1. What is the prostate?

The prostate is a gland in the male reproductive system. The prostate makes and stores a component of semen and is located in the pelvis, under the bladder and in front of the rectum. The prostate surrounds part of the urethra, the tube that empties urine from the bladder. A healthy prostate is about the size of a walnut. Because of the prostate’s location, the flow of urine can be slowed or stopped if the prostate grows too large.

2. What is prostate cancer?

Prostate cancer forms in the tissues of the prostate. Except for skin cancer, cancer of the prostate is the most common cancer in American men. It was estimated that more than 186,000 men in the United States would be diagnosed with prostate cancer in 2008 (1). In most men with prostate cancer, the disease grows very slowly. The majority of men with low-grade, early prostate cancer (which means that cancer cells have been found only in the prostate gland) live a long time after their diagnosis. Even without treatment, many of these men will not die of prostate cancer, but rather will live with it until they eventually die of some other, unrelated cause. Nevertheless, it was estimated that nearly 29,000 men would die from prostate cancer in 2008 (1).

3. Who is at risk for prostate cancer?

An important risk factor is age; more than 70 percent of men diagnosed with this disease are over the age of 65. African American men have a substantially higher risk of prostate cancer than white men, including Hispanic men. In addition, dramatic differences in the incidence of prostate cancer are seen in different populations around the world.

Genetic factors appear to play a role in prostate cancer development, particularly among families in which the diagnosis is made in men under age 60. The risk of prostate cancer rises with the number of close relatives who have the disease.

Some evidence suggests that dietary factors may increase or decrease the risk of prostate cancer.

4. What are the symptoms of prostate cancer?

Most of the time, prostate cancer does not initially cause symptoms. By the time symptoms do occur, the disease may have spread beyond the prostate. Symptoms of prostate cancer may include the following:

• Urinary problems:
  • Not being able to urinate.
  • Having a hard time starting or stopping the flow of urine.
  • 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.

Although these symptoms can be symptoms of cancer, they are much more likely to be caused by noncancerous conditions. It is important to check with a doctor.

5. What other prostate conditions can cause symptoms like these?

As men get older, their prostate may grow bigger and block the flow of urine or interfere with sexual function. This common condition, called benign prostatic hyperplasia (BPH), is not cancer, but it can cause many of the same symptoms as prostate cancer. Although BPH may not be a threat to life, it may require treatment with medicine or surgery to relieve symptoms. An infection or inflammation of the prostate, called prostatitis, may also cause many of the same symptoms as prostate cancer. Again, it is important to check with a doctor.

6. Can prostate cancer be found before a man has symptoms?

Yes. Prostate cancer screening is looking for the disease before a person has any symptoms. Two screening tests commonly used to detect prostate cancer in the absence of symptoms are the digital rectal exam (DRE), in which a doctor feels the prostate through the rectum to find hard or lumpy areas, and a blood test that detects a substance made by the prostate called prostate-specific antigen (PSA). Together, these tests can detect many “silent” prostate cancers that have not caused symptoms. Due to the widespread use of PSA testing in the United States, approximately 90 percent of all prostate cancers are currently diagnosed at an early stage, and, consequently, men are surviving longer after diagnosis.


7. How reliable are the screening tests for prostate cancer?

Neither of the screening tests for prostate cancer is perfect. Most men with an elevated PSA level do not have prostate cancer (false positives), and some men with prostate cancer have a low PSA level (false negatives). The DRE is also associated with false positives and false negatives. Using the DRE and PSA together will miss fewer cancers (greater sensitivity) but also increases the number of false positives and subsequent biopsies in men without cancer (lower specificity).

The National Cancer Institute’s (NCI) Early Detection Research Network (EDRN) has a Prostate Collaborative Group that is exploring a variety of strategies to find better ways to detect prostate cancer early. In addition, NCI’s prostate cancer Specialized Program of Research Excellence (SPORE) is funding projects to identify new diagnostic and prognostic biological markers, or biomarkers, of prostate cancer besides PSA.

