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Prostate Cancer - Introduction

This section has been reviewed and approved by the Cancer.Net Editorial Board, 01/2017

ON THIS PAGE: You will find some basic information about this disease and the parts of the body it may affect. This is the first page of Cancer.Net’s Guide to Prostate Cancer. To see other pages, use the menu. Think of that menu as a roadmap to this full guide.

About the prostate

The prostate is a walnut-sized gland located behind the base of a man’s penis, in front of the rectum, and below the bladder. It surrounds the urethra, the tube-like channel that carries urine and semen through the penis. The prostate's main function is to make seminal fluid, the liquid in semen that protects, supports, and helps transport sperm.

About prostate cancer

Cancer begins when healthy cells in the prostate change and grow out of control, forming a tumor. A tumor can be cancerous or benign. A cancerous tumor is malignant, meaning it can grow and spread to other parts of the body. A benign tumor means the tumor can grow but will not spread.

Prostate cancer is somewhat unusual when compared with other types of cancer. This is because many prostate tumors do not spread to other parts of the body. Some prostate cancers grow very slowly and may not cause symptoms or problems for years. Even when prostate cancer has spread to other parts of the body, it often can be managed, allowing men with advanced prostate cancer to live with good health and quality of life for several years. However, if the cancer cannot be well controlled with existing treatments, it can cause pain, fatigue, and sometimes, death.

About prostate-specific antigen (PSA)

Prostate-specific antigen (PSA) is a protein produced by cells in the prostate gland. PSA is detected using a blood test. Higher-than-normal levels of PSA can be found in men with prostate cancer, as well as other non-cancerous prostate conditions. Those conditions include benign prostatic hyperplasia (BPH), which is an enlarged prostate, and prostatitis, which is inflammation or infection of the prostate. In addition, ejaculation and riding a bicycle can temporarily increase PSA values, so these activities should be avoided before people have PSA testing. See the Screening section for more information.

More than 95% of prostate cancers are a type called adenocarcinomas. A rare type of prostate cancer known as neuroendocrine cancer or small cell cancer tends to be more aggressive, spread outside the prostate earlier, and usually does not make too much PSA. Read more about neuroendocrine tumors.

Looking for More of an Introduction?

If you would like more of an introduction, explore these related items. Please note that these links will take you to other sections on Cancer.Net:

The next section in this guide is Statistics. It helps explain how many men are diagnosed with this disease and general survival rates. Or, use the menu to choose another section to continue reading this guide.

Prostate Cancer - Statistics

This section has been reviewed and approved by the Cancer.Net Editorial Board, 01/2017

ON THIS PAGE: You will find information about the number of men who are diagnosed with prostate cancer each year. You will also read information on surviving the disease. Remember, survival rates depend on several factors. Use the menu to see other pages.

Prostate cancer is the most common cancer among men, except for skin cancer. This year, an estimated 161,360 men in the United States will be diagnosed with prostate cancer. For unknown reasons, the risk of prostate cancer is 74% higher in black men than in non-Hispanic white men. Most prostate cancers (92%) are found when the disease is confined to the prostate and nearby organs. This is referred to as the local or regional stage.

The 5-year survival rate tells you what percent of men live at least 5 years after the cancer is found. Percent means how many out of 100. The 5-year survival rate for most men with local or regional prostate cancer is almost 100%. Ninety-eight percent (98%) are alive after 10 years, and 96% live for at least 15 years. For men diagnosed with prostate cancer that has spread to other parts of the body, the 5-year survival rate is 29%.

Prostate cancer is the third leading cause of cancer death in men in the United States. It is estimated that 26,730 deaths from this disease will occur this year. Although the number of deaths from prostate cancer continues to decline among all men, the death rate remains more than twice as high in black men than any other group. A man’s individual survival depends on the type of prostate cancer and the stage of the disease.

It is important to remember that statistics on the survival rates for men with prostate cancer are an estimate. The estimate comes from annual data based on the number of men with this cancer in the United States. Also, experts measure the survival statistics every 5 years. So the estimate may not show the results of better diagnosis or treatment available for less than 5 years. People should talk with their doctor if they have questions about this information. Learn more about understanding statistics.

Statistics adapted from the American Cancer Society's publication, Cancer Facts & Figures 2017.

