Prostate Cancer: Frequently Asked Questions
Here are some answers to frequently asked questions about prostate cancer.
What is the prostate?
The prostate is a male sex gland that produces a thick fluid that forms part of the semen. The prostate is about the size of a walnut, although it can grow larger. It's located below the bladder and in front of the rectum. It surrounds the upper part of the urethra. This is the tube that empties urine from the bladder. The prostate needs male hormones, such as testosterone, to work normally.
What causes prostate cancer?
The exact cause of prostate cancer is not known. Men with close relatives who have had prostate cancer are more likely to get it. So it may be linked to genes. Some studies have found that diets high in red meat or high-fat dairy foods seem to slightly increase risk. Studies are being done to see if contact with certain chemicals increases the risk for prostate cancer.
What are the symptoms of prostate cancer?
Many men with prostate cancer have no symptoms. The cancer is often found during a digital rectal examination (DRE) or a PSA blood test. These are the most common symptoms of prostate cancer:
A need to urinate often, especially at night
Weak or interrupted urine flow
Trouble starting to urinate
Trouble emptying the bladder
Being unable to urinate
Painful or burning feeling when you urinate
Blood in your urine or semen
Pain or stiffness in your lower back, hips, ribs, or upper thighs
Not able to have an erection
Weakness or numbness in legs or feet
How is a digital rectal examination (DRE) done?
The prostate can be felt through the wall of the rectum. For a digital rectal exam (DRE), you bend over and a healthcare provider inserts a lubricated, gloved finger into your rectum. He or she checks for hard or lumpy areas in the prostate.
What does PSA mean?
PSA stands for prostate-specific antigen. The PSA test measures the level of PSA in the blood. PSA is made by prostate tissue. The level of PSA in the blood may rise in men who have prostate cancer. It may also rise in men with noncancer enlargement of the prostate (BPH), or an infection in the prostate. Experts don’t fully understand what PSA does. It doesn't seem to cause harm even when the blood level is very high. PSA does not make the cancer grow or spread. A healthcare provider can’t diagnose prostate cancer with a PSA test alone. This is because a high PSA level may also show other problems that aren’t cancer. But the results of a PSA test can help a provider decide whether to check more for signs of cancer.
Some healthcare providers use the PSA blood test to screen for prostate cancer in men who don't have any symptoms. But it's not always clear how helpful this test is. Expert groups advise asking your healthcare provider about the pros and cons of this test before deciding whether to be screened for prostate cancer.
What are normal PSA levels?
In men without prostate cancer, most healthcare providers consider a normal test range to be from 0 ng/mL to 4 ng/mL. This range changes slightly with age and race. When a man gets older, the normal range increases. A result of less than 4 ng/mL is generally considered normal. A test result higher than 4 ng/mL, or a significant rise in PSA, even in the normal range, are of concern. More tests may be needed. These may include a repeat PSA or a biopsy of the prostate.
What is a prostate biopsy?
A biopsy is when samples of tissue are removed and checked in a lab for cancer cells. A urologist can take tissue samples from your prostate, often right in his or her office. A biopsy is most often done by inserting a needle through the rectal wall or the perineum into the prostate. The perineum is the area between the anus and the testicles. The healthcare provider often uses a transrectal ultrasound to help guide the needle into the prostate. About 12 samples are taken from different parts of the prostate during a biopsy. This helps makes sure that the test is thorough.
What is staging?
Staging is the process of finding out how far a cancer has spread in the body. Staging might involve tests to see if the cancer can be found beyond the prostate gland. It can spread to tissues nearby or to other organs further away. A healthcare provider may use blood tests, X-rays, CT or MRI scans, and nuclear medicine bone scans to help find a cancer's stage. For prostate cancer, the PSA level at the time of diagnosis and the grade of the cancer (see next question) are also important in figuring out the stage of the cancer.
What is the Gleason score?