8. Does prostate cancer screening save lives?

The benefits of screening and local therapy (surgery or radiation therapy) for early prostate cancer remain unclear, and it is not known for certain whether prostate cancer screening saves lives. Because of this uncertainty, NCI, which is part of the National Institutes of Health, is supporting research to learn more about screening for prostate cancer. Currently, researchers are conducting a large randomized clinical trial, called the Prostate, Lung, Colorectal, and Ovarian (PLCO) Cancer Screening Trial, to determine whether screening with PSA tests and DREs reduces the death rate from this disease. The researchers are also assessing the risks of screening. Specifically, men who have an elevated PSA level or a suspicious DRE are more likely to have a biopsy, which is an invasive procedure, and, if the biopsy is positive, the risks of surgery, radiation therapy, and even active surveillance (also called watchful waiting) must be taken into account.

Initial results from the PLCO trial showed that annual PSA testing for 6 years and DRE testing for 4 years (performed in the same years as the first four PSA tests) did not reduce the number of prostate cancer deaths through a median follow-up period of 11.5 years (range 7.2 to 14.8 years) (2). At 7 years of follow-up, a point in time when follow-up of the participants was essentially complete, 23 percent more cancers had been diagnosed in the screening group than in the control group, in which men were randomly assigned to “usual care.” These results suggest that many men were diagnosed with, and treated for, cancers that would not have been detected in their lifetime without screening and were consequently exposed to the potential harms of unnecessary treatments, such as surgery and radiation therapy. Nonetheless, it remains possible that a small benefit from the earlier detection of these “excess” cancers could emerge with longer follow-up. Therefore, follow-up of the PLCO participants will continue until all participants have been followed for at least 13 years.

In contrast, initial results from another large randomized, controlled trial of prostate cancer screening, called the European Randomized Study of Screening for Prostate Cancer (ERSPC), found a 20 percent reduction in prostate cancer deaths associated with PSA testing every 4 years (3). At the time the results were reported, the participants had been followed for a median of 9 years. The average number of PSA tests per participant in ERSPC was 2.1. Most participating centers in this trial used a lower PSA cutoff value as an indicator of abnormality than was used in the PLCO trial (3.0 nanograms per milliliter versus 4.0 nanograms per milliliter). As in the PLCO trial, many more cancers were diagnosed in the screening group than in the control group. The ERSPC researchers estimated that 1,410 men would have to be screened and 48 additional cancers would have to be detected to prevent one death from prostate cancer.

9. How is prostate cancer diagnosed?

A diagnosis of prostate cancer can be confirmed only by biopsy. During a biopsy, a urologist (a doctor who specializes in diseases of urinary and sex organs in men, and urinary organs in women) removes tissue samples, usually with a needle. This is generally done in the doctor’s office with local anesthesia. Then, a pathologist (a doctor who identifies diseases by studying tissues under a microscope) checks for cancer cells.

Men may have blood tests to see if the cancer has spread. Some men also may need the following imaging tests:

• Bone scan: A doctor injects a small amount of a radioactive substance into a blood vessel, and 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.
• Computerized tomography (CT) scan: An x-ray machine linked to a computer takes a series of detailed pictures of areas inside the body. Doctors often use CT scans to see the pelvis or abdomen.

• Magnetic resonance imaging (MRI): A strong magnet linked to a computer is used to make detailed pictures of areas inside the body.

Prostate cancer is described by both grade and stage.

• Grade describes how closely the tumor resembles normal glandular tissue of the prostate. Based on the microscopic appearance of the tumor tissue, pathologists may describe it as low-, medium-, or high-grade cancer. One way of grading prostate cancer, called the Gleason system, uses scores of 2 to 10. Another system uses G1 through G4. In both systems, the higher the score, the higher the grade of the tumor. High-grade tumors generally grow more quickly and are more likely to spread than low-grade tumors.

• Stage refers to the extent of the cancer. Early prostate cancer, stages I and II, is localized. It has not spread outside the prostate gland. Stage III prostate cancer, often called locally advanced disease, extends outside the gland and may be in the seminal vesicles. Stage IV means the cancer has spread beyond the seminal vesicles to lymph nodes and/or to other tissues or organs.

10. How is localized prostate cancer treated?

Three treatment options are generally accepted for men with localized prostate cancer: Radical prostatectomy, radiation therapy (with or without hormonal therapy), and active surveillance (also called watchful waiting).

