Questions To Ask The Doctor
- What treatment do you think is best for me?
- Whats the goal of this treatment? Do you think it could cure the cancer?
- Will treatment include surgery? If so, who will do the surgery?
- What will the surgery be like?
- Will I need other types of treatment, too?
- Whats the goal of these treatments?
- What side effects could I have from these treatments?
- What can I do about side effects that I might have?
- Is there a clinical trial that might be right for me?
- What about special vitamins or diets that friends tell me about? How will I know if they are safe?
- How soon do I need to start treatment?
- What should I do to be ready for treatment?
- Is there anything I can do to help the treatment work better?
- Whats the next step?
What Increases Your Risk Of Prostate Cancer
Factors that can elevate risk prostate cancer include:
- A family history of prostate cancer
- Inherited genetic mutations, such as BRCA1/BRCA2 genes and Lynch syndrome
- Conditions such as prostatitis, inflammation of the prostate, and benign prostatic hyperplasia or BPH, a noncancerous enlargement of the prostate gland
- A diet high in red meats and high-fat dairy and low in fruits and vegetables
- Age: approximately 60 percent of cases are diagnosed in men older than 65
- Race and ethnicity: African-American men and Caribbean men of African ancestry are more likely to be diagnosed with prostate cancer
Research has also shown that a healthy lifestyle, including a well-balanced diet and maintaining a healthy weight, may reduce prostate cancer risk.
Current Psa Screening Recommendations
PSA-based screening refers to testing healthy men without symptoms.
Until recently, physician societies disagreed on screening recommendations, but with the publication of the U.S. Preventive Services Task Force Guideline in May 2018, all the major physician groups are broadly in agreement, including the American College of Physicians , the American Cancer Society , American Urological Association , and American Society of Clinical Oncology :
- They advise supporting men so that they make informed decisions about screening that reflect their personal preferences and values.
- Routine screening is not recommended in men between ages 40 and 54 of average risk.
- For men ages 55 to 69 years, the U.S. Preventive Services Task Force concluded with moderate certainty that the net benefit of PSA-based screening is small for some men, making the decision up to the judgment of the physician and the values of the patient.”
- For men 70 years and older, they recommend against routine screening because the expected harms are thought to outweigh the benefits.
- Your doctor should not screen you unless you express a preference for it.
- A discussion of the benefits and harms of screening should include a family history of prostate cancer, race or ethnicity, any medical conditions that affect your overall health and lifespan, and your values about risk and benefit.
- If you have less than a 10-year life expectancy, screening is not recommended.
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Who Is More Likely To Develop Prostate Cancer
Anyone who has a prostate can develop prostate cancer. But certain factors can make you more likely to develop it:
- Age. Your chance of developing prostate cancer increases as you get older. Prostate cancer is rare in people under age 50.
- Family health history. Your risk of prostate cancer is higher if you have a parent, sibling, or child who has or has had prostate cancer.
- Race. African Americans are more likely to get prostate cancer. They’re also more likely to:
- Get prostate cancer at a younger age.
- Have more serious prostate cancer.
- Die from prostate cancer.
What Kind Of Treatment Will I Need
There are many ways to treat prostate cancer. The main kinds of treatment are observation, active surveillance, surgery, radiation, hormone therapy, and chemo. Sometimes more than one kind of treatment is used.
The treatment thats best for you will depend on:
- Any other health problems you might have
- The stage and grade of the cancer
- Your feelings about the need to treat the cancer
- The chance that treatment will cure the cancer or help in some way
- Your feelings about the side effects that might come with treatment
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Looking For More Of An Introduction
If you would like more of an introduction, explore these related items. Please note that these links will take you to other sections on Cancer.Net:
ASCO Answers Fact Sheet:Read a 1-page fact sheet that offers an introduction to prostate cancer. This free fact sheet is available as a PDF, so it is easy to print.
ASCO Answers Guide:Get this free 52-page booklet that helps you better understand the disease and treatment options. The booklet is available as a PDF, so it is easy to print.
Cancer.Net Patient Education Video:View a short video led by an ASCO expert in prostate cancer that provides basic information and areas of research.
Cancer.Net En Español: Read about prostate cancer in Spanish or read a 1-page ASCO Answers Fact Sheet in Spanish. Infórmase sobre cáncer de próstata en español o una hoja informativa de una página, Respuestas sobre el cáncer.
The next section in this guide is Statistics. It helps explain the number of people who are diagnosed with prostate cancer and general survival rates. Use the menu to choose a different section to read in this guide.
About The Prostate And Prostate Cancer
The prostate gland is part of the male reproductive system and produces fluid that mixes with semen during ejaculation to help sperm travel. The prostate is a walnut-sized, rubbery organ that surrounds the urethrathe urinary duct that carries urine from the bladder out of the bodyand sits directly below the bladder.
