This National Cancer Institute (NCI) booklet (NIH Publication No. 05-1576) has important information about
prostate*
cancer. Prostate cancer is the second most common type of cancer
among men in this country. Only skin cancer is more common. Out of every three
men who are diagnosed with cancer each year, one is diagnosed with prostate
cancer.
You will read about possible causes, screening, symptoms, diagnosis, and
treatment. You will also find ideas about how to cope with the disease.
Scientists are studying prostate cancer to find out more about its causes. And
they are looking for better ways to treat it.
NCI provides information about cancer, including the publications mentioned in
this booklet. You can order these materials by telephone or on the Internet.
You can also read them online and print your own copy.
If the prostate grows too large, it squeezes the urethra. This may slow or stop
the flow of urine from the bladder to the penis.
Normally, cells grow and divide to form new cells as the body needs them. When
cells grow old, they die, and new cells take their place.
Sometimes, this orderly process goes wrong. New cells form when the body does
not need them, and old cells do not die when they should. These extra cells can
form a mass of tissue called a growth or
tumor.
-
Benign tumors are not cancer:
-
Benign tumors are rarely life-threatening.
-
Generally, benign tumors can be removed. They usually do not grow back.
-
Cells from benign tumors do not invade the tissues around them.
-
Cells from benign tumors do not spread to other parts of the body.
-
Malignant tumors are cancer:
-
Malignant tumors are generally more serious than benign tumors. They may be
life-threatening.
-
Malignant tumors often can be removed. But sometimes they grow back.
-
Cells from malignant tumors can invade and damage nearby tissues and organs.
-
Cells from malignant tumors can spread
(metastasize)
to other parts of the
body. Cancer cells spread by breaking away from the original
(primary)
tumor
and entering the bloodstream or
lymphatic system.
The cells invade other organs
and form new tumors that damage these organs. The spread of cancer is called
metastasis.
When prostate cancer spreads, cancer is often found in nearby
lymph nodes.
If
cancer has reached these nodes, it also may have spread to other lymph nodes,
the bones, or other organs.
When cancer spreads from its original place to another part of the body, the
new tumor has the same kind of abnormal cells and the same name as the primary
tumor. For example, if prostate cancer spreads to bones, the cancer cells in
the bones are actually prostate cancer cells. The disease is metastatic
prostate cancer, not bone cancer. For that reason, it is treated as prostate
cancer, not bone cancer. Doctors call the new tumor "distant" or metastatic
disease.
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Risk Factors
No one knows the exact causes of prostate cancer. Doctors often cannot explain
why one man develops prostate cancer and another does not. However, we do know
that prostate cancer is not contagious. You cannot "catch" it from another
person.
Research has shown that men with certain
risk factors
are more likely than
others to develop prostate cancer. A risk factor is something that may increase
the chance of developing a disease.
Studies have found the following risk factors for prostate cancer:
-
Age: Age is the main risk factor for prostate cancer. This disease is
rare in men younger than 45. The chance of getting it goes up sharply as a man
gets older. In the United States, most men with prostate cancer are older than
65.
-
Family history: A man's risk is higher if his father or brother had
prostate cancer.
-
Race: Prostate cancer is more common in African American men than in
white men, including Hispanic white men. It is less common in Asian and
American Indian men.
-
Certain prostate changes: Men with cells called high-grade
prostatic intraepithelial neoplasia
(PIN) may be at increased risk for prostate cancer.
These prostate cells look abnormal under a microscope.
-
Diet: Some studies suggest that men who eat a diet high in animal fat or
meat may be at increased risk for prostate cancer. Men who eat a diet rich in
fruits and vegetables may have a lower risk. (More about diet studies is in
"The Promise of Cancer Research".)
Many of these risk factors can be avoided. Others, such as family history,
cannot be avoided. You can help protect yourself by staying away from known
risk factors whenever possible.
Scientists have also studied whether BPH, obesity, smoking, a
virus
passed
through sex, or lack of exercise might increase the risk for prostate cancer.
At this time, these are not clear risk factors. Also, most studies have not
found an increased risk of prostate cancer for men who have had a
vasectomy.
A
vasectomy is
surgery
to cut or tie off the tubes that carry sperm out of the
testicles.
Most men who have known risk factors do not get prostate cancer. On the other
hand, men who do get the disease often have no known risk factors, except for
growing older.
If you think you may be at risk, you should talk with your doctor. Your doctor
may be able to suggest ways to reduce your risk and can plan a schedule for
checkups.
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Screening
Your doctor can check you for prostate cancer before you have any symptoms.