• Radical prostatectomy is a surgical procedure to remove the entire prostate gland and nearby tissues. Sometimes lymph nodes in the pelvic area (the lower part of the abdomen, located between the hip bones) are also removed. Radical prostatectomy may be performed using a technique called nerve-sparing surgery that may prevent damage to the nerves needed for an erection. However, nerve-sparing surgery is not always possible.
• Radiation therapy involves the delivery of radiation to the prostate. Radiation therapy is usually administered in an outpatient setting using an external beam of radiation. Radiation can also be delivered in a technique known as brachytherapy, which involves implanting radioactive seeds directly into, or very close to, the tumor using a needle. Patients with high-risk prostate cancer are candidates for adding hormonal therapy to standard radiation therapy.

• Active Surveillance (watchful waiting) may be an option recommended for patients with early-stage prostate cancer, particularly those who have low-grade tumors with only a small amount of cancer seen in the biopsy specimen. These patients have regular examinations, PSA tests, and, sometimes, scheduled biopsies. If there is evidence of cancer growth, active treatment may be recommended. Older patients and those with serious medical problems may also be good candidates for active surveillance.

11. How does a patient decide what the best treatment option is for localized prostate cancer?

Choosing a treatment option involves the patient, his family, and one or more doctors. They will need to consider the grade and stage of the cancer, the man’s age and health, and his values and feelings about the potential benefits and harms of each treatment option. Since both surgery and radiation therapy are options for localized disease, consultation with both a urologist and a radiation oncologist is recommended. Often it is useful to seek additional opinions—from the same type of doctor, an internist, a family practice physician, or a medical oncologist. Because there are several reasonable options for most patients, patients may hear different opinions and recommendations and the decision can be difficult. However, patients should try to get as much information as possible and allow themselves enough time to make a decision. There is rarely a need to make a decision without taking time to discuss and understand the pros and cons of the various approaches.


12. Where can a person find more information about prostate cancer and its treatment?

NCI has several other resources that readers may find helpful, including the following:

• The Prostate Cancer Home Page provides links to NCI resources about prevention, screening, treatment, clinical trials, and supportive care for this type of cancer. This page can be found on NCI’s Web site at http://www.cancer.gov/cancertopics/types/prostate on the Internet.
• Prostate Cancer Treatment (PDQ®) includes information about prostate cancer treatment, including surgery, chemotherapy, radiation therapy, and hormone therapy. This summary of information from PDQ, the NCI’s comprehensive cancer information database, is available at http://www.cancer.gov/cancertopics/pdq/treatment/prostate/patient on the Internet.

• Treatment Choices for Men With Early-Stage Prostate Cancer describes the treatment choices available to men diagnosed with early-stage prostate cancer and examines the pros and cons of each treatment. This NCI booklet is available at http://www.cancer.gov/cancertopics/prostate-cancer-treatment-choices on the Internet.

Selected References

1. American Cancer Society (2008). Cancer Facts and Figures 2008. Atlanta, GA: American Cancer Society. Retrieved March 18, 2009, from http://www.cancer.org/downloads/STT/2008CAFFfinalsecured.pdf.
2. Andriole G, Crawford E, Grubb R, et al. Seven year mortality results and related findings from the prostate component of the PLCO randomized cancer screening trial. New England Journal of Medicine. Published online ahead of print March 18, 2009.

3. Schröder FH, Hugosson J, Roobol MJ, et al. Screening and prostate-cancer mortality in a randomized European study. New England Journal of Medicine 2009; 360(13):1320–1328.
   

# # #

• National Cancer Institute Fact Sheet 5.29, Prostate-Specific Antigen (PSA) Test ¹
  (http://www.cancer.gov/cancertopics/factsheet/Detection/PSA)
• Understanding Prostate Changes: A Health Guide for Men ²
  (http://www.cancer.gov/cancertopics/understanding-prostate-changes)
• What You Need To Know About™ Prostate Cancer ³
  (http://www.cancer.gov/cancertopics/wyntk/prostate)

How can we help?

We offer comprehensive research-based information for patients and their families, health professionals, cancer researchers, advocates, and the public.

• Call NCI’s Cancer Information Service 1–800–4–CANCER (1–800–422–6237)
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Glossary Terms

The area of the body that contains the pancreas, stomach, intestines, liver, gallbladder, and other organs.

