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Chances are that you know someone who has prostate cancer or has been treated for it. One out of every seven American men will be diagnosed with the disease in their lifetime.
The survival rate is increasing, and awareness, screening
The prostate is a
The prostate begins to develop while a baby is in his mother’s womb. Fueled by androgens (male hormones), it continues to grow until adulthood.
Sometimes, the part of the prostate around the urethra may keep growing, causing benign prostatic hyperplasia (BPH). While this condition may interfere with passing urine and needs to be treated, it is not prostate cancer.
Prostate Cancer Types
Almost all prostate cancers begin in the gland cells of the prostate and are known as adenocarcinomas.
Pre-cancerous changes of the prostate: By age 50, about half of all men have small changes in the size and shape of the cells in the prostate. This is called prostatic intraepithelial neoplasia (PIN).
Some research has indicated these cellular changes may eventually develop into prostate cancer. But this is controversial, and preventive treatment is not recommended.
Prostate Cancer Risk Factors
Anything that increases your chance of getting prostate cancer is a risk factor. These include:
- Age: This is the most important risk factor. Most men who develop prostate cancer are older than 50. About two of every three prostate cancers are diagnosed in men older than 65.
- Family history: Risk is higher when other members of your family (especially father, brother, son) have or had prostate cancer, especially if they were young when they developed it.
- Race: African-American men have nearly double the risk of prostate cancer as white men. It is found less often in Asian American, Hispanic and American Indian men.
- Diet: A high-fat diet, particularly a diet high in animal fats, may increase risk; diets high in fruits and vegetables may decrease risk.
- Nationality: Prostate cancer is more prevalent in North America and northwestern Europe than other parts of the world.
- Some research suggests that inflammation of the prostate (prostatitis) may play a role in prostate cancer. Sexually transmitted diseases (STDs) are being investigated as possible risk factors as well.
Prostate Cancer Prevention
Certain actions may help lower your risk of prostate cancer:
- Eat at least five servings of fruits and vegetables daily and eat less red meat. Decrease fat intake.
- Tell your doctor about supplements you take. Some of these may decrease the PSA level. A recent large study found that selenium and vitamin E, once thought to decrease
riskof prostate cancer, have no effect.
- Exercise regularly
- Maintain your ideal weight
Other ways to prevent prostate cancer are being investigated. These include:
Lycopenes: These substances found in tomatoes, pink grapefruit and watermelon may help prevent damage to cells.
- Proscar® (finasteride) or Avodart® (
dutesteride): If you are at high risk for prostate cancer, talk to your urologist or other providerwho is familiar with studies about these drugs.
Research shows that many cancers can be prevented.
Visit the Prevention section of our website to find out steps you can take to avoid cancer.
Prostate cancer often shows no symptoms in the early stages. If symptoms do appear, they vary from man to man. Symptoms of prostate cancer may include:
- Painful or burning urination
- Inability to urinate or difficulty in starting to urinate
- Difficulty trying to hold back urination
- Weak or interrupted urine flow
- Frequent or urgent need to urinate
- Trouble emptying the bladder completely
- Blood in the urine or semen
- Continual pain in the lower back, pelvis, hips or thighs
- Difficulty having an erection
Having any of these symptoms does not mean you have prostate cancer. Some of the same symptoms can occur with BPH (benign prostatic hypertrophy) or other health problems. If you notice one or more of these symptoms for more than two weeks, see your doctor and ask for a prostate cancer test.
Did You Know?
The experts at MD Anderson specialize in diagnosing prostate cancer. They have the expertise and technology to evaluate the growth pattern and extent of each particular cancer, which will affect treatment.
If you have prostate cancer, it’s important to get an accurate diagnosis as soon as possible. This helps increase the odds for successful treatment and recovery.
Prostate Cancer Diagnosis
If you have symptoms that may signal prostate cancer, your doctor will ask you questions about your health, your lifestyle and your family medical history.
One or more of the following tests may be used to find out if you have cancer and if it has spread. These tests also may be used to find out if treatment is working.
Digital Rectal Exam (DRE)
The simplest screening test for prostate cancer is the digital rectal exam (DRE). The health care provider gently inserts a gloved forefinger into the rectum to feel the prostate gland for enlargement or other abnormalities, such as a lump.
The DRE is not a definitive cancer test, but regular exams help detect changes in the prostate over time that might signal cancer or pre-cancerous conditions.
