Patient education: Prostate cancer (The Basics)

What is prostate cancer? — Prostate cancer happens when normal cells in the prostate gland change into abnormal cells and grow out of control. The prostate gland makes fluid that is part of semen. This gland sits below the bladder and in front of the rectum, and forms a ring around the urethra, the tube that carries urine out of the body (figure 1).

Prostate cancer occurs most often in males older than 50 years. Although prostate cancer is very common, most people do not die from it. This is because prostate cancer usually grows very slowly.

What are the symptoms of prostate cancer? — Prostate cancer often causes no symptoms at first. But if symptoms do occur, they can include:

●Needing to urinate more often than usual

●A urine stream that is slower than usual

These symptoms can also be caused by conditions that are not prostate cancer. But if you have these symptoms, tell your doctor or nurse.

Is there a test for prostate cancer? — Yes. Doctors use a blood test called a PSA test and an exam called a rectal exam to check for prostate cancer. In a rectal exam, your doctor or nurse puts a finger in your anus and up into your rectum. They press on the rectum wall to feel for abnormal areas on the prostate (figure 2).

If your doctor or nurse suspects that you have prostate cancer, they will follow up with 1 or more tests. These can include:

●Biopsy – A doctor will take a small sample of tissue from your prostate. Then, another doctor will look at the sample under a microscope to see if it has cancer.

●Ultrasound, MRI scan, or other imaging tests – These tests create images of the inside of the body and can show abnormal growths.

What is cancer staging? — Cancer staging is a way in which doctors find out how far a cancer has spread.

How is prostate cancer treated? — People with prostate cancer can often choose their treatment.

The main options are:

●Active surveillance – If you choose this option, you will not have treatment right away. But you will have routine tests to check whether the cancer is starting to grow more quickly. If so, you can start active treatment then.

●Surgery – Prostate cancer can sometimes be treated with surgery to remove the prostate gland.

●Radiation therapy – Radiation kills cancer cells. Radiation can be given from a machine that moves around your body. Or a doctor might put a source of radiation directly into your prostate gland.

●Hormone therapy – Male hormones in the body make prostate cancer grow. Hormone therapy reduces the levels of these hormones, which can shrink the cancer. For hormone therapy, you might take medicines. Or you might have surgery to remove your testicles. (Male hormones are made in the testicles.) This treatment is usually only for those with advanced cancer. But some people with early-stage cancer get it along with radiation or surgery.

●Chemotherapy – Chemotherapy is the medical term for medicines that kill cancer cells or stop them from growing. If you have advanced prostate cancer, you might get chemotherapy if hormone therapy stops working. In some cases, chemotherapy and hormone therapy are given at the same time.

Some people, especially older males with other serious medical conditions, might choose not to do any of the above. Instead, they might choose "watchful waiting." Watchful waiting is not exactly the same as active surveillance. It does not require regular testing, but involves treating symptoms when they happen.

How do I choose which treatment to have? — You and your doctor will have to work together to choose the right treatment for you. The right treatment will depend on:

●The stage of your cancer

●Your age

●Whether you have other health problems

●How you feel about the treatment options

Always let your doctors and nurses know how you feel about a treatment. Any time you are offered a treatment, ask:

●What are the benefits of this treatment? Is it likely to help me live longer? Will it reduce or prevent symptoms?

●What are the downsides to this treatment?

●Are there other options besides this treatment?

●What happens if I do not have this treatment?

What happens after treatment? — After treatment, you might keep getting checked to see if the cancer comes back or starts growing more quickly. Others choose not to be checked. Follow-up tests can include PSA tests, exams, biopsies, or imaging tests.

What happens if the cancer comes back or spreads? — If the cancer comes back, you might have more radiation therapy, surgery, or hormone therapy. You might also have chemotherapy or immunotherapy. Immunotherapy is the medical term for medicines, including vaccines, that work with the body's infection-fighting system (the "immune system") to stop cancer growth.

Can prostate cancer be prevented? — Those who are at high risk of getting prostate cancer can sometimes take a medicine to help prevent the disease. If you have a family history of prostate cancer, talk to your doctor.

More on this topic

Patient education: Cancer screening (The Basics)
Patient education: What are clinical trials? (The Basics)
Patient education: Choosing treatment for low-risk localized prostate cancer (The Basics)
Patient education: Bone metastases (The Basics)
Patient education: Prostate biopsy (The Basics)
Patient education: Prostate removal surgery (The Basics)

Patient education: Treatment for advanced prostate cancer (Beyond the Basics)
Patient education: Prostate cancer screening (Beyond the Basics)