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Top questions about prostate cancer

What you should know about prostate cancer

Prostate cancer is the most common type of cancer found in American men, after skin cancer. If you or a loved one is diagnosed with prostate cancer, one of the first things you can do is educate yourself about the disease and available treatment options.

What is prostate cancer?

Prostate cancer is cancer that occurs in a man’s prostate—the walnut-size gland in the male reproductive system. It is located below the bladder in front of the rectum and surrounds the upper part of the urethra, the tube that empties urine from the bladder. The prostate helps regulate bladder control and produces the seminal fluid that nourishes and transports sperm. Prostate cancer is one of the most common types of cancer in men.

What causes prostate cancer?

It is not yet known what specifically causes prostate cancer, but there are several risk factors for the disease, including age.

What are symptoms or signs of prostate cancer?

Early prostate cancer usually causes no symptoms. Typically it is found by a PSA test or digital rectal exam.

When should I start testing for prostate cancer?

There are benefits and risks to being tested. Three key groups—the American Cancer Society, the National Comprehensive Cancer Network and the American Urological Association—have urged family physicians to discuss the value and risks of routine testing with all male patients, taking into consideration their unique medical history. However, it’s worth noting that the majority of studies of prostate cancer prevention, screening, treatment and outcomes dramatically underestimate the risk to African American men, who are 60 percent more likely to get prostate cancer.

If I have prostate cancer, should I see a urologist or an oncologist for treatment?

The main types of doctors who treat prostate cancer include:

  • Urologists: surgeons who treat diseases of the urinary system and male reproductive system (including the prostate)
  • Radiation oncologists: doctors who treat cancer with radiation therapy
  • Medical oncologists: doctors who treat cancer with medicines such as chemotherapy or hormone therapy
  • Surgical oncologists: doctors who treat cancer by removing tumors and surrounding tissue during an operation. Surgical oncologists also perform certain types of biopsies.

Depending on your case, you may see one or a combination of those doctors.

What are the potential side effects of prostate cancer treatment?

There are possible risks and potential side effects with any type of treatment for prostate cancer. They include incontinence, urinary issues, sexual dysfunction, hot flashes, hair loss, nausea and fatigue. Other side effects, such as lymphedema, are also possible, depending on the type of treatment. Some of these may be temporary, while others are long term.

Questions about prostate cancer treatment

Treatment for prostate cancer depends on many factors, including the type and location of the disease. Here are the answers to some common questions about prostate cancer treatment:

Should I consider surgery?

Candidates for surgery to treat prostate cancer have one or more of the following characteristics:

  • Overall good health
  • No spread of cancer to bone
  • Tumor confined to the prostate gland (stages T1 and T2)
  • Under the age of 70
  • Expected to live another 10 years or more

Depending on the extent of your disease, there are two main surgical options: radical (open) prostatectomy or robotic or laparoscopic prostatectomy.

Is radiation an option for me?

Radiation therapy uses targeted energy, similar to X-rays, to kill cancer cells, shrink tumors and provide relief of certain cancer-related symptoms. Radiation may be used instead of surgery in men with early-stage prostate cancer that has not spread to other parts of the body. It may also be used in combination with surgery to ensure that all cancerous tissue has been removed.

At Cancer Treatment Centers of America® (CTCA), our radiation oncologists use a variety of therapies and tools to deliver maximum radiation doses to tumors, with less damage to healthy tissues and organs. Focusing the radiation directly on the tumor may lower the risk of side effects. Our range of radiation therapy options includes external beam radiation therapy, stereotactic body radiation therapy, high-dose rate brachytherapy and low-dose rate brachytherapy.

Can I treat my prostate cancer with chemotherapy?

Chemotherapy is the use of strong drugs to kill cancer cells. It is not a common treatment for prostate cancer, but it may be used if cancer has spread outside the prostate gland and hormone therapy has been unsuccessful. Typically, chemotherapy drugs for prostate cancer are usually given intravenously (injected into a vein). Doctors give chemotherapy in cycles, with each period of treatment followed by a rest period to allow the body time to recover. Each cycle typically lasts for a few weeks.