Not normal. An abnormal lesion or growth may be cancer, premalignant (likely to become cancer), or benign (not cancer).

Closely monitoring a patient's condition but withholding treatment until symptoms appear or change. Also called expectant management, observation, and watchful waiting.

A benign (not cancer) condition in which an overgrowth of prostate tissue pushes against the urethra and the bladder, blocking the flow of urine. Also called benign prostatic hypertrophy and BPH.

Pertaining to biology or to life and living things. In medicine, refers to a substance made from a living organism or its products. Biologicals may be used to prevent, diagnose, treat or relieve of symptoms of a disease. For example, antibodies, interleukins, and vaccines are biologicals. Biological also refers to parents and children who are related by blood.

A biological molecule found in blood, other body fluids, or tissues that is a sign of a normal or abnormal process, or of a condition or disease. A biomarker may be used to see how well the body responds to a treatment for a disease or condition. Also called molecular marker and signature molecule.

The removal of cells or tissues for examination by a pathologist. The pathologist may study the tissue under a microscope or perform other tests on the cells or tissue. There are many different types of biopsy procedures. The most common types include: (1) incisional biopsy, in which only a sample of tissue is removed; (2) excisional biopsy, in which an entire lump or suspicious area is removed; and (3) needle biopsy, in which a sample of tissue or fluid is removed with a needle. When a wide needle is used, the procedure is called a core biopsy. When a thin needle is used, the procedure is called a fine-needle aspiration biopsy.

Tissue removed from the body and examined under a microscope to determine whether disease is present.

The organ that stores urine.

A tissue with red blood cells, white blood cells, platelets, and other substances suspended in fluid called plasma. Blood takes oxygen and nutrients to the tissues, and carries away wastes.

A procedure in which a sample of blood is examined to measure the amounts of certain substances made in the body. An abnormal amount of a substance can be a sign of disease in the organ or tissue that produces it.

A tube through which the blood circulates in the body. Blood vessels include a network of arteries, arterioles, capillaries, venules, and veins.

A technique to create images of bones on a computer screen or on film. A small amount of radioactive material is injected into a blood vessel and travels through the bloodstream; it collects in the bones and is detected by a scanner.

A benign (not cancer) condition in which an overgrowth of prostate tissue pushes against the urethra and the bladder, blocking the flow of urine. Also called benign prostatic hyperplasia and benign prostatic hypertrophy.

A type of radiation therapy in which radioactive material sealed in needles, seeds, wires, or catheters is placed directly into or near a tumor. Also called implant radiation therapy, internal radiation therapy, and radiation brachytherapy.

Treatment with drugs that kill cancer cells.

A type of research study that tests how well new medical approaches work in people. These studies test new methods of screening, prevention, diagnosis, or treatment of a disease. Also called clinical study.

Having to do with the colon or the rectum.

A series of detailed pictures of areas inside the body taken from different angles. The pictures are created by a computer linked to an x-ray machine. Also called CAT scan, computed tomography scan, computerized axial tomography scan, and CT scan.

In a clinical trial, the group that does not receive the new treatment being studied. This group is compared to the group that receives the new treatment, to see if the new treatment works.

A series of detailed pictures of areas inside the body taken from different angles. The pictures are created by a computer linked to an x-ray machine. Also called CAT scan, computed tomography scan, computerized axial tomography scan, and computerized tomography.

The process of identifying a disease, such as cancer, from its signs and symptoms.

An examination in which a doctor inserts a lubricated, gloved finger into the rectum to feel for abnormalities. Also called DRE.

An examination in which a doctor inserts a lubricated, gloved finger into the rectum to feel for abnormalities. Also called digital rectal examination.

In medicine, the swelling of the penis with blood, causing it to become firm.

Inherited; having to do with information that is passed from parents to offspring through genes in sperm and egg cells.

An organ that makes one or more substances, such as hormones, digestive juices, sweat, tears, saliva, or milk. Endocrine glands release the substances directly into the bloodstream. Exocrine glands release the substances into a duct or opening to the inside or outside of the body.

A description of a tumor based on how abnormal the cancer cells look under a microscope and how quickly the tumor is likely to grow and spread. Grading systems are different for each type of cancer.

