THE

CLEVELAND CLINIC IN

CANADA,IT IS SAID TO HAVE

FEWER SIDE EFFECTS.

DRUGS

A CHOLESTEROL DRUG

SLASHES PROSTATE CANCER

DEATHS,ITS CALLED STATINS .

USED AT THE PROSTATE

CANCER RESEARCH

PROGRAM IN THE FRED

HUTCHINSON CANCER

RESEARCH CENTER OF

SEATTLE.

Side Effects of Treatment

All prostate cancer treatments can cause side effects. The most common side effects are sexual, urinary, and bowel problems. Some of these problems happen soon after treatment and others develop over time. Talk to your doctor or nurse if you have any of

these side effects. There may be a way to help.

Erectile dysfunction (ED) means not being able to keep an erection for intercourse. ED is the most common long-lasting side effect. It can happen with any treatment.

Urinary problems are another long-lasting side effect. This can mean leaking or dribbling urine. It can also mean sometimes not being able to hold your urine at all. Urinary problems are more common after surgery than with other treatments.

Bowel problems can also be a long-lasting side effect. This can mean sometimes having "bowel urgency" (needing to have a bowel movement right away and not being able to wait). Long-lasting bowel problems are more common after external beam radiation or hormone treatment than after prostate surgery or with watchful waiting.

Hormone treatments can have other side effects. They can cause hot flashes, breast swelling, and loss of sex drive. They can also cause tiredness, depression, and memory problems. Hormone treatments can weaken bones and raise the chance they will break.

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

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

COUNSELING AND THERAPY

TO NAME A FEW METHODS OF

PROSTATE CANCER COUNSELING &

SUPPORT GROUPS:

INDIVIDUAL FAMILY COUNSELING

THERE ARE MIND & BODY THERAPIES AVAILABLE AT THE

CANCER TREATMENT CENTERS OF AMERICA (CTCA).THIS

PREPARES A PATIENT OF ALL OPTIONS AVAILABLE TO THEM

& THEIR FAMILIES

LAUGHTER THERAPY

LAUGHTER TENDS TO REDUCE STRESS, IMPROVE PAIN, &

BALANCE B/P

GUIDED IMAGERY

THIS SORT OF THERAPY IS A RELAXATION TECHNIQUE. IT

TEACHES PATIENTS TO USE POSITIVE MENTAL IMAGES TO

HELP MANAGE STRESS, PHYSICAL DISCOMFORT, PAIN

NAUSEA, & ANXIETY.

Where can I get more information? Where

can I get a copy of this guide?

For more information about prostate cancer treatment, research, and support, visit the Medline Plus Web site:

www.nlm.nih.gov/Medline plus/prostatecancer.html

For more information about screening for prostate cancer, visit the Centers for Disease Control and Prevention Web site:

www.cdc.gov/cancer/prostate/publications/decision guide

For more information about prostate cancer treatment and research, visit the National Cancer Institute Web site:

www.cancer.gov/cancertopics/types/prostate

For an electronic copy of this guide and materials about choosing treatments and medicines for other medical conditions, visit this Web site:

www.effectivehealthcare.ahrq.gov

For a free print copy call:

The AHRQ Publications Clearinghouse

(800)358-9295

Ask for AHRQ Publication Number 08-EHC010-2A