Screening
can help doctors find and treat cancer early. But studies so far have
not shown that screening tests reduce the number of deaths from prostate
cancer. You may want to talk with your doctor about the possible benefits and
harms of being screened. The decision to be screened, like many other medical
decisions, is a personal one. You should decide after learning the pros and
cons of screening.
Your doctor can explain more about these tests:
-
Digital rectal exam:
The doctor inserts a lubricated, gloved finger into
the rectum and feels the prostate through the rectal wall. The prostate is
checked for hard or lumpy areas.
-
Blood test for
prostate-specific antigen
(PSA): A lab checks the level
of PSA in a man's blood sample. A high PSA level is commonly caused by BPH or
prostatitis
(inflammation of the prostate). Prostate cancer may also cause a
high PSA level.
The digital rectal exam and PSA test can detect a problem in the prostate. They
cannot show whether the problem is cancer or a less serious condition. Your
doctor will use the results of these tests to help decide whether to check
further for signs of cancer. Information about other tests is in the
"Diagnosis" section.
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Symptoms
A man with prostate cancer may not have any symptoms. For men who have symptoms
of prostate cancer, common symptoms include:
-
Urinary problems
-
Not being able to urinate
-
Having a hard time starting or stopping the urine flow
-
Needing to urinate often, especially at night
-
Weak flow of urine
-
Urine flow that starts and stops
-
Pain or burning during urination
-
Difficulty having an
erection
-
Blood in the urine or semen
-
Frequent pain in the lower back, hips, or upper thighs
Most often, these symptoms are not due to cancer. BPH, an infection, or another
health problem may cause them. Any man with these symptoms should tell his
doctor so that problems can be diagnosed and treated as early as possible. He
may see his regular doctor or a
urologist.
A urologist is a doctor whose
specialty is diseases of the urinary system.
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Diagnosis
If you have a symptom or test result that suggests cancer, your doctor must
find out whether it is due to cancer or to some other cause. Your doctor will
ask about your personal and family medical history. You will have a physical
exam. You may have lab tests. Your visit may include a digital rectal exam, a
urine test to check for blood or infection, and a blood test to measure PSA
level.
You also may have other exams:
-
Transrectal ultrasound:
The doctor inserts a probe into the man's rectum
to check for abnormal areas. The probe sends out sound waves that people cannot
hear (ultrasound). The waves bounce off the prostate. A computer uses the
echoes to create a picture called a
sonogram.
-
Cystoscopy:
The doctor uses a thin, lighted tube to look into the
urethra and bladder.
-
Transrectal biopsy: A
biopsy
is the removal of tissue to look for cancer
cells. It is the only sure way to diagnose prostate cancer. The doctor inserts
a needle through the rectum into the prostate. The doctor takes small tissue
samples from many areas of the prostate. Ultrasound may be used to guide the
needle. A
pathologist
checks for cancer cells in the tissue.
You may want to ask the doctor these questions before having a biopsy:
-
Where will the biopsy take place? Will I have to go to the hospital?
-
How long will it take? Will I be awake? Will it hurt?
-
What are the risks? What are the chances of infection or bleeding after the
biopsy?
-
How long will it take me to recover?
-
How soon will I know the results?
-
If I do have cancer, who will talk to me about the next steps? When?
|
If the
physical exam and test results do not suggest cancer, your doctor may suggest medicine to reduce
symptoms caused by an enlarged prostate. Surgery also can relieve these
symptoms. The surgery most often used in such cases is
transurethral resection of the prostate
(TURP or TUR). In TURP, an instrument is inserted through the
urethra to remove prostate tissue that is pressing against the upper part of
the urethra and restricting the flow of urine. You should talk to your doctor
about the best treatment option.
If cancer is present, the pathologist studies tissue samples from the prostate
under a microscope to report the
grade
of the tumor. The grade tells how much
the tumor tissue differs from normal prostate tissue. It suggests how fast the
tumor is likely to grow. Tumors with higher grades tend to grow faster than
those with lower grades. They are also more likely to spread.
One system of grading prostate cancer uses G1 through G4. Another way of
grading is with the
Gleason score.
The pathologist gives each area of cancer a
grade of 1 through 5. The pathologist adds the two most common grades together
to make a Gleason score. Or the pathologist may add the most common grade and
the highest (most abnormal) grade to get the score. Gleason scores can range
from 2 to 10.
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Staging
To plan your treatment, your doctor needs to know the extent
(stage)
of the
disease. The stage is based on the size of the tumor, whether the cancer has
spread outside the prostate and, if so, where it has spread.