A system for classifying cancer cells in terms of how abnormal they appear when examined under a microscope. The objective of a grading system is to provide information about the probable growth rate of the tumor and its tendency to spread. The systems used to grade tumors vary with each type of cancer. Grading plays a role in treatment decisions.

A term used to describe cells that look abnormal under a microscope. These cells are more likely to grow and spread quickly than cells in low-grade cancer or in growths that may become cancer.

Treatment that adds, blocks, or removes hormones. For certain conditions (such as diabetes or menopause), hormones are given to adjust low hormone levels. To slow or stop the growth of certain cancers (such as prostate and breast cancer), synthetic hormones or other drugs may be given to block the body’s natural hormones. Sometimes surgery is needed to remove the gland that makes a certain hormone. Also called endocrine therapy, hormone therapy, and hormone treatment.

Treatment that adds, blocks, or removes hormones. For certain conditions (such as diabetes or menopause), hormones are given to adjust low hormone levels. To slow or stop the growth of certain cancers (such as prostate and breast cancer), synthetic hormones or other drugs may be given to block the body’s natural hormones. Sometimes surgery is needed to remove the gland that makes a certain hormone. Also called endocrine therapy, hormonal therapy, and hormone treatment.

In medicine, a process that makes pictures of areas inside the body. Imaging uses methods such as x-rays (high-energy radiation), ultrasound (high-energy sound waves), and radio waves.

The number of new cases of a disease diagnosed each year.

Invasion and multiplication of germs in the body. Infections can occur in any part of the body and can spread throughout the body. The germs may be bacteria, viruses, yeast, or fungi. They can cause a fever and other problems, depending on where the infection occurs. When the body’s natural defense system is strong, it can often fight the germs and prevent infection. Some cancer treatments can weaken the natural defense system.

Redness, swelling, pain, and/or a feeling of heat in an area of the body. This is a protective reaction to injury, disease, or irritation of the tissues.

Use of a syringe and needle to push fluids or drugs into the body; often called a "shot."

A medical procedure that invades (enters) the body, usually by cutting or puncturing the skin or by inserting instruments into the body.

A temporary loss of feeling in one small area of the body caused by special drugs or other substances called anesthetics. The patient stays awake but has no feeling in the area of the body treated with the anesthetic.

Treatment that affects cells in the tumor and the area close to it.

Restricted to the site of origin, without evidence of spread.

Cancer that has spread from where it started to nearby tissue or lymph nodes.

A term used to describe cells that look nearly normal under a microscope. These cells are less likely to grow and spread more quickly than cells in high-grade cancer or in growths that may become cancer.

One of a pair of organs in the chest that supplies the body with oxygen, and removes carbon dioxide from the body.

A rounded mass of lymphatic tissue that is surrounded by a capsule of connective tissue. Lymph nodes filter lymph (lymphatic fluid), and they store lymphocytes (white blood cells). They are located along lymphatic vessels. Also called lymph gland.

A procedure in which radio waves and a powerful magnet linked to a computer is used to create detailed pictures of areas inside the body. These pictures can show the difference between normal and diseased tissue. Magnetic resonance imaging makes better images of organs and soft tissue than other scanning techniques, such as computed tomography (CT) or x-ray. Magnetic resonance imaging is especially useful for imaging the brain, the spine, the soft tissue of joints, and the inside of bones. Also called MRI, NMRI, and nuclear magnetic resonance imaging.

A diagnostic indication that disease may develop.

A doctor who specializes in diagnosing and treating cancer using chemotherapy, hormonal therapy, biological therapy, and targeted therapy. A medical oncologist often is the main health care provider for someone who has cancer. A medical oncologist also gives supportive care and may coordinate treatment given by other specialists.

Too small to be seen without a microscope.

A procedure in which radio waves and a powerful magnet linked to a computer is used to create detailed pictures of areas inside the body. These pictures can show the difference between normal and diseased tissue. MRI makes better images of organs and soft tissue than other scanning techniques, such as computed tomography (CT) or x-ray. MRI is especially useful for imaging the brain, the spine, the soft tissue of joints, and the inside of bones. Also called magnetic resonance imaging, NMRI, and nuclear magnetic resonance imaging.