Although this test usually is not as reliable as the PSA blood test, a DRE may be able to find cancer if a man has a normal PSA level. A DRE also may be used to tell if prostate cancer has spread or returned after treatment.
Prostate-specific antigen (PSA) Test
Prostate-specific antigen (PSA) is a protein produced by the cells of the prostate gland. It is found mostly in semen, but a small amount is in the blood as well.
A blood test measures the amount of PSA circulating in the blood, expressed in nanograms per milliliter (ng/mL). This level is used to assess prostate cancer risk. A higher PSA level usually means a higher chance of having prostate cancer.
However, the test has limitations. PSA is produced by both prostate tissue and prostate cancer. Sometimes prostate cancer does not produce much PSA and higher levels can be caused by factors other than cancer, including:
- Enlarged prostate, also called benign prostatic hyperplasia (BPH), which is found often in older men
- Age: PSA levels normally go up slowly as men age
- Prostate infection or inflammation, which also is called prostatitis
- PSA may rise briefly after ejaculation, then return to normal levels
On the other hand, certain conditions may make PSA levels low, even when a man has prostate cancer. These include:
- Some drugs used to treat BPH or other conditions
- Certain herbal medicines or supplements
Despite its limitations, PSA testing has helped detect prostate cancer in countless men. In 1984, before PSA testing was available, the chance of finding early prostate cancer was about 50%. In 1993, after PSA testing became widely used, that figure jumped to more than 90%.
Men with very low PSA levels may need to be tested every two years. However, if PSA is higher, the doctor may recommend more frequent testing.
Because prostate cancer develops slowly, physicians usually do not recommend the PSA test for men who are older than 75 or have other significant health issues.
Additional PSA Testing
Besides screening, PSA testing can be used in other ways in men who have been diagnosed with prostate cancer. For instance, it may:
- Help doctors plan your treatment or further testing
- Determine if cancer has metastasized (spread beyond the prostate)
- Find out if treatment is working or cancer has returned
- Aid in active surveillance (also called watchful waiting) by showing if cancer is growing
If your doctor suspects prostate cancer, a biopsy may be performed. This is the only way to tell for sure if you have prostate cancer.
Biopsies for prostate cancer are done in a doctor’s office or other facility as an outpatient procedure. A local anesthetic like dentists use, often lidocaine, is injected into the area close to the prostate to make the procedure more comfortable.
A small transrectal ultrasound (TRUS) probe with an imaging device is inserted into the rectum so the doctor can view the prostate on a video screen. Using this image as a guide, the physician injects a thin needle through the wall of the rectum into the prostate. Several tiny samples of tissue are removed.
Sometimes a biopsy will not find prostate cancer, even if it is there. If your doctor is concerned that you may have prostate cancer based on a follow-up PSA test, a second biopsy may be performed.
Some people have an elevated risk of developing prostate cancer. Review the prostate cancer screening guidelines to see if you need to be tested.
In rare cases, prostate cancer can be passed down from one generation to the next. Genetic counseling may be right for you. Visit our genetic testing page to learn more.
Prostate Cancer Risk Assessment
If you are diagnosed with prostate cancer, your doctor will make a series of estimates about the risk the disease may be harmful in the future. Factors include:
- Gleason score (see below)
- PSA level
- Clinical stage, which is based on findings of the digital rectal exam (DRE)
- Less than 10% chance of having spread to other parts of the body
- Low risk of progressing if not treated
- PSA less than 10 ng/nL
- Gleason score of 6 or lower
- No tumor felt on DRE or feels contained within the prostate gland with only a small abnormal area
- 10% to 15% chance of having spread
- Higher chance (up to 70% over 15 years) of progressing if not treated
- PSA of 10 to 20 ng/mL
- Gleason score of 7
- Tumor can be felt on one or both sides of the prostate on DRE, but it seems to be contained within the gland
- Aggressive features that increase the chance of spreading now or in the future
- PSA over 20 ng/mL
- Gleason score of 8 to10
- Tumor can be felt on DRE and seems to have spread outside the gland
Gleason Grading System
If a biopsy finds prostate cancer, it will be classified using the Gleason grading system. This helps doctors choose the best treatment options and predict how quickly the cancer is growing.
Prostate cancer contains several types of cells. The Gleason system uses the numbers 1 to 5 to grade the most common (primary) and next most common (secondary) cell types found in a tissue sample. The sum of these two numbers is the Gleason score, which indicates how aggressive the tumor is. The higher the Gleason score, the more aggressive the cancer.