You may have blood tests to see if the cancer has spread. Some men also may
need
imaging
tests:
-
Bone scan:
The doctor injects a small amount of a
radioactive
substance
into a blood vessel. It travels through the bloodstream and collects in the
bones. A machine called a scanner detects and measures the radiation. The
scanner makes pictures of the bones on a computer screen or on film. The
pictures may show cancer that has spread to the bones.
-
CT scan:
An
x-ray
machine linked to a computer takes a series of
detailed pictures of areas inside your body. Doctors often use CT scans to see
the
pelvis
or
abdomen.
-
MRI:
A strong magnet linked to a computer is used to make detailed
pictures of areas inside your body.
These are the stages of prostate cancer:
-
Stage I: The cancer cannot be felt during a digital rectal exam. It is
found by chance when surgery is done for another reason, usually for BPH. The
cancer is only in the prostate.
-
Stage II: The cancer is more advanced, but it has not spread outside the
prostate.
-
Stage III: The cancer has spread outside the prostate. It may be in the
seminal vesicles.
It has not spread to the lymph nodes.
-
Stage IV: The cancer may be in nearby muscles and organs (beyond the
seminal vesicles). It may have spread to the lymph nodes. It may have spread to
other parts of the body.
-
Recurrent cancer
is cancer that has come back (recurred) after a time when it
could not be detected. It may recur in or near the prostate. Or it may recur in
any other part of the body, such as the bones.
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Treatment
Many men with prostate cancer want to take an active part in making decisions
about their care. It is natural to want to learn all you can about prostate
cancer and your treatment choices. However, shock and stress after the
diagnosis can make it hard to think of everything you want to ask your doctor.
It often helps to make a list of questions before an appointment.
To help remember what the doctor says, you may take notes or ask whether you
may use a tape recorder. You may also want to have a family member or friend
with you when you talk to the doctor - to take part in the discussion, to take
notes, or just to listen.
You do not need to ask all your questions at once. You will have other chances
to ask your doctor or nurse to explain things that are not clear and to ask for
more details.
Your doctor may refer you to a specialist, or you may ask for a referral.
Specialists who treat prostate cancer include
urologists,
urologic oncologists,
medical oncologists, and
radiation oncologists.
Before starting treatment, you might want a second opinion about your diagnosis
and treatment plan. Many insurance companies cover a second opinion if you or
your doctor requests it. It may take some time and effort to gather medical
records and arrange to see another doctor. Usually it is not a problem to take
several weeks to get a second opinion. In most cases, the delay in starting
treatment will not make treatment less effective. To make sure, you should
discuss this delay with your doctor. Some men with prostate cancer need
treatment right away.
There are a number of ways to find a doctor for a second opinion:
-
Your doctor may refer you to one or more specialists. At cancer centers,
several specialists often work together as a team.
-
NCI's Cancer Information Service, at 1-800-4-CANCER, can tell you about nearby
treatment centers. Information Specialists also can provide online assistance
through
LiveHelp at http://www.cancer.gov/cis.
-
A local or state medical society, a nearby hospital, or a medical school can
usually provide the names of specialists.
-
The American Board of Medical Specialties (ABMS) has a list of doctors who have
had training and passed exams in their specialty. You can find this list in the Official
ABMS Directory of Board Certified Medical Specialists. This Directory
is in most public libraries. Also, ABMS offers this information at
http://www.abms.org. (Click on "Who's Certified.")
-
NCI provides a helpful fact sheet called "How
To Find a Doctor or Treatment Facility If You Have Cancer."
Men with prostate cancer have many treatment options. The treatment that is
best for one man may not be best for another.
Treatment may involve
surgery,
radiation therapy, or
hormone therapy. You may have a
combination of treatments. If your doctor recommends
watchful waiting, your health will be
monitored closely. You will have treatment only if symptoms occur or get worse.
Cancer treatment is either
local therapy or
systemic therapy:
-
Local therapy: Surgery and radiation therapy are local treatments. They
remove or destroy cancer in the prostate. When prostate cancer has spread to
other parts of the body, local therapy may be used to control the disease in
those specific areas.
-
Systemic therapy: Hormone therapy is systemic therapy. Hormones are
given to control cancer that has spread.
The treatment that is right for you depends on the stage of the cancer, the
grade of the tumor, your symptoms, and your general health. Your doctor will
describe your treatment choices and the expected results.
Because cancer treatments often damage healthy cells and tissues,
side effects are common. Side effects
depend mainly on the type and extent of the treatment. Side effects may not be
the same for each man, and they may change from one treatment session to the
next. NCI's booklet
Know Your Options: Understanding Treatment Choices for Prostate Cancer
can tell you more about treatments and their side effects.
