Prostate Cancer

Are there different kinds of prostate cancer?
There are a few. Some are very rare. Most prostate cancers are a type called adenocarcinoma (AD-no-KAR-suh-NO-muh). This cancer starts from gland cells. Your doctor can tell you more about the type you have.

Questions to ask the doctor:

• Why do you think I have cancer?
• Is there a chance I don’t have cancer?
• Would you please write down the kind of cancer you think I might have?
• What will happen next?

How does the doctor know I have prostate cancer?
Prostate cancer tends to grow slowly over many years. Most men with early prostate cancer don’t have changes that they notice. Signs of prostate cancer most often show up later, as the cancer grows. Some signs of prostate cancer are trouble peeing, blood in the pee (urine), trouble getting an erection, and pain in the back, hips, ribs, or other bones. If signs are pointing to prostate cancer, more tests will be done. Here are some of the tests you may need:

Tests that may be done

• PSA blood test: PSA is a substance in the blood that’s made by the prostate gland. Prostate cancer can make PSA levels go up. Blood tests will be done to see what your PSA level is and how it changes over time.
• Transrectal ultrasound (TRUS): For this test, a small wand is put into your rectum. It gives off sound waves and picks up the echoes as they bounce off the prostate gland. The echoes are made into a picture on a computer screen.
• Prostate biopsy: For a biopsy (by-op-see), the doctor takes out a small piece of tissue where the cancer seems to be. This tissue is checked for cancer cells. A core needle biopsy is often used to find prostate cancer. Ask the doctor what kind of biopsy you need and how it’s done.
• Lymph (limf) node biopsy: Lymph nodes are small bean-shaped parts of the immune system. A lymph node biopsy may be done if the doctor thinks the cancer might have spread from the prostate to nearby lymph nodes.
• CT scan: This is sometimes called a “CAT scan.” It’s a kind of x-ray that takes many pictures of the body. A CT scan can show whether the cancer has spread outside the prostate. CT scans can also be used to guide the needle during a biopsy.
• Bone scan: This test may be done to see if the cancer has spread to your bones. To do it, a small amount of low-level radioactive material is put into your blood. It settles in damaged areas of bone all over the body. A special camera finds the radioactivity and makes a picture of your bones.
• MRI: Uses radio waves and strong magnets instead of x-rays to make clear pictures. MRI scans can show the prostate gland and can show if the cancer has spread outside the prostate.

Grading prostate cancer
The prostate cancer cells will be given a grade using the Gleason system. Grading the cancer helps to know how fast the cancer might grow and spread.

Cancer cells are graded from 2 to 10 based on how much they look like normal prostate cells. Those that look very different from normal cells are given a higher grade and are likely to grow faster. Ask your doctor to explain the grade of your cancer. The grade helps the doctor decide which treatment is best for you.

Questions to ask the doctor:

• What tests will I need to have?
• Who will do these tests?
• Where will they be done?
• Who can explain them 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, the doctor will want to find out how far it has spread. This is called staging. You may have heard other people say that their cancer was “stage 1” or “stage 2.” Your doctor will want to find out the stage of your cancer to help decide what type of treatment is best for you. The stage describes the growth or spread of the cancer through the prostate. It also tells if the cancer has spread to other parts of your body that are close by or farther away. Your cancer can be stage 1, 2, 3, or 4. The lower the number, the less the cancer has spread. A higher number, like stage 4, means a more serious cancer that has spread outside the prostate. For most men, the stage is not known until after surgery, so your doctor may wait until then to tell you the stage. Be sure to ask the doctor about the cancer stage and what it means for you.

Questions to ask the doctor

• Do you know the stage of the cancer?
• If not, how and when will you find out the stage of the cancer?
• Would you explain to me what the stage means in my case?
• Based on the stage of the cancer, how long do you think I’ll live?
• What will happen next?

What kind of treatment will I need?
There are many ways to treat prostate cancer. The main kinds of treatment are watchful waiting, surgery, radiation, hormone therapy, and chemo. Sometimes more than one kind of treatment is used.