The National Cancer Institute, part of the National Institutes of Health of the United States Department of Health and Human Services, is the Federal Government's principal agency for cancer research. The National Cancer Institute conducts, coordinates, and funds cancer research, training, health information dissemination, and other programs with respect to the cause, diagnosis, prevention, and treatment of cancer. Access the National Cancer Institute Web site at http://www.cancer.gov. Also called NCI.

A federal agency in the U.S. that conducts biomedical research in its own laboratories; supports the research of non-Federal scientists in universities, medical schools, hospitals, and research institutions throughout the country and abroad; helps in the training of research investigators; and fosters communication of medical information. Access the National Institutes of Health Web site at http://www.nih.gov. Also called NIH.

A bundle of fibers that receives and sends messages between the body and the brain. The messages are sent by chemical and electrical changes in the cells that make up the nerves.

A type of surgery that attempts to save the nerves near the tissues being removed.

A patient who visits a health care facility for diagnosis or treatment without spending the night. Sometimes called a day patient.

Having to do with the ovaries, the female reproductive glands in which the ova (eggs) are formed. The ovaries are located in the pelvis, one on each side of the uterus.

A doctor who identifies diseases by studying cells and tissues under a microscope.

PDQ is an online database developed and maintained by the National Cancer Institute. Designed to make the most current, credible, and accurate cancer information available to health professionals and the public, PDQ contains peer-reviewed summaries on cancer treatment, screening, prevention, genetics, complementary and alternative medicine, and supportive care; a registry of cancer clinical trials from around the world; and directories of physicians, professionals who provide genetics services, and organizations that provide cancer care. Most of this information, and more specific information about PDQ, can be found on the NCI's Web site at http://www.cancer.gov/cancertopics/pdq. Also called Physician Data Query.

Having to do with the pelvis (the lower part of the abdomen located between the hip bones).

The lower part of the abdomen, located between the hip bones.

Medical doctor.

In medicine, action taken to decrease the chance of getting a disease or condition. For example, cancer prevention includes avoiding risk factors (such as smoking, obesity, lack of exercise, and radiation exposure) and increasing protective factors (such as getting regular physical activity, staying at a healthy weight, and having a healthy diet).

A situation or condition, or a characteristic of a patient, that can be used to estimate the chance of recovery from a disease or the chance of the disease recurring (coming back).

A gland in the male reproductive system. The prostate surrounds the part of the urethra (the tube that empties the bladder) just below the bladder, and produces a fluid that forms part of the semen.

Cancer that forms in tissues of the prostate (a gland in the male reproductive system found below the bladder and in front of the rectum). Prostate cancer usually occurs in older men.

A substance produced by the prostate. It may be found in higher levels in the blood of men who have prostate cancer, benign prostatic hyperplasia, infection or inflammation of the prostate. Also called PSA.

Inflammation of the prostate gland.

A substance produced by the prostate. It may be found in higher levels in the blood of men who have prostate cancer, benign prostatic hyperplasia, infection or inflammation of the prostate. Also called prostate-specific antigen.

Energy released in the form of particle or electromagnetic waves. Common sources of radiation include radon gas, cosmic rays from outer space, medical x-rays, and energy given off by a radioisotope (unstable form of a chemical element that releases radiation as it breaks down and becomes more stable).

A doctor who specializes in using radiation to treat cancer.

The use of high-energy radiation from x-rays, gamma rays, neutrons, protons, and other sources to kill cancer cells and shrink tumors. Radiation may come from a machine outside the body (external-beam radiation therapy), or it may come from radioactive material placed in the body near cancer cells (internal radiation therapy). Systemic radiation therapy uses a radioactive substance, such as a radiolabeled monoclonal antibody, that travels in the blood to tissues throughout the body. Also called irradiation and radiotherapy.

Surgery to remove the entire prostate. The two types of radical prostatectomy are retropubic prostatectomy (surgery through an incision in the wall of the abdomen) and perineal prostatectomy (surgery through an incision between the scrotum and the anus).

Giving off radiation.

A study in which the participants are assigned by chance to separate groups that compare different treatments; neither the researchers nor the participants can choose which group. Using chance to assign people to groups means that the groups will be similar and that the treatments they receive can be compared objectively. At the time of the trial, it is not known which treatment is best. It is the patient's choice to be in a randomized trial.

The last several inches of the large intestine closest to the anus.