You should consider both the expected benefits and possible side effects of
each treatment option. You may want to discuss with your doctor the possible
effects on sexual activity. You can work with your doctor to create a treatment
plan that reflects your medical needs and personal values.
At any stage of disease,
supportive care is available to control
pain and other symptoms, to relieve the side effects of treatment, and to ease
emotional concerns. Information about such care is available on NCI's Web site
at http://www.cancer.gov/cancertopics/coping
and from Information Specialists at 1-800-4-CANCER or
LiveHelp.
You may want to talk to your doctor about taking part in a
clinical trial, a research study of new
treatment methods. The section on "The
Promise of Cancer Research" has more information about clinical trials.
You may want to ask your doctor these questions before your treatment begins:
-
What is the stage of the disease? Do any lymph nodes show signs of cancer? Has
the cancer spread?
-
What is the grade of the tumor?
-
What is the goal of treatment? What are my treatment choices? Which do you
recommend for me? Why?
-
What are the expected benefits of each kind of treatment?
-
What are the risks and possible side effects of each treatment? How can side
effects be managed?
-
What can I do to prepare for treatment?
-
Will I need to stay in the hospital? If so, for how long?
-
How will treatment affect my normal activities? Will it affect my sex life?
Will I have urinary problems? Will I have bowel problems?
-
What will the treatment cost? Will my insurance cover it?
-
Would a clinical trial (research study) be appropriate for me?
|
Surgery is a common treatment for early stage prostate cancer. Your doctor may
remove the whole prostate or only part of it. In some cases, your doctor can
use a method known as
nerve-sparing surgery. This type of
surgery may save the
nerves that control erection. But if you
have a large tumor or a tumor that is very close to the nerves, you may not be
able to have this surgery.
Each type of surgery has benefits and risks. Your doctor can further describe
these types:
-
Radical retropubic prostatectomy: The
doctor removes the entire prostate and nearby lymph nodes through an
incision (cut) in the abdomen.
-
Radical perineal prostatectomy: The
doctor removes the entire prostate through a cut between the
scrotum and the
anus. Nearby lymph nodes may be removed
through a separate cut in the abdomen.
-
Laparoscopic prostatectomy: The
doctor removes the entire prostate and nearby lymph nodes through small
incisions, rather than a single long cut in the abdomen. A thin, lighted tube
(a
laparoscope) is used to help remove the
prostate.
-
Transurethral resection of the prostate (TURP):
The doctor removes part of the prostate with a long, thin device that is
inserted through the urethra. The cancer is cut from the prostate. TURP may not
remove all of the cancer. But it can remove tissue that blocks the flow of
urine.
-
Cryosurgery: This type of surgery
for prostate cancer is under study at some medical centers. (More about
cryosurgery is in "The Promise of
Cancer Research" section.)
-
Pelvic lymphadenectomy: This is
routinely done during prostatectomy. The doctor removes lymph nodes in the
pelvis to see if cancer has spread to them. If there are cancer cells in the
lymph nodes, the disease may have spread to other parts of the body. In this
case, the doctor may suggest other types of treatment.
The time it takes to heal after surgery is different for each man and depends
on the type of surgery he has had. You may be uncomfortable for the first few
days. However, medicine can help control the pain. Before surgery, you should
discuss the plan for pain relief with your doctor or nurse. After surgery, your
doctor can adjust the plan if you need more pain relief.
After surgery, the urethra needs time to heal. You will have a
catheter. A catheter is a tube put through
the urethra into the bladder to drain urine. You will have the catheter for 5
days to 3 weeks. Your nurse or doctor will show you how to care for it.
Surgery may cause short-term problems, such as
incontinence. After surgery, some men may
lose control of the flow of urine (urinary
incontinence). Most men regain bladder control after a few
weeks.
Some men may become
impotent. Nerve-sparing surgery is an
attempt to avoid the problem of impotence. If a man can have nerve-sparing
surgery and the operation is a success, impotence may not last. In some cases,
men become permanently impotent. You can talk with your doctor about medicine
and other ways to help manage the sexual effects of cancer treatment.
If your prostate is removed, you will no longer produce semen. You will have
dry orgasms. If you wish to father
children, you may consider
sperm banking or a
sperm retrieval procedure.
You may want to ask your doctor these questions before choosing surgery:
-
What kinds of surgery can I consider? Is nerve-sparing surgery an option for
me? Which operation do you recommend for me? Why?
-
How will I feel after the operation?
-
If I have pain, how can we control it?