The next section in this guide is Medical Illustrations. It offers drawings of body parts often affected by this disease. Or, use the menu on the left side of your screen to choose another section to continue reading this guide.

Prostate Cancer - Medical Illustrations

This section has been reviewed and approved by the Cancer.Net Editorial Board, 01/2017

ON THIS PAGE: You will find a basic drawing of the main body parts affected by this disease. To see other pages, use the menu.

The illustration shows the male urinary tract. Two kidneys are located on either side of the spine near the bottom of the rib cage. Each kidney connects to a ureter through the renal pelvis and calyx. The ureters run down the body to connect to the bladder, which is located in the pelvic cavity in front of the rectum and directly above the prostate. The prostate is a walnut-sized gland located at the base of the penis. A cross-section of the bladder and prostate shows the 2 ureteric orifices where the ureters connect to the bladder and that the prostate is located directly under the bladder and surrounds the urethra, which allows urine and seminal fluid to exit the body through the penis. Under the prostate, layers of corpus spongiosum tissue and bulbospongiosus muscle surround the urethra. Copyright 2003 American Society of Clinical Oncology. Robert Morreale/Visual Explanations, LLC.

For medical illustrations showing the different stages of prostate cancer, please visit the Stages and Grades section.

The next section in this guide is Risk Factors and Prevention. It explains what factors may increase the chance of developing this disease and what men can do to lower their risk. Or, use the menu on the side of your screen to choose another section to continue reading this guide.

Prostate Cancer - Risk Factors and Prevention

This section has been reviewed and approved by the Cancer.Net Editorial Board, 01/2017

ON THIS PAGE: You will find out more about the factors that increase the chance of developing this type of cancer. To see other pages, use the menu.

A risk factor is anything that increases a person’s chance of developing cancer. Although risk factors often influence the development of cancer, most do not directly cause cancer. Some people with several risk factors never develop cancer, while others with no known risk factors do. However, knowing your risk factors and talking about them with your doctor may help you make more informed lifestyle and health care choices.

The following factors may raise a man’s risk of developing prostate cancer:

  • Age. The risk of prostate cancer increases with age, especially after age 50. More than 80% of prostate cancers are diagnosed in men who are 65 or older.

  • Race/ethnicity. Black men have a higher risk of prostate cancer than white men. They are also more likely to develop prostate cancer at an earlier age and to have aggressive tumors that grow quickly. The exact reasons for these differences are not known and may involve socioeconomic or other factors. Hispanic men have a lower risk of developing prostate cancer and dying from the disease than non-Hispanic white men.

Prostate cancer occurs most often in North America and northern Europe. It also appears that prostate cancer is increasing among Asian men living in urbanized environments, such as Hong Kong, Singapore, and North American and European cities, particularly among those who have a lifestyle with less physical activity and a less healthy diet.

  • Family history. Prostate cancer that runs in a family, called familial prostate cancer, occurs about 20% of the time. This type of prostate cancer develops because of a combination of shared genes and shared environmental or lifestyle factors.

    Hereditary prostate cancer, meaning the cancer is inherited, is rare and accounts for about 5% of cases. Hereditary prostate cancer occurs when gene mutations are passed down within a family from 1 generation to the next. Hereditary prostate cancer may be suspected if a man’s family history includes any of the following characteristics:

    • 3 or more first-degree relatives with prostate cancer

    • Prostate cancer in 3 generations on the same side of the family

    • 2 or more close relatives, such as a father, brother, son, grandfather, uncle, or nephew, on the same side of the family diagnosed with prostate cancer before age 55

If a man has a first-degree relative, meaning a father, brother, or son, with prostate cancer, his risk of developing prostate cancer is 2 to 3 times higher than the average risk. This risk increases with the number of relatives diagnosed with prostate cancer. 

  • Hereditary breast and ovarian cancer (HBOC) syndrome. HBOC is associated with mutations to the BRCA1 and/or BRCA2 genes. BRCA stands for BReast CAncer. HBOC is most commonly associated with an increased risk of breast and ovarian cancers in women. However, men with HBOC also have an increased risk of developing breast cancer and a more aggressive form of prostate cancer. Mutations in the BRCA1 and BRCA2 genes are thought to cause only a small percentage of familial prostate cancers. Men who have BRCA1 or BRCA2 mutations should consider screening for prostate cancer at an earlier age. Genetic testing may only be appropriate for families with prostate cancer that may also have HBOC. Talk with a genetic counselor or doctor for more information.

