What is prostate cancer?

The prostate is part of the male reproductive system. It is a small organ below the bladder that makes fluid for semen. The prostate surrounds the urethra, the tube that carries urine from the bladder out of the body through the penis. Prostate cancer is the abnormal growth of cells in the prostate gland. Prostate cancer cells can spread within the prostate, to nearby lymph nodes and other tissues, and to other parts of the body.

When the cancer hasn't spread outside the prostate, it is called localized prostate cancer. With localized prostate cancer, your options depend on how likely it is that your cancer will grow. Test results, including the Gleason score from your prostate biopsy, will show if your cancer is likely to grow.

• Low-risk cancer isn't likely to grow right away. If your cancer is low-risk, you can choose active surveillance. This means your cancer will be watched closely by your doctor with regular checkups and tests to see if the cancer grows. This choice allows you to delay having surgery or radiation, often for many years. If the cancer grows very slowly, you may never need treatment.
• Medium-risk cancer is more likely to grow. Some people with this type of cancer may be able to choose active surveillance. Others may need to choose surgery or radiation.
• High-risk cancer is most likely to grow. If you have high-risk cancer, you will likely need to choose surgery or radiation.

If your cancer has already spread outside the prostate or to other parts of the body, then you may have other treatments, like chemotherapy or hormone therapy.

If you are older or have other serious health problems, like heart disease, you may choose not to have treatments to cure your cancer. Instead, you can just have treatments to manage your symptoms. This is called watchful waiting.

Prostate cancer usually grows slowly. It usually takes years to get large enough to cause any problems. But sometimes it grows quickly. When prostate cancer spreads beyond the prostate, it goes first to the lymph nodes in the pelvis, and then on to the bones, lungs, or other organs.

About 12 out of 100 men in the U.S. will be diagnosed with prostate cancer sometime during their lifetime. But most people who are diagnosed with prostate cancer don't die from it.

Prostate cancer usually doesn't cause symptoms in its early stages. Most people don't know they have it until it is found during a regular medical exam.

When there are symptoms of prostate cancer, they often include urinary problems, such as:

• Not being able to urinate at all.
• Having a hard time starting or stopping the flow of urine.
• Having to urinate often, especially at night.
• Feeling pain or burning during urination.

Less common symptoms may include:

• Difficulty having an erection.
• Blood in your urine or semen.
• Deep and frequent pain in your lower back, belly, hip, or pelvis.

Treatment for localized prostate cancer is based on many things, including your age and overall health. One important factor is the risk that the cancer will grow. Test results, including the Gleason score from your prostate biopsy, can show if the cancer is likely to grow.

• Low-risk cancer isn't likely to grow right away. Active surveillance may be a good choice. It lets you avoid or delay treatments that can cause serious side effects. If the cancer grows very slowly, you may never need treatment. Radiation therapy or surgery to remove the prostate may also be options.
• Medium-risk cancer is more likely to grow. Active surveillance may be an option for some people who have a medium-risk cancer. Others may need to be treated with radiation therapy or surgery.
• High-risk cancer is most likely to grow and spread. A combination of treatments may be used, such as surgery, radiation therapy, and hormone therapy.

Your doctor will talk with you about your options and then make a treatment plan.

There are some risk factors for prostate cancer that you can't control, such as getting older or inheriting certain gene changes. But you may be able to help lower your risk for prostate cancer (and some other cancers) by staying at a healthy weight, being active, and not smoking.

Your doctor will ask you about your family history and your medical history. You'll have a physical examination that includes a digital rectal exam, in which the doctor inserts a gloved finger into your rectum to feel your prostate.

Other tests may include:

• Blood tests, such as a prostate-specific antigen (PSA) and a complete blood count (CBC).
• Imaging tests, such as:
  • A transrectal ultrasound.
  • An MRI, a multiparametric MRI (mpMRI), or a positron emission tomography MRI (PET-MRI).
  • A CT scan or a PET-CT scan.
  • A bone scan.
• Prostate biopsy. A biopsy is the only way to confirm whether you have prostate cancer.
• Genetic tests. These include tests to look for inherited gene changes and tests that look for biomarkers.

The side effects of hormone therapy for prostate cancer depend in part on the type of therapy you have. Your doctor can tell you what to expect. In general, possible side effects include:

• Erection problems and reduced sex drive.
• Thin or brittle bones (osteoporosis).
• Increased risk for diabetes and heart disease.
• Weight gain.
• Changes in appearance, such as thinning hair, smaller genitals, and larger breasts.
• Reduced muscle mass.
• Hot flashes.
• Fatigue.
• Mood swings.

Some of the side effects of hormone therapy medicines may go away after you stop taking the medicine. Surgery (bilateral orchiectomy) tends to cause fewer side effects, but any side effects will be permanent.

Be sure to tell your doctor about any problems you have. Treatment and healthy lifestyle changes can help with some side effects.