-
Will I have any lasting side effects?
-
Is there someone I can talk with who has had the same surgery I'll be having?
|
Radiation therapy (also called radiotherapy) uses high-energy rays to kill
cancer cells. It affects cells only in the treated area.
For early stage prostate cancer, radiation treatment may be used instead of
surgery. It also may be used after surgery to destroy any cancer cells that
remain in the area. In later stages of prostate cancer, radiation treatment may
be used to help relieve pain.
Doctors use two types of radiation therapy to treat prostate cancer. Some men
receive both types:
-
External radiation: The radiation
comes from a large machine outside the body. Men go to a hospital or clinic for
treatment. Treatments are usually 5 days a week for several weeks. Many men
receive
3-dimensional conformal radiation therapy.
This type of treatment more closely targets the cancer. It spares healthy
tissue.
-
Internal radiation (implant
radiation therapy or
brachytherapy): The radiation
comes from radioactive material usually contained in small seeds. The seeds are
put into the tissue. They give off radiation for months. The seeds are harmless
and do not need to be removed.
Side effects depend mainly on the dose and type of radiation. You are likely to
be very tired during radiation therapy, especially in the later weeks of
treatment. Resting is important, but doctors usually advise patients to try to
stay as active as they can.
If you have external radiation, you may have diarrhea or frequent and
uncomfortable urination. Some men have lasting bowel or urinary problems. Your
skin in the treated area may become red, dry, and tender. You may lose hair in
the treated area. The hair may not grow back.
Internal radiation treatment may cause incontinence. This side effect usually
goes away. Lasting side effects from internal radiation are not common.
Both internal and external radiation can cause impotence. Internal radiation is
less likely to have this effect.
You may want to ask your doctor these questions before choosing radiation
therapy:
-
How will radiation be given?
-
When will treatment start? When will it end? How often will I have treatments?
-
What can I do to take care of myself before, during, and after treatment?
-
How will I feel during treatment? Will I be able to drive myself to and from
treatment?
-
How will we know the treatment is working?
-
How will I feel after the radiation?
-
Are there any lasting effects?
-
What is the chance that the cancer will come back in my prostate?
-
How often will I need checkups?
|
Hormone therapy keeps prostate cancer cells from getting the male hormones
(androgens) they need to grow. The testicles are the body's main source of the
male hormone testosterone. The adrenal gland makes a
small amount of testosterone.
Hormone treatment uses drugs or surgery:
-
Drugs: Your doctor may suggest a drug that can block natural hormones.
-
Surgery: Surgery to remove the testicles is called
orchiectomy.
After orchiectomy or treatment with an LH-RH agonist, your body no longer gets
testosterone from the testicles. However, the adrenal gland still produces a small amount
of male hormones. You may receive an antiandrogen to block the action of the
male hormones that remain. This combination of treatments is known as total
androgen blockade. Studies have not shown whether
total androgen blockade is more effective
than surgery or an LH-RH agonist alone.
Doctors can usually control prostate cancer that has spread to other parts of
the body with hormone therapy. The cancer often does not grow for several
years. But in time, most prostate cancers can grow with very little or no male
hormones. Hormone therapy is no longer helpful. At that time, your doctor may
suggest other forms of treatment that are under study.
Hormone therapy is likely to affect your
quality of life. It often causes side
effects such as impotence, hot flashes, loss of sexual desire, and weaker
bones. An LH-RH agonist may make your symptoms worse for a short time when you
first take it. This temporary problem is called "flare." The treatment
gradually causes your testosterone level to fall. Without testosterone, tumor
growth slows. Your condition may improve. (To prevent flare, your doctor may
give you an antiandrogen for a while along with the LH-RH agonist.)
Antiandrogens (such as nilutamide) can cause nausea, diarrhea, or breast growth
or tenderness. Rarely, they may cause liver problems (pain in the abdomen,
yellow eyes, or dark urine). Some men who use nilutamide may have difficulty
breathing. Some may have trouble adjusting to sudden changes in light.
If used for a long time, ketoconazole may cause liver problems, and
aminoglutethimide can cause skin rashes. If you receive total androgen
blockade, you may have more side effects than if you have just one type of
hormone treatment.
Any treatment that lowers hormone levels can weaken your bones. Your doctor can
suggest medicines or
dietary supplements that can reduce your
risk of bone fractures.
You may want to ask your doctor these questions before choosing hormone
therapy:
-
What kind of hormone therapy will I have? Would you recommend drugs or surgery?
Why?
-
When will treatment start? How often will I have treatments? When will it end?