Gleason grades 1 and 2 are rarely seen since these changes are now usually classified as benign or occur at the center of the gland and remain undiscovered. That means the usual lowest grade is 3. Gleason scores of:
- 3+3 are low grade and have the lowest risk of harm
- 3+4 and 4+3 are intermediate risk — the latter being the more aggressive type
- 4+4 through 5+5 are the highest risk
If the prostate cancer is determined to be intermediate or high risk, imaging tests such as bone scans and CAT (computed axial tomography) or MRI (magnetic resonance imaging) scans may be used to determine if the cancer has spread.
Taken together, the disease risk status and imaging results will help your doctor plan the best treatment.
At MD Anderson, you receive customized care that is planned by some of the nation’s leading experts. Your personal team of specialists communicates and collaborates at every step to be sure you receive the most advanced therapies with the least impact on your body.
Prostate cancer treatment options may include:
- Open prostatectomy (often with nerve-sparing techniques)
- Minimally invasive laparoscopic robotic surgery
- Intensity modulated radiation therapy (IMRT)
- Proton therapy for prostate cancer
- Prostate cancer brachytherapy
- Molecular-targeted therapy
- Vaccine therapy and gene therapy
- Hormone therapy for prostate cancer
- Active surveillance
MD Anderson has a multidisciplinary prostate cancer clinic to help you decide which prostate cancer treatment is best for you.
If you and your physician decide surgery is your best alternative, you should look for a surgeon with as much experience as possible in performing the procedure. Studies have shown this increases odds for successful surgery with fewer side effects.
The surgeons at MD Anderson are among the most experienced and skilled in the country in prostate cancer procedures. They have the latest technology and equipment as well as an effective team approach.
In addition, our status as one of the nation’s most active prostate cancer research centers enables us to offer a wide range of clinical trials of new treatments for all stages of prostate cancer.
Prostate Cancer Treatments
If you are diagnosed with prostate cancer, your doctor will discuss the best options to treat it. This depends on several factors, including:
- Your age and general health
- Stage and grade of cancer
- Whether the cancer has spread
- Side effects of treatment
Your treatment for prostate cancer will be customized to your particular needs. One or more of the following therapies may be recommended to treat the cancer or help relieve symptoms.
The most frequent surgical procedure to treat prostate cancer is radical prostatectomy, which is removal of:
- The entire prostate gland
- Both seminal vesicles, which play a part in making semen
- A short segment of the urine tube that passes through the prostate
The urinary system is reconstructed by suturing (sewing) the bladder opening to the urethra. In some patients, one or more lymph node groups in the pelvic area may be removed to find out if the prostate cancer has spread. This is called lymphadenectomy or lymph node dissection. In more advanced prostate cancer, one or both of the neurovascular bundles, which play a part in erectile function, may be partially or completely removed.
Prostate Cancer Surgery Techniques
The two main surgical techniques for removal of the prostate are:
Open: A large incision is made in the lower abdomen, and the prostate is removed.
Robot-assisted (laparoscopic) minimally invasive: Multiple small incisions are made in the abdomen, and then an endoscope connected to robotic arms is inserted. A miniature video camera and surgical tools are attached to the end of the endoscope. The surgeon, seated at a console, can view the surgery site on a video screen and control the robotic arms. MD Anderson surgeons are experts at nerve-sparing techniques and sural nerve grafts that may help men keep urinary and sexual function.
The robotic technique is commonly used in the United States. Studies show robotic-assisted surgery may result in:
- Less blood loss
- Shorter hospital stays
- Less urinary tract scarring
- Fewer complications
However, the techniques are fairly equal in retaining urinary and sexual function and controlling cancer. The experience of the surgeon probably will affect your result more than which set of tools is used.
Recovery of function after prostate cancer surgery
Urinary control: Most men have stress urinary incontinence (leakage of a small amount of urine when laughing, sneezing, coughing, etc.) after a radical prostatectomy.
- Within a few days to three months, most men have 90% or more of the urinary function they had before surgery.
- At one year, approximately 95% of men have pre-surgery levels of urinary control or are very close.
- Approximately 10% have rare urinary accidents and wear protective pads.
- Fewer than 5% have permanent significant leakage problems.
Sexual function: Since the prostate and seminal vesicles produce the majority of semen, sexual climax after a prostatectomy does not produce fluid. However, the climax response is preserved.