The prostate gland, which grows during puberty, is considered an organ and is made up of several dozen lobules or saclike glands, held together with connective prostate tissue and muscle between them. The glands are called exocrine glands, because they secrete liquid to outside the body.
An enlarged prostate, called benign prostatic hyperplasia , is common in men over the age of 40 and may obstruct the urinary tract. The abnormal prostate cell growth in BPH is not cancerous and doesnt increase your risk of getting prostate cancer. However, symptoms for BPH and prostate cancer can be similar.
A condition called prostatic intraepithelial neoplasia , where prostate gland cells look abnormal when examined under a microscope, may be connected to an increased risk of prostate cancer. Prostate cancer is often caught by a doctor performing a digital rectal exam , through a prostate-specific antigen blood test, through a prostate biopsy or with a CT scan.
Another condition, prostatitis, is the inflammation of the prostate. While not cancerous, it may cause higher PSA levels in the blood.
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Treatment Of Benign Prostatic Hyperplasia
Some men with BPH eventually find their symptoms bothersome enough to require treatment. BPH cannot be cured, but medications or surgery can often ease symptoms.
Men with mild symptoms of BPH who are not bothersome often choose steps to help relieve their symptoms:
Certain medications can make BPH symptoms worse, so lets talk to your doctor or pharmacist about the medications you are taking, such as:
Many men with mild to moderate symptoms of BPH choose prescription drugs over surgery since the early 90s. Two main types of drugs are used. One type relaxes the muscles near the prostate and the other reduces the prostate gland. Some evidence suggests that taking both drugs together may be best at preventing BPH symptoms from getting worse.
The types of surgery for BPH include:
What Questions Should I Ask My Healthcare Provider
If you have prostate cancer, you may want to ask your healthcare provider:
- Why did I get prostate cancer?
- What is my Gleason score? What is my Grade Group? What do these numbers mean for me?
- Has the cancer spread outside of the prostate gland?
- What is the best treatment for the stage of prostate cancer I have?
- If I choose active surveillance, what can I expect? What signs of cancer should I look out for?
- What are the treatment risks and side effects?
- Is my family at risk for developing prostate cancer? If so, should we get genetic tests?
- Am I at risk for other types of cancer?
- What type of follow-up care do I need after treatment?
- Should I look out for signs of complications?
A note from Cleveland Clinic
Prostate cancer is a common cancer that affects males. Most prostate cancers grow slowly and remain in the prostate gland. For a small number, the disease can be aggressive and spread quickly to other parts of the body. Men with slow-growing prostate cancers may choose active surveillance. With this approach, you can postpone, and sometimes completely forego, treatments. Your healthcare provider can discuss the best treatment option for you based on your Gleason score and Group Grade.
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Transurethral Resection Of The Prostate
Transurethral resection of the prostate is a urological operation that involves cutting away a section of the prostate. It is most often used to relieve symptoms of urinary blockage, not necessarily to treat prostate cancer.
An instrument called a resectoscope is inserted through the opening of the urethra and the surgeon removes the inner part of the prostate gland .
The intervention lasts about an hour and it is most often used for non-cancerous blockage, but may also be used in cases of prostate cancer. The doctor doesnt need to make any incisions on the body. While most people can go home the same day, it is also likely that patients spend one or two days in the hospital. After the surgery, a urinary catheter will be placed because of the swelling that blocks urine flow.
Prostate Removal Side Effects
It is a common but temporary effect of prostate surgery. Usually, the symptoms improve within a year after the prostate removal.
Erectile dysfunction is one of the most common prostate removal side effects. About 40% of men lose some erectile function after radical prostatectomy, but they see gradual improvements within 2-3 years.
One of the side effects that occur after prostate removal is related to fertility. Following the surgery, a man will no longer be able to produce or ejaculate semen. But there are options the patient can discuss with the doctor, like freezing and storing sperm.
Other side effects of prostate removal
In rare cases, bowel function is affected and dry orgasms appear.
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Symptoms Of Prostate Cancer
- Frequent urge to pass urine, especially at night
- Weak or interrupted urine stream
- Pain or burning when passing urine
- Blood in the urine or semen
- Painful ejaculation
- Nagging pain in the back, hips, or pelvis
Prostate cancer can spread to the lymph nodes of the pelvis. Or it may spread throughout the body. It tends to spread to the bones. So bone pain, especially in the back, can be a symptom of advanced prostate cancer.
Risks Of The Procedure
As with any surgical procedure, certain complications can occur. Somepossible complications of both the retropubic and perineal approaches to RPmay include:
Some risks associated with surgery and anesthesia in general include:
Reactions to medications, such as anesthesia
Difficulty with breathing
One risk associated with the retropubic approach is the potential forrectal injury, causing fecal incontinence or urgency.
There may be other risks depending on your specific medical condition. Besure to discuss any concerns with your doctor prior to the procedure.