-
Where will I go for treatment? Will I be able to drive home afterward?
-
If I have surgery, how long will I need to stay in the hospital?
-
How will I feel during treatment?
-
What can I do to take care of myself during treatment?
-
How will we know the treatment is working?
-
Which side effects should I tell you about?
-
Will there be lasting side effects?
|
You may choose watchful waiting if the risks and possible side effects of
treatment outweigh the possible benefits. Your doctor may offer this choice if
you are older or have other serious health problems. Your doctor may also
suggest watchful waiting if you are diagnosed with early stage prostate cancer
that seems to be slowly growing. Your doctor will offer you treatment if
symptoms occur or get worse.
Watchful waiting avoids or delays the side effects of surgery and radiation,
but this choice has risks. It may reduce the chance to control cancer before it
spreads. Also, it may be harder to cope with surgery and radiation therapy as
you age.
You may decide against watchful waiting if you do not want to live with an
untreated cancer. If you choose watchful waiting but grow concerned later, you
should discuss your feelings with your doctor. A different approach is nearly
always available.
Watchful waiting is under study. See "The
Promise of Cancer Research" for information about this study.
You may want to ask your doctor these questions before choosing watchful
waiting:
-
If I choose watchful waiting, can I change my mind later on?
-
Will the cancer be harder to treat later?
-
How often will I have checkups?
-
Between checkups, what problems should I report?
|
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Complementary and Alternative Medicine
Some men with prostate cancer use
complementary and alternative medicine
(CAM):
-
An approach is generally called complementary medicine when it is used along
with standard treatment.
-
An approach is called alternative medicine when it is used instead of standard
treatment.
Acupuncture,
massage therapy, herbal products, vitamins or special diets,
visualization, meditation, and spiritual healing are types of CAM.
Many men say that CAM helps them feel better. However, some types of CAM may
change the way standard treatment works. These changes could be harmful. And
some types of CAM could be harmful even if used alone.
Some types of CAM are expensive. Health insurance may not cover the cost.
NCI offers a booklet called Thinking About Complementary and Alternative Medicine:
A Guide for People with Cancer.
You also may request materials from the Federal Government's National Center
for Complementary and Alternative Medicine. You can reach their clearinghouse
toll-free at
1-888-644-6226 (voice) and 1-866-464-3615 (TTY). In addition, you can visit the
Center's Web site at
http://www.nccam.nih.gov, or send an email to
info@nccam.nih.gov.
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Nutrition and Physical Activity
It is important for men with prostate cancer to take care of themselves. Taking
care of yourself includes eating well and staying as active as you can.
You need the right amount of calories to maintain a good weight. You also need
enough protein to keep up your strength. Eating well may help you feel better
and have more energy. Your doctor, dietitian, or other health care provider can
suggest a healthy diet. Also, the NCI booklet
Eating Hints for Cancer Patients
has many useful ideas and recipes.
Many men find they feel better when they stay active. Walking, yoga, swimming,
and other exercise can keep you strong and increase your energy. Exercise may
reduce pain and make treatment easier to handle. It also can help relieve
stress. Whatever physical activity you choose, be sure to talk to your doctor
before you start. Also, if your activity causes you pain or other problems, be
sure to let your doctor or nurse know about it.
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Follow-up Care
Follow-up care after treatment for prostate cancer is important. Even when the
cancer seems to have been completely removed or destroyed, the disease
sometimes returns because undetected cancer cells remained somewhere in the
body after treatment. Your doctor will monitor your recovery and check for
recurrence
of the cancer. Checkups help ensure that any changes in your health
are noted and treated if needed. Checkups may include lab tests, x-rays,
biopsies, or other tests. Between scheduled visits, you should contact your
doctor if you have any health problems.
Facing Forward Series: Life After Cancer Treatment is an NCI booklet for people
who have completed their treatment. It answers questions about follow-up care
and other concerns. It has tips for making the best use of medical visits. It
also suggests ways to talk with your doctor about creating a plan of action for
recovery and future health.
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Sources of Support
Learning you have prostate cancer can change your life and the lives of those
close to you. These changes can be hard to handle. It is normal for you, your
family, and your friends to have many different and sometimes confusing
feelings.
You may worry about caring for your family, keeping your job, or continuing
daily activities. Concerns about treatments and managing side effects, hospital
stays, and medical bills are also common. Doctors, nurses, and other members of
your health care team can answer questions about treatment, working, or other
activities. Meeting with a social worker, counselor, or member of the clergy
can be helpful if you want to talk about your feelings or concerns. Often, a
social worker can suggest resources for financial aid, transportation, home
care, or emotional support.