The success of preserving sexual function (the ability to maintain erections for sex) depends on:
- Age, sexual function before surgery and medical history
- Number of nerve bundles spared
- Experience and expertise of the surgeon
Radiation often is used to treat prostate cancer that is contained within the prostate or the surrounding area. For early-stage disease, patients often have a choice between surgery and radiation with similar outcomes. For larger or more aggressive tumors, radiation therapy may be used in combination with hormone therapy. Radiation also may be used to treat prostate cancer tumors that are not completely removed or that come back after surgery.
The newest radiation therapy techniques and remarkable skill allow MD Anderson doctors to target tumors more precisely than ever before, delivering the maximum amount of radiation with the least damage to healthy cells.
MD Anderson provides the most advanced radiation treatments for prostate cancer, including:
- Intensity-modulated radiotherapy (IMRT): External radiation which is tailored to the specific shape of the tumor, avoiding surrounding normal organs
- Brachytherapy: Tiny radioactive seeds are placed in the prostate very close to the tumor and left permanently
Because the prostate can move within the body from day to day, techniques are used to ensure the radiation is being given to the exact location of the organ each day. These include:
- Ultrasound imaging through the abdomen
- Implanting gold markers that show up on X-rays
- CT or CAT (computed axial tomography) scan
- Proton therapy
The Proton Therapy Center at MD Anderson is one of the largest and most advanced centers in the world. It’s the only proton therapy facility in the country located within a comprehensive cancer center. This means this cutting-edge therapy is backed by all the expertise and compassionate care for which MD Anderson is famous.
Proton therapy delivers high radiation doses directly into the tumor, sparing nearby healthy tissue and vital organs. For many patients, this results in better cancer control with fewer side effects.
The majority of prostate cancers are hormone-sensitive, which means male hormones (androgens) such as testosterone fuel growth of the cancer. About one-third of prostate cancer patients require hormone therapy (also called androgen deprivation), which blocks testosterone production or blocks testosterone from interacting with the tumor cells. This reduces the tumor size or makes it grow more slowly. While hormone therapy may help control prostate cancer, it does not cure it.
Hormone therapy is most often used for late-stage, high-grade tumors (Gleason score of 8 or higher) or in patients with cancer that has spread outside the prostate. However, doctors have different opinions about the length and timing of hormone therapy.
Hormone therapy may be used to treat prostate cancer if:
- Surgery or radiation is not possible
- Cancer has metastasized (spread) or recurred (come back after treatment)
- Cancer is at high risk of returning after radiation
- Shrinking the cancer before surgery or radiation increases the chance for successful treatment
Intermittent hormone therapy is a variation of hormone therapy in which drugs are used for a period of time, then stopped and started again. For some men, this approach to prostate cancer causes fewer side effects. The effectiveness of this approach is still being studied, but it appears particularly useful in some situations.
The types of hormone therapies for prostate cancer are:
Anti-androgens: These drugs, which include Eulexin® (flutamide or flutamin) and Casodex® (bicalutamide), block testosterone from interacting with the cancer cell. They are taken by mouth every day.
Anti-androgens are used most often in combination with LHRH agonists (see below). Occasionally, anti-androgens are used as an alternative to LHRH agonists if the side effects are excessive for the patient.
LHRH agonists: These drugs work by over-stimulating the pituitary gland to release luteinizing hormone-releasing hormone (LHRH). After an initial surge, this signals the testicles to suppress testosterone production. Treatments are injections, which last from one to six months, or implants of small pellets just under the skin.
LHRH agonists may cause a spike or flare in the testosterone level before treatment takes effect. To offset this effect, anti-androgens may be given for a few weeks before the initial LHRH injection. The effects of LHRH are usually not permanent, such that testosterone production may resume once the medication is stopped.
Orchiectomy: Surgical removal of the testicles. This removes the organ, which produces testosterone, and is another way to keep testosterone from the prostate cancer. Orchiectomy is an efficient, cost-effective and convenient method of reducing testosterone, and it is an option if you will be treated with testosterone suppression indefinitely. After this surgery, most men cannot have erections.