The treatment that’s best for you will depend on:

• Your age
• Any other health problems you might have
• The stage and grade of the cancer
• Your feelings (and your doctor’s) 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

Because prostate cancer often grows very slowly, some men may never need treatment at all. The doctor may plan to keep track of the cancer without doing treatment. This is called watchful waiting. It might be done if the cancer is small, is not causing any problems, and seems to be growing very slowly.

Surgery for prostate cancer
There are many types of surgery for prostate cancer. Some are done to try to cure the cancer; others are done to control the cancer or make symptoms better. Talk to the doctor about the kind of surgery planned and what you can expect.

Any type of surgery can have risks and side effects. Be sure to ask the doctor what you can expect. If you have problems, let your doctors know. Doctors who treat prostate cancer should be able to help you with any problems that come up.

Radiation treatment
Radiation (pronounced RAY-dee-A-shun) uses high-energy rays (like x-rays) to kill cancer cells. There are different ways to use radiation to treat prostate cancer. It can be aimed at the prostate gland from a machine outside the body. In some cases, small radioactive pellets, or seeds, each about the size of a grain of rice, are put right into your prostate.

If your doctor suggests radiation treatment, talk about what side effects might happen. Side effects depend on the type of radiation that’s used. The most common side effects of radiation to the prostate are:

• Diarrhea, leaking stool, or blood in the stool
• Having to pee (pass urine) a lot, leaking urine, burning when you pee, or blood in your urine
• Erection problems
• Feeling very tired (fatigue, which is pronounced fuh-TEEG)
• Fluid build-up in your legs

Most side effects get better after treatment ends. Some might last longer. Talk to your doctor about what you can expect.

Hormone Treatment
This treatment reduces your levels of male hormones, called androgens (AN-druh-jens), or stops them from working. This often makes prostate cancers shrink or grow more slowly. But hormone therapy does not cure prostate cancer. If you’re going to get hormone treatment, ask your doctor what you can expect it to do. Changing your hormone levels can cause side effects like less desire for sex, trouble getting an erection, hot flashes, bone thinning, and weight gain. Talk to your doctor about what you can expect from your hormone treatment.

Chemo
Chemo (KEY-mo) is the use of drugs to fight cancer. The drugs may be given into a vein or taken as pills. These drugs go into the blood and spread through the body. Chemo is given in cycles or rounds. Each round of treatment is followed by a break. Chemo may be used if the cancer has spread outside the prostate gland and hormone treatment isn’t working. It’s not used for early prostate cancer.

Chemo can make you feel very tired, sick to your stomach, and cause your hair to fall out. But these problems go away after treatment ends. There are ways to treat most chemo side effects. If you have side effects, talk to your cancer care team so they can help.

Clinical Trials
Clinical trials are research studies that test new drugs or other treatments in people. They compare standard treatments with others that may be better. Clinical trials are one way to get the newest cancer treatment. They are the best way for doctors to find better ways to treat cancer. If your doctor can find one that’s studying the kind of cancer you have, it’s up to you whether to take part. And if you do sign up for a clinical trial, you can always stop at any time.

What about other treatments that I hear about?
When you have cancer you might hear about other ways to treat the cancer or treat your symptoms. These may not always be standard medical treatments. These treatments may be vitamins, herbs, special diets, and other things. You may wonder about these treatments.

Some of these are known to help, but many have not been tested. Some have been shown not to help. A few have even been found to be harmful. Talk to your doctor about anything you’re thinking about using, whether it’s a vitamin, a diet, or anything else.

Questions to ask the doctor:

• What treatment do you think is best for me?
• What’s 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?
• What’s 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?
• What’s the next step?

What will happen after treatment?
You’ll be glad when treatment is over. But it’s hard not to worry about cancer coming back. Even when cancer never comes back, people still worry about it. For years after treatment ends, you will see your cancer doctor. At first, your visits may be every few months. Then, the longer you’re cancer-free, the less often the visits are needed.

Be sure to go to all of these follow-up visits. Your doctors will ask about symptoms, do physical exams, and may do blood tests and maybe other tests to see if the cancer has come back.

* Information on this page is from American Cancer Society (www.cancer.org)