Friends and relatives can be supportive. Support groups also can help. In these
groups, patients or their family members meet with other patients or their
families to share what they have learned about coping with the disease and the
effects of treatment. Groups may offer support in person, over the telephone,
or online. You may want to talk with a member of your health care team about
finding a support group.
You and your partner may be concerned about the effects of prostate cancer on
your sexual relationship. You may want to talk with your doctor about possible
treatment side effects and whether these are likely to last. Whatever the
outlook, you and your partner may find it helps to discuss your concerns. You
can find ways to be intimate during and after treatment. For some couples, it
helps to talk with a sex counselor.
Information Specialists at 1-800-4-CANCER and at
LiveHelp (http://www.cancer.gov/cis) can
help you locate programs, services, and publications. Also, you may want to
read the NCI fact sheet "National Organizations That Offer Services to People
With Cancer and Their Families."
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The Promise of Cancer Research
Doctors all over the country are conducting many types of clinical trials
(research studies in which people volunteer to take part). They are studying
new ways to prevent, detect, and treat prostate cancer.
Clinical trials are designed to answer important questions and to find out
whether new approaches are safe and effective. Research already has led to many
advances, and researchers continue to search for more effective methods for
dealing with prostate cancer.
Men who join clinical trials may be among the first to benefit if a new
approach is effective. And even if people in a trial do not benefit directly,
they still make an important contribution by helping doctors learn more about
prostate cancer and how to control it. Although clinical trials may pose some
risks, researchers do all they can to protect their patients.
If you are interested in being part of a clinical trial, talk with your doctor.
You may want to read the NCI booklet Taking Part in Cancer Treatment Research Studies. It explains how clinical trials are carried out and explains their possible benefits and risks.
NCI's Web site includes a section on clinical trials at http://www.cancer.gov/clinicaltrials.
It has general information about clinical trials as well as detailed
information about specific ongoing studies of prostate cancer. Information
Specialists at 1-800-4-CANCER or at
LiveHelp at http://www.cancer.gov can
answer questions and provide information about clinical trials.
Researchers are looking for ways to prevent prostate cancer:
-
Diet: Some studies suggest that eating foods that have tomatoes in them
may help protect men from prostate cancer.
Lycopene
is an
antioxidant
in
tomatoes and some other fruits and vegetables. Research is in progress to see
if lycopene can help prevent prostate cancer. A diet low in fat is also under
study.
-
Dietary supplements: The Selenium and Vitamin E Cancer Prevention Trial
(SELECT) is studying these two supplements. The goal of the study is to learn
whether these supplements can reduce the risk of developing prostate cancer.
-
Drug: The Prostate Cancer Prevention Trial was a large study to test a
drug that doctors thought might lower the risk of prostate cancer. The drug is
finasteride.
In the study, the drug did reduce the chance of developing
prostate cancer. However, men who developed prostate cancer while taking the
drug were more likely to have tumors that seemed to be high-grade. High-grade
cancer grows and spreads more quickly than low-grade cancer. Researchers are
now studying tumors from men in the study to see if they were really high-grade
or only looked that way. If you are concerned about getting prostate cancer,
you may want to talk with your doctor about the potential benefits and possible
risks of taking finasteride. You also may consider taking part in another
prostate cancer prevention trial.
Researchers are studying ways to check for prostate cancer in men who have no
symptoms. Screening can help find prostate cancer at an early stage. But
studies have not shown whether screening saves lives. The Prostate, Lung,
Colorectal, and Ovarian Cancer Screening Trial (PLCO) is designed to show if
certain screening tests can reduce the number of deaths from these cancers. NCI
supports this study. The prostate screening tests that PLCO is studying are the
PSA test and digital rectal exam. Researchers will screen the men in the study
until 2007. The trial will assess the harms and potential benefits of routine
screening for prostate cancer. The results of this trial may change the way men
are screened for prostate cancer.
Researchers are studying many types of treatment and their combinations:
-
Surgery: Different methods of surgery are being developed:
-
Robotic prostatectomy: The doctor uses a laparoscope and a surgical
robot to help remove the prostate.
-
Cryosurgery: Surgeons use a tool that freezes and kills prostate tissue
in men with early prostate cancer.
-
Radiation therapy: Doctors are studying different doses of radiation
therapy. They are looking at the use of radioactive implants after external
radiation. And they are combining radiation therapy with hormone therapy.
-
Hormone therapy: Researchers are studying different schedules of hormone
therapy.
-
Biological therapy:
Doctors are testing cancer
vaccines
that help the
immune system
kill cancer cells.