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Prognosis For Prostate Cancer
It is not possible for a doctor to predict the exact course of a disease, as it will depend on each person’s individual circumstances. However, your doctor may give you a prognosis, the likely outcome of the disease, based on the type of prostate cancer you have, the test results, the rate of tumour growth, as well as your age, fitness and medical history.
Prostate cancer often grows slowly and even more aggressive types tend to grow more slowly than other types of cancer. If diagnosed early, prostate cancer has one of the highest five year survival rates.
What About Trans People
People born with a prostate can develop prostate cancer. Individuals born without a prostate cannot develop prostate cancer.
Trans women who use hormone therapy such as estrogen may have a lower risk, but the risk is still present.
Anyone born with a prostate should speak to their doctor about screening for prostate cancer.
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Are Prostate Problems Always A Sign Of Prostate Cancer
Not all growths in the prostate are cancerous, and not all prostate problems indicate cancer. Other conditions that cause similar prostate cancer symptoms include:
- Benign prostatic hyperplasia : At some point, almost every man will develop benign prostatic hyperplasia . This condition enlarges the prostate gland but doesnt increase cancer risk. The swollen gland squeezes the urethra and blocks the flow of semen and urine. Medications, and sometimes surgery, can help.
- Prostatitis: Men younger than 50 are more prone to prostatitis, inflammation and swelling of the prostate gland. Bacterial infections are often the cause. Treatments include antibiotics or other medications.
Genetic Testing For Prostate Cancer
You may hear a lot about genetics or genomics. Both terms are related to genes and cell DNA, but they are different. These tests are being used to learn more about the DNA of cancer cells, and link DNA mutations with treatments. In the future, genetic testing may be the first step doctors take when diagnosing prostate cancer.
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Us Preventive Services Task Force Issues New Prostate Cancer Screening Guidelines
Prostate cancer is usually though not always a very slow-growing cancer that takes a long time to start affecting the body.
Most often, it only causes symptoms when it grows to pinch the urethra or invade the sphincter or other body parts.
In fact, some men with prostate cancer don’t show any signs or symptoms of their illness, the CDC notes.
Bilateral Orchiectomy Or Surgical Castration
This is another type of prostate surgery, in which both testicles are removed. It is recommended in order to treat or prevent testicular cancer, prostate cancer, and male breast cancer. Bilateral orchiectomy lowers testosterone, the hormone that causes prostate and breast cancer to spread more quickly. By decreasing the levels of testosterone, cancer may spread at a lower rate, and some symptoms, such as bone pain, may be more tolerable.
This procedure usually lasts between 30 and 60 minutes and most people usually go home the day of the surgery, as it has a short recovery time.
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Prostate Cancer Treatment Options: What Are They
Prostate cancer is, most often, a slow-growing cancer.
For some men, prostate cancer causes no symptoms or long-term issues, so treatment isn’t necessary.
In these cases, doctors may recommend active surveillance. That is, they’ll keep an eye on the development of the tumor using various tools and tests, including:
- Digital rectal exams
- Transrectal ultrasounds
- Prostate biopsies
Men who require treatment for their condition are most often treated with surgery, radiation therapy, hormone therapy, or a combination of these modalities.
What Are Prostate Tests And How Is Prostate Cancer Diagnosed
Tests which check for prostate cancer include:
- A digital rectal exam . In this exam, your provider feels your prostate for lumps or anything unusual by inserting a lubricated, gloved finger into your rectum.
- A prostate-specific antigen blood test. A high PSA blood level may be a sign of prostate cancer. But many other things can cause high PSA levels, too.
- Imaging tests. These tests may use ultrasound or MRI to make pictures of your prostate.
If these tests show that you might have prostate cancer, the next step is usually a prostate biopsy. A biopsy is the only way to diagnose prostate cancer.
During a biopsy, a doctor uses a hollow needle to remove some prostate tissue. The tissue is studied under a microscope to look for cancer cells.
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Psa Screening For Prostate Cancer: A Controversial History
The history of the role of the prostate-specific antigen test for prostate cancer is controversial.
The prostate-specific antigen blood test was created in the late 1980s, and tests for elevated levels of the antigen. Elevated levels can be suggestive of prostate cancer. The test itself is insufficient for diagnosing prostate cancer and was initially proposed as a marker of prostate cancer recurrence or disease progression. But doctors quickly began using it for cancer screening throughout the United States. By 1992, PSA testing as a cancer screen was at its peak.
Also, in the late 1980s, surgeons in the United States and Europe perfected the technique of radical prostatectomy, which involves removal of the prostate gland and any cancer within it. Initially, it seemed like an ideal situation: Men could have a simple blood test and prostate cancers that had not spread outside of the prostate gland could be cured.
But as time wore on, problems emerged that had not been anticipated when PSA screening was introduced: