If you have prostate cancer
What is prostate cancer?
Cancer can start anywhere in the body, and prostate cancer starts in the prostate gland. This cancer starts when cells in the prostate grow out of control.
Cancer cells can spread to other parts of the body. Sometimes prostate cancer cells can travel to bones or other organs and grow there. When cancer cells spread, this is called metastasis. To doctors, cancer cells in a new location look just like the ones that started in the prostate.
Cancer is always named after the place where it started. So if prostate cancer spreads to the bones (or anywhere else), it is still called prostate cancer. Only cancer that started in bone cells can be called bone cancer.
The Prostate
The prostate is a gland found only in men, so prostate cancer only affects men.
The prostate is just below the bladder (the hollow organ where urine is stored) and in front of the rectum (the last part of the intestines). The tube that carries urine passes through the prostate (it's called the urethra). The prostate makes some of the fluid that helps keep sperm alive and healthy.
There are many types of prostate cancer. Some are very rare. Most prostate cancers are a type called adenocarcinoma. This cancer starts in glandular cells. Your doctor will be able to tell you more about the type of cancer you have.
Questions for the doctor
- What made you conclude that I have cancer?
- Is there any chance that it's not cancer?
- Can you write down the exact type of cancer you think I might have?
- What will happen next?
- How does the doctor know that I have prostate cancer?
Prostate cancer usually grows slowly over a period of many years. Most men with prostate cancer don't have changes that they can notice. More often, signs of prostate cancer appear later, as the cancer develops.
Some signs of prostate cancer include problems urinating, blood in the urine, difficulty getting an erection, and pain in the back, hips, ribs, or other bones.
If signs indicate prostate cancer may be present, more tests will be done. Most men won't need all of the tests, but here are some of the tests you may need:
PSA blood test: Prostate-specific antigen (PSA) is a protein that is made by the prostate gland and can be found in the blood. Prostate cancer can raise the amount of PSA in the blood. Blood tests will be done to determine your PSA level and how it changes over time.
Transrectal ultrasound: For this test, a small wand is placed inside the rectum to emit sound waves and pick up the echoes that bounce back from the prostate gland. The echoes are made into a picture that is displayed on a monitor.
Magnetic resonance imaging: This test (known as MRI) uses radio waves and strong magnets to make detailed pictures of the body. MRIs can be used to examine the prostate and can show whether cancer has spread outside the prostate and to nearby organs.
Prostate biopsy: For a prostate biopsy, your doctor uses a long, hollow needle to remove small pieces of the prostate where cancer might be. This is often done while using TRUS or MRI (or a fusion of the two) to examine the prostate. The prostate samples are then examined for cancer cells. Ask your doctor which type of biopsy is required for you and how it will be done.
Lymph node biopsy: Lymph nodes are small, bean-shaped components of the immune system. A lymph node biopsy may be done if your doctor thinks cancer has spread from the prostate to nearby lymph nodes.
CT scan: This test is sometimes called a CAT scan. A CT scan uses X-rays to create detailed pictures of your body. It can show if cancer has spread outside of the prostate.
Bone scan: This test may be done to find out if cancer has spread to your bones. For this test, a small amount of a low-level radioactive substance is injected into your blood. It will settle on areas of bone damage throughout your body. A special camera looks for this radioactivity, creating a picture of your bones.
Questions for the doctor
What tests will I need?
Who will do these tests?
Where will they be done?
Who can explain the results to me?
How and when will I get the results?
Who will explain the results to me?
What do I need to do next?
How serious is my cancer?
If you have prostate cancer, your doctor will want to know how far it has spread. This is called the stage of your cancer. You may have heard other people say their cancer was “stage 1” or “stage 2.” Your doctor will want to find out the stage of your cancer to help decide what types of treatment might be best for you.
The stage is based on the growth or spread of cancer in the prostate, and whether it has spread to other parts of the body. It also includes the level of prostate-specific antigen in your blood and the grade of the cancer. Prostate cancer cells are given a grade based on how they look under a microscope. Those that look very different from a normal cell are classified as a higher grade, and they tend to grow faster. The grade of cancer may be assigned as a Gleason score (ranging from 6 to 10) or in a grade group (ranging from 1 to 5). Ask your doctor to explain the grade of your cancer. The grade can also help decide which treatments might be best for you.
Your cancer may be classified as stage 1, 2, 3, or 4. The lower the number, the less the cancer has spread. A higher number, such as stage 4, means a more serious cancer that has spread outside the prostate.
If the cancer has not spread to other parts of the body, you may also be given a risk group. The risk group is based on the extent of the cancer in the prostate, your PSA level, and the results of the prostate biopsy. The risk group can help indicate whether other tests should be done, and what the best treatment options might be.
Be sure to ask your doctor about your cancer's stage, grade, and risk group, as well as what it might mean for you.
Questions for your doctor
Do you know your cancer's stage and risk group?
If you don't know, how and when will you find out?
Could you explain to me what the stage and risk group mean for me?
What happens next?
What kind of treatment will I need?
There are many ways to treat prostate cancer. The main forms of treatment are observation, active surveillance, surgery, radiation therapy, hormone therapy, and chemotherapy. Sometimes, more than one kind of treatment is used.
The treatment that is best for you will depend on:
- Your age
- Any other health problems you may have
- The stage and grade of the cancer
- Your (and your doctor's) opinion about the need to treat the cancer
- The likelihood that the treatment will be effective in curing the cancer or that it will have some benefit
- Your feelings about the side effects that might come with each treatment
- Monitoring
Because prostate cancer often grows very slowly, some men (especially older men and those with other health problems) may never need any treatment. Your doctor may choose to keep your cancer under surveillance without treatment, which is called observation. This plan may be used if your cancer is small, is not causing any problems, and appears to be growing very slowly.