-
Chemotherapy: Researchers are testing anticancer drugs and combining
them with hormone therapy.
-
Watchful Waiting: Men with early prostate cancer usually do not have any
symptoms of disease. For these men, researchers are comparing having surgery or
radiation right away against watchful waiting. Men in the watchful waiting
group do not receive treatment until they have symptoms. The results of the
study will help doctors know whether to treat early stage prostate cancer right
away, or only if symptoms appear or get worse.
Researchers also are looking at ways to lessen the side effects of treatment,
such as bone thinning and impotence.
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National Cancer Institute Information Resources
You may want more information for yourself, your family, and your doctor. The
following National Cancer Institute (NCI) services are available to help you.
Telephone
The NCI's Cancer Information Service (CIS) provides accurate, up-to-date
information on cancer to patients and their families, health professionals, and
the general public. Information Specialists translate the latest scientific
information into understandable language and respond in English, Spanish, or on
TTY equipment. Calls to the CIS are free.
Telephone: 1-800-4-CANCER (1-800-422-6237)
TTY: 1-800-332-8615
Internet
The NCI's Web site (http://www.cancer.gov) provides information
from numerous NCI sources. It offers current information on cancer prevention,
screening, diagnosis, treatment, genetics, supportive care, and ongoing
clinical trials. It has information about NCI's research programs and funding
opportunities, cancer statistics, and the Institute itself. Information
Specialists provide live, online assistance through
LiveHelp.
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National Cancer Institute Publications
National Cancer Institute (NCI) publications can be ordered by writing to the
address below:
Publications Ordering Service
National Cancer Institute
Suite 3035A
6116 Executive Boulevard, MSC 8322
Bethesda, MD 20892-8322
Many NCI publications can be viewed, downloaded, and ordered from
http://www.cancer.gov/publications on the Internet. In addition, people
in the United States and its territories may order these and other NCI
publications by calling the NCI's Cancer Information Service at 1-800-4-CANCER.
Publications About Prostate Changes and Prostate Cancer
Understanding Prostate Changes: A Health Guide for Men
What You Need To Know About Prostate Cancer (also available in Spanish: Lo que
usted necesita saber sobre el cáncer de próstata)
Publications About Cancer Treatment and Support
Know Your Options: Understanding Treatment Choices for Prostate Cancer
Radiation Therapy and You: A Guide to Self-Help During Cancer Treatment (also
available in Spanish: La radioterapia y usted: una guía de autoayuda durante el
tratamiento del cáncer)
Chemotherapy and You: A Guide to Self-Help During Cancer Treatment (also
available in Spanish: La quimioterapia y usted: una guía de autoayuda durante
el tratamiento del cáncer)
Helping Yourself During Chemotherapy: 4 Steps for Patients
Biological Therapy: Treatments That Use Your Immune System to Fight Cancer
Eating Hints for Cancer Patients: Before, During & After Treatment (also
available in Spanish: Consejos de alimentación para pacientes con cáncer:
antes, durante y después del tratamiento)
Understanding Cancer Pain (also available in Spanish:
El dolor relacionado con
el cáncer)
Pain Control: A Guide for People with Cancer and Their Families (also available
in Spanish: Control del dolor: guía para las personas con cáncer y sus
familias)
Get Relief from Cancer Pain
Thinking About Complementary and Alternative Medicine: A Guide for People with Cancer
"Biological Therapies for Cancer: Questions and Answers" (also available in
Spanish: "Terapias biológicas: el uso del sistema inmune para tratar el
cáncer")
"How To Find a Doctor or Treatment Facility If You Have Cancer" (also available
in Spanish: "Cómo encontrar a un doctor o un establecimiento de tratamiento si
usted tiene cáncer")
"National Organizations That Offer Services to People With Cancer and Their
Families" (also available in Spanish: "Organizaciones nacionales que brindan
servicios a las personas con cáncer y a sus familias")
Publications About Living With Cancer
Advanced Cancer: Living Each Day
Facing Forward Series: Life After Cancer Treatment (also available in Spanish:
Siga adelante: la vida después del tratamiento del cáncer)
Facing Forward Series: Ways You Can Make a Difference in Cancer
Taking Time: Support for People with Cancer and the People Who Care About Them
When Cancer Recurs: Meeting the Challenge
Publications About Clinical Trials
Taking Part in Cancer Treatment Research Studies
Taking Part in Clinical Trials: Cancer Prevention Studies: What Participants
Need To Know (also available in Spanish: La participación en los estudios
clínicos: estudios para la prevención del cáncer)
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