The organs involved in producing offspring. In women, this system includes the ovaries, the fallopian tubes, the uterus, the cervix, and the vagina. In men, it includes the prostate, the testes, and the penis.

Something that may increase the chance of developing a disease. Some examples of risk factors for cancer include age, a family history of certain cancers, use of tobacco products, certain eating habits, obesity, lack of exercise, exposure to radiation or other cancer-causing agents, and certain genetic changes.

A picture of structures inside the body. Scans often used in diagnosing, staging, and monitoring disease include liver scans, bone scans, and computed tomography (CT) or computerized axial tomography (CAT) scans and magnetic resonance imaging (MRI) scans. In liver scanning and bone scanning, radioactive substances that are injected into the bloodstream collect in these organs. A scanner that detects the radiation is used to create pictures. In CT scanning, an x-ray machine linked to a computer is used to produce detailed pictures of organs inside the body. MRI scans use a large magnet connected to a computer to create pictures of areas inside the body.

In medicine, an instrument that takes pictures of the inside of the body.

Checking for disease when there are no symptoms. Since screening may find diseases at an early stage, there may be a better chance of curing the disease. Examples of cancer screening tests are the mammogram (breast), colonoscopy (colon), Pap smear (cervix), and PSA blood level and digital rectal exam (prostate). Screening can also include checking for a person’s risk of developing an inherited disease by doing a genetic test.

The fluid that is released through the penis during orgasm. Semen is made up of sperm from the testicles and fluid from the prostate and other sex glands.

A gland that helps produce semen.

When referring to a medical test, sensitivity refers to the percentage of people who test positive for a specific disease among a group of people who have the disease. No test has 100% sensitivity because some people who have the disease will test negative for it (false negatives).

Cancer that forms in tissues of the skin. There are several types of skin cancer. Skin cancer that forms in melanocytes (skin cells that make pigment) is called melanoma. Skin cancer that forms in basal cells (small, round cells in the base of the outer layer of skin) is called basal cell carcinoma. Skin cancer that forms in squamous cells (flat cells that form the surface of the skin) is called squamous cell carcinoma. Skin cancer that forms in neuroendocrine cells (cells that release hormones in response to signals from the nervous system) is called neuroendocrine carcinoma of the skin. Most skin cancers form in older people on parts of the body exposed to the sun or in people who have weakened immune systems.

When referring to a medical test, specificity refers to the percentage of people who test negative for a specific disease among a group of people who do not have the disease. No test is 100% specific because some people who do not have the disease will test positive for it (false positive).

The extent of a cancer in the body. Staging is usually based on the size of the tumor, whether lymph nodes contain cancer, and whether the cancer has spread from the original site to other parts of the body.

Cancer that began in the prostate, has grown beyond the outer layer of the prostate to nearby tissues, and may be found in the seminal vesicles (glands that help produce semen). The Gleason score (a number that describes how abnormal the cells look under a microscope) can be any level.

Care given to improve the quality of life of patients who have a serious or life-threatening disease. The goal of supportive care is to prevent or treat as early as possible the symptoms of a disease, side effects caused by treatment of a disease, and psychological, social, and spiritual problems related to a disease or its treatment. Also called comfort care, palliative care, and symptom management.

A procedure to remove or repair a part of the body or to find out whether disease is present. An operation.

An indication that a person has a condition or disease. Some examples of symptoms are headache, fever, fatigue, nausea, vomiting, and pain.

A group or layer of cells that work together to perform a specific function.

An abnormal mass of tissue that results when cells divide more than they should or do not die when they should. Tumors may be benign (not cancer), or malignant (cancer). Also called neoplasm.

The tube through which urine leaves the body. It empties urine from the bladder.

Having to do with urine or the organs of the body that produce and get rid of urine.

Fluid containing water and waste products. Urine is made by the kidneys, stored in the bladder, and leaves the body through the urethra.

A doctor who specializes in diseases of the urinary organs in females and the urinary and sex organs in males.

Closely monitoring a patient's condition but withholding treatment until symptoms appear or change. Also called active surveillance, expectant management, and observation.

A type of high-energy radiation. In low doses, x-rays are used to diagnose diseases by making pictures of the inside of the body. In high doses, x-rays are used to treat cancer.