  • Other genetic changes. Other genes that may carry an increased risk of developing prostate cancer include HPC1, HPC2, HPCX, and CAPB. However, none of them has been shown to cause prostate cancer or be specific to this disease. Research to identify genes associated with an increased risk of prostate cancer is ongoing, and researchers are constantly learning more about how specific genetic changes can influence the development of prostate cancer. Currently there are no genetic tests available to determine a man's chance of developing prostate cancer.

  • Agent Orange exposure. The U.S. Department of Veterans Affairs lists prostate cancer as a disease associated with exposure to Agent Orange, a chemical used during the Vietnam War.

  • Diet. No study has proven that diet and nutrition can directly cause or prevent the development of prostate cancer. However, many studies that look at links between certain eating behaviors and cancer suggest there may be a connection.

Prevention

Different factors cause different types of cancer. Researchers continue to look into what factors cause this type of cancer. Although there is no proven way to completely prevent this disease, you may be able to lower your risk. Talk with your doctor for more information about your personal risk of cancer.

Hormones and chemoprevention

High levels of testosterone, a male sex hormone, may speed up or cause the development of prostate cancer. For instance, it is very uncommon for a man whose body no longer makes testosterone to develop prostate cancer. In addition, stopping the body’s production of testosterone, called androgen deprivation therapy (ADT), often shrinks a prostate tumor. See the Treatment Options section for more information.

A class of drugs called 5-alpha-reductase inhibitors (5-ARIs), which includes dutasteride (Avodart) and finasteride (Proscar), may lower a man’s risk of developing prostate cancer. In clinical trials, both drugs have reduced the risk of prostate cancer. Some previous studies suggested that 5-ARIs were linked to more aggressive prostate cancers, but newer studies have shown this claim isn’t true. Interestingly, according to the results of a long-term follow-up study published in 2013, 78% of men taking finasteride or a placebo were alive 15 years later. These results suggest that taking finasteride does not decrease in the risk of death for men with prostate cancer. This subject remains controversial, and the U.S. Food and Drug Administration (FDA) has not approved these drugs for prostate cancer prevention. However, 5-ARI is FDA approved for the treatment of lower urinary tract symptoms. Because the decision to take a 5-ARI is different for each patient, any men considering taking this class of medications should discuss the benefits and side effects with their doctor.

Dietary changes

There is not enough information right now to make clear recommendations about the role diet plays in prostate cancer. Dietary changes may need to be made many years earlier in a man’s life to reduce the risk of developing prostate cancer.

Here is a brief summary of the current research:

  • A diet high in fat, especially animal fat, may increase prostate cancer risk. However, no prospective studies, meaning studies that look at men who follow either high-fat or low-fat diets and then measure the total number of men in each group diagnosed with prostate cancer, have yet shown that diets high in animal fat raise the risk of prostate cancer.

  • A diet high in vegetables, fruits, and legumes, such as beans and peas, may decrease the risk of prostate cancer. It is unclear which nutrients are directly responsible. Although lycopene, the nutrient found in tomatoes and other vegetables, has been linked to a lower risk of prostate cancer, the data so far have not demonstrated a relationship.

  • Currently no specific vitamins, minerals, or other supplements have conclusively shown in clinical trials to prevent prostate cancer. Some, including vitamin D, vitamin E, and selenium, may even be harmful for some men. Men should talk with their doctors before taking any supplements to prevent prostate cancer.

  • Specific changes to diet may not stop or slow the development of prostate cancer, and it is possible such changes would need to be made early in life to have an effect.

The next section in this guide is Screening. It explains how tests may find cancer before signs or symptoms appear. Or, use the menu to choose another section to continue reading this guide.

Prostate Cancer - Screening

This section has been reviewed and approved by the Cancer.Net Editorial Board, 01/2017

ON THIS PAGE: You will find out more about screening for this type of cancer. You will also learn the risks and benefits of screening. To see other pages, use the menu.