The Gleason score is the most common system for grading prostate cancer. The pathologist looks at biopsy samples under a microscope. The grade refers to how the cancer cells look when compared with normal prostate cells. The grade of your cancer will help your healthcare provider predict how fast the cancer may grow and spread. A scale of 2 to 10 is used to grade prostate cancer. The lower the number, the more the cancer cells look like normal cells. This means the cancer can be easier to treat and cure. This is because cancer cells that look more like normal cells tend to grow and spread slowly. Higher grades of cancer look very different from normal prostate cells. These grades of cancer are harder to treat. Most prostate cancers are graded at least 6. Prostate cancers with low scores are less likely to spread to other organs than those with high scores.
Where can prostate cancer spread?
Prostate cancer can spread and form tumors in other parts of the body. When prostate cancer spreads, it often shows up in nearby lymph nodes first. It then travels to the bones. It can also spread to the liver, lungs, bladder, and other organs.
How is prostate cancer treated?
Not all men with prostate cancer need treatment right away. Some may never need treatment. For those who do, there are a number of treatments. These include surgery, external radiation therapy, internal radiation therapy (brachytherapy), hormone therapy, chemotherapy, and a vaccine. A healthcare provider advises a treatment plan to fit each man's needs based on various factors. These include the cancer's stage and Gleason score, the man's age, overall health, and his feelings about the treatments and their side effects. A healthcare provider can also talk about the option of a clinical trial.
What is active surveillance?
There are times when it may be best to not treat the prostate cancer. For example, in older men whose prostate cancer is slow-growing and found at an early stage, the side effects and risks of treatment may be greater than its possible benefits. In those cases, the healthcare provider may suggest active surveillance. This means watching the cancer closely and treating it if it grows or causes symptoms.
Should I get a second opinion?
Many people with cancer get a second opinion from another healthcare provider. There are many reasons to get a second opinion, such as:
Being diagnosed with a rare type of cancer
Not feeling comfortable with the treatment decision
Having several options for how to treat the cancer
Not having yet met with a cancer expert
How can I get a second opinion?
You can get a second opinion in many ways:
Ask your primary care provider. Your healthcare provider may be able to suggest a specialist. This may be a surgeon, medical oncologist, or radiation oncologist. These providers sometimes work together at cancer centers or hospitals. Don’t be afraid to ask your healthcare provider about a second opinion.
Call the National Cancer Institute's Cancer Information Service. The number is 800-4-CANCER (800-422-6237). This service has information about treatment facilities. These include cancer centers and other programs supported by the National Cancer Institute.
Seek other options. Check with a local medical society, a nearby hospital or medical school, or cancer advocacy group to get names of healthcare providers who can give you a second opinion. Or ask other people who have had cancer to refer you to someone.
What is a prostatectomy?
A prostatectomy is surgery that removes all or part of the prostate. Surgery to remove the entire prostate is called radical prostatectomy. It can be done in 3 ways:
Retropubic prostatectomy. The surgeon removes the prostate and nearby lymph nodes through a cut (incision) in the belly (abdomen).
Perineal prostatectomy. The surgeon removes the prostate through an incision between the scrotum and the anus. The provider may also remove nearby lymph nodes through an incision in the abdomen.
Laparoscopic prostatectomy. A surgeon does this through small incisions in the abdomen with a small scope and long, thin tools. This is often done with the surgeon sitting at a control panel and controlling robotic arms. This is known as robotic-assisted surgery.
Is leaking of urine (incontinence) a long-term side effect of prostate surgery?
It may take time for some men to regain bladder control after surgery for prostate cancer. As healing continues, incontinence usually happens less. But some men may have long-term problems. Special exercises should help lessen the problem and may make it go away completely.
How will prostate cancer surgery affect my sex life?