Side effects of hormone therapies for prostate cancer may include:
- Impotence, inability to get or maintain an erection
- Loss of libido (sex drive)
- Hot flashes
- Growth of breast tissue and tenderness of breasts
- Loss of muscle mass, weakness
- Decreased bone mass (osteoporosis)
- Shrunken testicles
- Loss of self-esteem, aggressiveness/alertness and higher cognitive functions such as prioritizing or rationalization
- Anemia (low red blood cell count)
- Weight gain
- Higher cholesterol levels
- Increased risk of heart attacks, diabetes and high blood pressure (hypertension)
If you are treated with hormone therapy and have side effects, be sure to mention them to your doctors. Many of these side effects can be treated successfully.
We have the expertise to examine each prostate cancer tumor carefully to determine gene-expression profiles. Ongoing research will help us determine the most effective and least invasive treatment targeted to specific cancers. This personalized medicine approach sets us above and beyond most cancer centers and allows us to attack the specific causes of each cancer for the best outcome.
The tumor is frozen with a long, thin probe inserted into the tumor. Intensive follow-up with X-rays or other imaging procedures is required to ensure that the tumor has been destroyed.
MD Anderson is leading some of the world’s most innovative research into these newer agents that are specially designed to treat each cancer’s specific genetic/molecular profile to help your body fight the disease.
These agents help the body fight the cancer on a molecular basis.
Most physicians reserve the use of chemotherapy for prostate cancer that has spread to other organs and is no longer responding to hormone therapy.
- Taxotere® (docetaxel) is the one of the standard chemotherapy agents for adenocarcinoma of the prostate.
- Cisplatin-based chemotherapy is used to treat the small-cell variant of prostate cancer.
Active Surveillance or Watchful Waiting
Because prostate cancer usually grows slowly, some men with prostate cancer, especially those who are older or have other health problems, may never be treated for it. Instead, their doctors may recommend active surveillance, an approach also known as "watchful waiting."
This approach involves closely monitoring the prostate cancer without active treatment such as surgery or radiation therapy. Prostate biopsy procedures and PSA tests are repeated at set intervals, and treatment may be recommended if the tumor shows an increase in the volume or the grade (Gleason score).
Long-term studies of active surveillance for men with low-volume, low-grade prostate cancer tumors show that approximately 70% can maintain this approach for up to 10 years without requiring treatment.
Side Effects of Treatment
After treatment for prostate cancer, you may have side effects. These depend the therapy you received and may involve:
- The urinary tract (the bladder and the urethra)
- The bowels, particularly the rectum
- Impotence and sexual function
Talk to your doctor about any side effects you have. Treatments are available to help with most of them.
Sexuality after Prostate Cancer
Impotence, or not being able to maintain an erection to have sex, may be a problem after prostate cancer treatment. This may be temporary or permanent. If you are able to get an erection, you may be able to achieve orgasm. However, no semen will be ejaculated during orgasm. Some people call this dry orgasm.
Talk to your health care provider about erection problems. Treatments include pills (such as Viagra®, Levitra® or Cialis®), vacuum erection devices and medications given by injections (shots). Learn more about sexuality and cancer.
Fertility after Prostate Cancer
Surgery to treat prostate cancer usually requires cutting the tubes between the testicles and urethra that transport the sperm and semen. Furthermore, surgery removes the prostate and seminal vesicles that produce the semen. Radiation significantly decreases the amount of semen that is produced, and semen is necessary to carry the sperm. This makes it impossible to father children without highly sophisticated sperm retrieval and in-vitro fertilization procedures.
If you want to have children in the future, it may be a good idea to bank sperm before cancer treatment. Speak to your doctor if you want more information or have questions.
Why choose MD Anderson for your prostate cancer treatment?
This specialized group communicates and collaborates closely – with you and each other – to be sure you receive the most advanced prostate cancer treatment with the least impact on your body. Your team includes medical, surgical and radiation oncologists, as well as a specially trained support staff. They work with the latest technology and techniques like hormone therapy, proton therapy
Investigating the Future
MD Anderson Cancer Center is proud to be one of the few cancer treatment centers in the nation to house a prestigious federally funded prostate cancer SPORE (Specialized Program of Research Excellence) program. We're studying new ways to prevent, diagnose and treat prostate cancers to give patients the most-advanced treatments with the least impact on the body.
And at MD Anderson you're surrounded by the strength of one of the nation's largest and most experienced comprehensive cancer centers, which has all the support and wellness services needed to treat the whole person – not just the disease.
None of us really knew what to expect, but MD Anderson has been incredible, from the second my parents walked through its doors. Everyone they’ve dealt with there has been both welcoming and helpful.
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