Active surveillance
Some younger men who are healthy and have a small, slow-growing cancer may consider active surveillance, which involves closer monitoring and then treating the cancer if it starts to cause symptoms.
Prostate cancer surgery
There are many types of prostate cancer surgery. Some surgeries are done to try to cure the cancer, while others are done to control the cancer or make symptoms better. Talk to your doctor about the kind of surgery that is planned and what to expect.
Side effects of surgery
There may be risks and side effects with any type of surgery. Be sure to ask your doctor what to expect. If you have any problems, tell your doctors so they can help you.
Radiation therapy
Radiation uses high-energy rays (like X-rays) to kill cancer cells. There are different ways radiation is used as a treatment for prostate cancer. Radiation may be delivered to the prostate gland from a machine outside the body. Or in some cases, small radioactive pellets or seeds (about the size of a grain of rice) may be placed directly into the prostate.
Side effects of radiation treatments
If your doctor suggests radiation therapy as a treatment, ask about the side effects that might occur. Side effects depend on the type of radiation used. The most common side effects of prostate radiation are diarrhea, stool leakage, or blood in the stool; having to urinate a lot, urine leakage, burning when urinating, or blood in the urine; erection problems; feeling tired (fatigue); and fluid buildup in the legs.
Most side effects get better after radiation ends. However, some may last longer. Talk to your doctor about what to expect.
Hormone therapy
This treatment lowers your levels of male hormones, known as androgens, or makes them stop working. This often causes prostate cancers to shrink or grow more slowly. However, hormone therapy does not cure prostate cancer. If you are going to have hormone therapy, ask your doctor to explain what effect you can expect it to have.
Side effects of hormone treatment
Changing your hormone levels can cause side effects such as decreased desire for sex, difficulty getting an erection, hot flashes, thinning of the bones, and weight gain. Talk to your doctor about the side effects you can expect from your hormone treatment.
Chemotherapy
Chemotherapy is the use of drugs to fight cancer. The drugs can be injected into a vein or taken as pills. These drugs enter the blood and spread throughout the body. Chemotherapy is given in cycles or rounds of treatment. Each round of treatment is followed by a rest period.
Chemotherapy may be used when the cancer has spread outside the prostate gland. This treatment is not given to men with early prostate cancer.
Side effects of chemotherapy
Chemotherapy may make you feel very tired, upset your stomach, or cause your hair to fall out. But these side effects go away after chemotherapy is finished.
There are ways to treat most side effects caused by chemotherapy. If you experience side effects, consult your doctor so they can help you.
Medications to Treat Cancer Spread to Bones
If prostate cancer spreads to other parts of the body, it almost always goes to the bones first. These areas of cancer spread can cause pain and weak bones that may fracture. Medications that can help strengthen bones and reduce the chance of fracture include bisphosphonates and denosumab. Sometimes, radiation, radiopharmaceuticals, or painkillers are given for pain control.
Side Effects of Bone Medications
A side effect of bisphosphonates and denosumab is damage to the jaw, known as osteonecrosis of the jaw (ONJ). Most people will need to get approval from their dentist before starting one of these medications.
Clinical Trials
Clinical trials are research to test new drugs or treatments in humans. These studies usually compare standard treatments with other treatments that might be better.
If you are interested in learning more about which clinical trials might be right for you, start by asking your doctor if the clinic or hospital where you work does clinical trials. See Clinical Trials for more information.
Clinical trials are one way to receive the latest cancer treatments. They are the best way for doctors to find better ways to treat cancer. If your doctor can find a clinical trial for your type of cancer, it will be up to you to decide whether you want to participate. If you enroll in a clinical trial, you can always stop participating at any time.
What should I know about other treatments I've heard about?
You may hear about other ways to treat cancer or its symptoms. These may not always be standard medical treatments. These treatments may include vitamins, herbs, special diets, and more. You may have concerns about these treatments.
Some of these methods are known to be helpful, but many have not been proven. Some provide no benefit, and some are even harmful. Talk to your doctor about anything you are considering using, whether it is a vitamin, diet, or any other method.
Questions for the doctor
What treatment do you think is best for me?
What is the goal of this treatment? Do you think it could cure the cancer?
Will the treatment include surgery? If so, who will do the surgery?
What will the surgery be like?
Will I need to receive other types of treatment as well?
What is the goal of these treatments?
What side effects might I experience from these treatments?
What can I do if I start having side effects?
Are there clinical trials that might be right for me?
What do you think about the vitamins or special diets my friends are telling me about? How will I know if they are safe?
How soon do I need to start treatment?
What should I do to prepare for treatment?
Is there anything I can do to help the treatment work more effectively?
What is the next step?
What will happen after treatment?
You will feel good about completing treatment. However, it is hard not to worry about the cancer coming back. When cancer comes back, it is called a recurrence. Even if the cancer never comes back, people tend to still be worried about this. After treatment, you will need to see your doctor for several years. At first, your appointments are scheduled every few months. Then, the longer you are cancer-free, the fewer appointments you will need.
Make sure you go to all your follow-up visits. Your doctors will ask about your symptoms, do physical exams, and may order blood tests and possibly other tests to see if the cancer has come back.
Facing cancer and dealing with treatment can be difficult, but it can also be a time for new changes in your life. You may be thinking about how to improve your health. Visit our profile for ways to prevent and reduce prostate inflammation naturally.
You can't change the fact that you have cancer. What you can change is the way you live the rest of your life by making healthy choices and feeling as good as possible.
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