What is active surveillance?

When you receive a prostate cancer diagnosis, your natural inclination may be to remove the cancer immediately. But not all prostate cancers are aggressive and many do not spread at the same rate. For some patients, the recommended treatment may just be to keep a close eye on the disease, through a strategy known as active surveillance. Active surveillance may be recommended for patients with:

  • A small tumor that is confined to the prostate
  • A slow-growing cancer
  • A cancer that is at low risk of growing locally or spreading

Active surveillance is not the recommended treatment for every patient with localized prostate cancer. A number of men, given the possibility that the cancer could become more aggressive, prefer to eliminate even the smallest tumor and accept the risk of side effects from treatment. It’s a very personal decision, and we’re here to explain all of your options and answer your questions or concerns.

How does hormone therapy work?

Male hormones (androgens, the most common of which is testosterone) typically fuel the growth of prostate cancer. Hormone therapy for prostate cancer is treatment that decreases the body’s levels of androgens (called androgen deprivation therapy, or ADT) and shrinks the size of the cancer in the prostate as well as other areas (metastases).

Am I a candidate for immunotherapy?

In patients with metastatic prostate cancer, immune therapies may be recommended as a second-line treatment for patients who have not been successful with hormone therapy.

Questions to ask your doctor

Asking questions of your doctor may help you make more informed decisions about your care. Open communication between a patient and his doctor is extremely important. Here are answers to some common questions prostate cancer patients should ask their doctors:

What is a prostate-specific antigen (PSA) level?

PSA is a substance produced by the prostate. It is mostly found in semen. The levels of PSA in the blood may be higher in men who have prostate cancer or other conditions. A PSA test is used primarily to screen for prostate cancer. A PSA test measures the amount of prostate-specific antigen (PSA) in your blood. Small amounts of PSA ordinarily circulate in the blood. The PSA test may detect high levels of PSA that could indicate the presence of prostate cancer. However, many other conditions, such as an enlarged or inflamed prostate, may also increase PSA levels.

What is a Gleason score?

The Gleason scale, developed by physician Donald Gleason in the 1960s, provides a score that helps predict the aggressiveness of prostate cancer. Pathologists assign two grades to prostate cancers ranging from one to five based on how they look under a microscope. This is called the Gleason score. The first, called the primary grade, is determined by observing the area where the prostate cancer cells are most prominent. The secondary grade considers the area where the cells are almost as prominent. These two numbers added together produce the total Gleason sum. This is a number between two and 10. A higher score means the cancer is more likely to spread.

A Gleason score between two and six means the cancer is likely to grow and spread very slowly. If the cancer is small, many years may pass before it becomes a problem. Thus, you may never need cancer treatment.

A Gleason score of seven means the cancer is likely to grow and spread at a modest pace. If the cancer is small, several years may pass before it becomes a problem. To prevent problems, treatment is needed.

A Gleason score between eight and 10 signifies the cancer is likely to grow and spread fast. If the cancer is small, a few years may pass before the cancer becomes a problem. To prevent problems, treatment is needed now.

How likely is my cancer to progress without treatment?

Oncologists who treat prostate cancer take a number of factors into consideration that predict how fast the cancer will grow. These factors include the clinical stage of the cancer, the PSA level and the appearance of the prostate cancer cells under the microscope (the Gleason sum). Together, these factors may be used to predict an individual’s risk of prostate cancer progression.

How much experience do you have treating my type and stage of prostate cancer?

Prostate cancer may be quite dangerous. But when caught early, it may be treated with a high success rate. Oncologists who are not only experienced in treating cancer but in treating your type of cancer are better equipped to explain the comprehensive treatment options available. When it comes to prostate cancer surgery, often the experience and skill of a surgeon is a major factor in the success of the operation. Don’t hesitate to ask whether your oncologist has experience treating prostate cancer and whether he or she is a board-certified specialist.

Next topic: What are the facts about prostate cancer?

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