Prostate cancer can be treated by a urologist, a urologic oncologist, a radiation oncologist, or a medical oncologist. Urinary symptoms can be checked by a family medicine doctor, an internal medicine doctor, or a urologist. Symptoms can also be checked by a physician assistant or a nurse practitioner.

Taking medicines as prescribed and getting enough sleep may help you feel better. Try to eat foods with protein and extra calories. Try to be active each day if you can. Talk to your doctor if pain keeps you from your daily activities. Consider joining a support group or talking with a counselor.

Cryosurgery uses extreme cold to destroy cancer cells. It may be used to treat early prostate cancer. It’s an option for those who can't have radiation therapy or a more invasive type of surgery. Or it may be used to treat prostate cancer that has come back after radiation therapy.

During this treatment, very thin needles, or probes, are put into the prostate. The doctor uses ultrasound to guide the probes into place. A very cold gas is passed through the probes. The gas freezes the prostate and destroys cancer cells.

A type of cryosurgery called focal cryotherapy may be an option in some cases. This targets just the tumor rather than the whole prostate. This may lead to fewer side effects, but the risk of cancer coming back (recurrence) is higher.

Some things can increase your chances of getting prostate cancer. These risk factors include:

Age.

Getting older is the main risk factor for prostate cancer. Most cases occur after age 65.

Family history.

Your chances of getting the disease are higher if someone in your family has had it. Your risk also depends on the age at which your relative was diagnosed.

Race.

Prostate cancer is more common among African-American people than people of other races.

What is localized prostate cancer?

Prostate cancer is the abnormal growth of cells in the prostate gland. Cancer that has not spread outside the prostate gland is called localized prostate cancer.

People with localized prostate cancer have options for their care. Some people with a slowly growing cancer choose active surveillance. This means that their doctors will watch them closely with regular checkups and tests. If their cancer grows, then they can decide about treatment. And some people choose watchful waiting. This means they don't want any treatment that tries to cure their cancer. Other people choose to treat their cancer right away. They can choose to have radiation to destroy the cancer cells in the prostate. Or they can choose to have surgery to remove the prostate (radical prostatectomy).

Test results, including the Gleason score from your prostate biopsy, show if a localized prostate cancer is likely to grow.

• Low-risk means that the cancer isn't likely to grow right away. There is a chance that it may grow so slowly that it never causes any problems.
• Medium-risk means that the cancer is more likely to grow.
• High-risk means that the cancer will most likely grow right away.

Some people may have limited treatment choices because of their health. For example, a person who has serious health concerns may not be well enough to have surgery. Or a person who has a serious bowel disease such as ulcerative colitis may not be able to have radiation. Your doctor will help you know if you have options.

This information is about choosing between radiation or surgery.

What are the key points about this decision?

• Radiation or surgery may be used to treat your prostate cancer. Both treatments work well. With either treatment, the chance of your cancer spreading is low.
• Both treatments can have side effects, such as bladder, bowel, and erection problems. Radiation is more likely to cause bowel problems. Surgery is more likely to cause leaking urine or erection problems.
• How you feel about each treatment may affect your choice. For example, you may choose surgery because you want the cancer removed through an operation. Or you may choose radiation because you want to avoid major surgery and its risks.

Why might you choose surgery?

If your goal is to treat the cancer by having your prostate removed, then you may want to choose surgery. For some people, the idea of "getting the cancer out" brings a sense of relief. For others, avoiding radiation may be what is important to them.

Why might you choose radiation?

If your goal is to treat the cancer and avoid the risks of major surgery, then you may want to choose radiation. For some people, preserving their sexual function for as long as possible is what they value most. Having radiation rather than surgery may help them avoid erection problems.

Your decision

To make the decision that is best for you, take the time to understand your options. Sometimes the medical facts will guide your decision. But a good decision also reflects what matters most to you. This includes how you feel about radiation or surgery and the likely side effects.

• Find out about the treatments. What would your radiation treatment plan be like? Or if you choose surgery, how would your surgery be done?
• Find out about the side effects. How important to you is being sexually active and being able to maintain an erection? If leaking urine is a side effect of your surgery, how much would that bother you?

Think about what you value. Then talk with your doctor.

Prostate cancer is the abnormal growth of cells in the prostate gland. (The prostate is part of the male reproductive system. It is a small organ below the bladder that makes fluid for semen.)

Most cases of prostate cancer occur after age 65. It usually grows slowly and can take years to grow large enough to cause any problems.

In some cases, the cancer grows more quickly. It may spread within the prostate, to nearby lymph nodes and other tissues, and to other parts of the body. But usually prostate cancer is found early, before the cancer has spread outside the prostate.

Experts don't know exactly what causes prostate cancer. But they do know that changes in the body's DNA are involved. These include DNA changes that are inherited as well as those that happen as you get older.

The prostate usually gets larger as you age. Having an enlarged prostate doesn't increase your chance of getting prostate cancer. But an enlarged prostate is sometimes caused by prostate cancer.