Screening is used to look for cancer before you have any symptoms or signs. Scientists have developed, and continue to develop, tests that can be used to screen a person for specific types of cancer. The overall goals of cancer screening are to:

  • Lower the number of people who die from the disease, or eliminate deaths from cancer altogether

  • Lower the number of people who develop the disease

Learn more about the basics of cancer screening.

Screening information for prostate cancer

Screening for prostate cancer is done to find evidence of cancer in otherwise healthy men. Two tests are commonly used to screen for prostate cancer:

  • Digital rectal examination (DRE). A DRE is a test in which the doctor inserts a gloved lubricated finger into a man’s rectum and feels the surface of the prostate for any irregularities.

  • PSA blood test. There is controversy about using the PSA test to look for prostate cancer in men with no symptoms of the disease. On one hand, the PSA test is useful for detecting early-stage prostate cancer, which helps many men get the treatment they need before the cancer spreads. On the other hand, PSA screening finds conditions that are not cancer, in addition to prostate cancers that would never threaten a man’s life. As a result, screening for prostate cancer may mean that some men have surgery and other treatments that may not be needed and may seriously affect a man’s quality of life.

    ASCO recommends that men with no symptoms of prostate cancer be discouraged from PSA screening if they are expected to live less than 10 years. For men expected to live longer than 10 years, ASCO recommends that they talk with their doctors to find out if the test is appropriate for them.

    Other organizations have different recommendations for screening:

    • The U.S. Preventive Services Task Force has concluded that the potential risks of PSA screening in healthy men outweigh the potential benefits. This task force may revisit screening for prostate cancer because of the availability of newer and more sophisticated tests.

    • Both the American Urological Association and the American Cancer Society recommend that men be told the risks and benefits of testing before PSA screening occurs.

    • The National Comprehensive Cancer Network considers a patient’s age, PSA value, DRE results, and other factors in their recommendations.

It is not easy to predict which tumors will grow and spread quickly and which will grow slowly. Every man should discuss his situation and personal risk of prostate cancer with his doctor so they can work together to make a decision.

The next section in this guide is Symptoms and Signs, and it explains what body changes or medical problems this disease can cause. Or, use the menu to choose another section to continue reading this guide.

Prostate Cancer - Symptoms and Signs

This section has been reviewed and approved by the Cancer.Net Editorial Board, 01/2017

ON THIS PAGE: You will find out more about body changes and other things that can signal a problem that may need medical care. To see other pages, use the menu.

Often, prostate cancer is found through a PSA test or DRE in men who have early-stage disease and no symptoms or signs, a process called screening. If a PSA test or DRE indicates that prostate cancer may be present, more monitoring and testing is needed to diagnose prostate cancer. When prostate cancer does cause symptoms or signs, it is usually diagnosed in a later stage. These symptoms and signs may include:  

  • Frequent urination

  • Weak or interrupted urine flow or the need to strain to empty the bladder

  • Blood in the urine

  • The urge to urinate frequently at night

  • Blood in the seminal fluid

  • New onset of erectile dysfunction

  • Pain or burning during urination, which is much less common

  • Discomfort when sitting, caused by an enlarged prostate

Sometimes men with prostate cancer do not have any of these changes. Or, the cause of a symptom may be another medical condition that is not cancer. Other noncancerous conditions, such as BPH or an enlarged prostate, can cause similar symptoms. Urinary symptoms also can be caused by an infection or other conditions.

If cancer has spread outside of the prostate gland, a man may experience:

  • Pain in the back, hips, thighs, shoulders, or other bones

  • Swelling or edema in the legs or feet

  • Unexplained weight loss

  • Fatigue

  • Change in bowel habits

If you are concerned about any changes you experience, please talk with your doctor. Your doctor will ask how long and how often you have been experiencing the symptom(s), in addition to other questions. This is to help find out the cause of the problem, called a diagnosis.

If cancer is diagnosed, relieving symptoms remains an important part of cancer care and treatment. This may also be called symptom management, palliative care, or supportive care. Be sure to talk with your health care team about symptoms you experience, including any new symptoms or a change in symptoms.

The next section in this guide is Diagnosis. It explains what tests may be needed to learn more about the cause of the symptoms. Or, use the menu to choose another section to continue reading this guide.