Erectile dysfunction (ED) is a common side effect of prostate cancer surgery. ED means having trouble getting or keeping an erection. Having nerve-sparing surgery may prevent long-lasting (permanent) injury to the nerves that control erection. But it may not be a choice in all cases. If a man regains the ability to have an erection, it may take up to 2 years after surgery. Some men may find their erections are not as firm as they were before. If the nerves connected to the tissue that controls erection have to be removed, permanent loss of erections will result. But there are treatments for all types of ED.
What are the treatments for erectile dysfunction (ED) after prostate cancer surgery?
Treatments can help men who have ED because of surgery for prostate cancer. Pills, injections, and vacuum pumps may help some men. If these are not helpful, a penile prosthesis can be implanted to help normal sexual function return. Healthcare providers usually advise waiting at least 1 month to a year after the surgery to see if sexual function will return on its own before getting an implant.
Does a prostatectomy cause sterility?
Yes. Sterility is the inability to father a child. It results from the removal of the prostate and the nearby seminal vesicles. The prostate gland helps create most of the fluid released during sexual intercourse and climax. The seminal vesicles also make some of the fluid. Men who have a prostatectomy no longer make semen, so they have dry orgasms. This means that they can’t get a woman pregnant during sex.
How can prostate cancer spread if I already had surgery or radiation therapy?
Even the best treatment for prostate cancer may not remove or kill every last cancer cell in the body. Tests are often done as part of the early treatment planning to see if the cancer has spread or not. But it's important to remember that the best scans can't look into the body like a microscope. Sometimes a few cells have escaped to other parts of the body and can't be detected yet. These cells may grow over months or years to cause problems later. The healthcare provider uses the tumor grade and staging tests to estimate how likely this is to happen.
What is external radiation therapy for prostate cancer?
External radiation is often an option to treat prostate cancer that hasn't spread to distant parts of the body. This treatment is a lot like getting an X-ray, although the radiation is stronger. You lie on a table while radiation is aimed at the cancer, usually from several angles. Treatments are given 5 days a week over several weeks. Radiation therapy works as well and has side effects similar to surgery.
What is brachytherapy for prostate cancer?
Brachytherapy is a form of internal radiation therapy. Radioactive pellets or seeds are implanted in the prostate. The radiation from the seeds kills cancer cells. Brachytherapy may be a choice if you have a lower Gleason score, lower PSA level, and a tumor that hasn’t spread to other parts of the body.
What is hormone therapy (androgen deprivation therapy) for prostate cancer?
Hormone therapy blocks the prostate cancer cells from the male hormones that they need to grow. These hormones include testosterone. Hormone therapy can affect all prostate cancer cells, even if they have spread to other parts of the body. There are several forms of hormone therapy. One is surgery to remove the testicles. The testicles make testosterone. Another type of hormone therapy is medicine to prevent the testicles from making testosterone, or to stop prostate cancer cells from being able to use it.
What is chemotherapy for prostate cancer?
Chemotherapy is the use of medicines that kill cancer cells. This type of treatment is most often used for advanced prostate cancer that's no longer responding to hormone therapy. It can also be used along with hormone therapy. Chemotherapy can cause side effects, such as nausea, vomiting, mouth sores, or hair loss. The side effects depend on the type of medicine and the dose used.
What is vaccine therapy for prostate cancer?
A vaccine is a type of medicine that can help boost the immune system. Vaccines are usually to help protect the body against infections. Sipuleucel-T is a vaccine that can be used to boost the immune system to help treat prostate cancer. It is used to treat advanced prostate cancer that is no longer reacting to hormone therapy. The vaccine does not cure prostate cancer. But it can often help men live longer.
Where can I get support?
There are many groups just for men dealing with prostate cancer. Talking with people who are going through similar experiences is often helpful. Support groups also offer information about treatment options, prognosis, and follow-up care. Your healthcare provider can recommend support groups in your area.
May 26, 2017
Early Detection, Diagnosis, and Staging. American Cancer Society., Treating Prostate Cancer. American Cancer Society.
Alteri, Rick, MD,Gersten, Todd, MD