Prostate Cancer - Diagnosis

This section has been reviewed and approved by the Cancer.Net Editorial Board, 01/2017

ON THIS PAGE: You will find a list of common tests, procedures, and scans that doctors use to find the cause of a medical problem. To see other pages, use the menu.

Doctors use many tests to find, or diagnose, cancer. They also do tests to learn if cancer has spread to another part of the body from where it started. If this happens, it is called metastasis. For example, imaging tests can show if the cancer has spread. Imaging tests show pictures of the inside of the body. Doctors may also do tests to learn which treatments could work best.

For most types of cancer, a biopsy is the only sure way for the doctor to know whether an area of the body has cancer. In a biopsy, the doctor takes a small sample of tissue for testing in a laboratory. If a biopsy is not possible, the doctor may suggest other tests that will help make a diagnosis, but this situation is rare for prostate cancer. For example, a biopsy may not be done when a patient has another medical problem that makes it difficult to do a biopsy, or when a person has a very high PSA level and a bone scan that indicates cancer.

This list describes options for diagnosing this type of cancer. Not all tests listed below are commonly used for every person. Your doctor may consider these factors when choosing a diagnostic test:

  • The type of cancer suspected

  • Your signs and symptoms

  • Your age and medical condition

  • The results of earlier medical tests

Preliminary tests

In addition to a physical examination, the following tests may be used to diagnose prostate cancer:

  • PSA test. As described in the Introduction and Screening sections, PSA is a type of protein released by prostate tissue that is found in higher levels in a man's blood. Levels can be raised when there is abnormal activity in the prostate, including prostate cancer, BPH, or inflammation of the prostate. Doctors can look at features of the PSA value, such as absolute level, change over time, and level in relation to prostate size, to decide if a biopsy is needed. In addition, a version of the PSA test allows the doctor to measure a specific component, called the “free” PSA, which can sometimes help find out if a tumor is noncancerous or cancerous.

  • DRE. A doctor uses a DRE to find abnormal parts of the prostate by feeling the area using a finger. It is not very precise; therefore, most men with early prostate cancer have normal DRE test results. See the Screening section for more information.

  • Biomarker tests. A biomarker is a substance that is found in the blood, urine, or body tissues of a person with cancer. It is made by the tumor or by the body in response to the cancer. A biomarker may also be called a tumor marker. Biomarker tests for prostate cancer include the 4Kscore, which predicts the chances a man will develop high-risk prostate cancer, and the Prostate Health Index (PHI), which predicts the chances a man will develop prostate cancer.

Confirming the diagnosis

If the PSA or DRE test results are abnormal, then the following tests can help confirm a diagnosis of cancer:

  • PCA3 test. The Prostate CAncer gene 3 (PCA3) assay looks for the PCA3 gene in a man’s urine. Unlike PSA, the PCA3 gene is only found in prostate cancer cells. Using a urine test, a doctor can find out whether this gene is present in the body. This test does not replace PSA. It is used along with a PSA to help decide if a prostate biopsy is needed.

  • Transrectal ultrasound (TRUS). A doctor inserts a probe into the rectum that takes a picture of the prostate using sound waves that bounce off the prostate. A TRUS is usually done at the same time as a biopsy.

  • Biopsy. A biopsy is the removal of a small amount of tissue for examination under a microscope. Other tests can suggest that cancer is present, but only a biopsy can make a definite diagnosis. To get a tissue sample, a surgeon most often uses TRUS and a biopsy tool to take very small slivers of prostate tissue. Biopsy specimens will be taken from multiple areas of the prostate. This is done to ensure that a good sample is taken for examination. Most men will have 12 to 14 pieces of tissue removed, and the procedure can take 20 to 30 minutes to complete.

    A pathologist then analyzes the sample(s). A pathologist is a doctor who specializes in interpreting laboratory tests and evaluating cells, tissues, and organs to diagnose disease. A patient usually can have this procedure at the hospital or doctor’s office without needing to stay overnight. The patient is given local anesthesia beforehand to numb the area and usually receives antibiotics before the procedure to prevent infection.

    Ask to review the results of the pathology report with your health care team.

  • MRI fusion biopsy. An MRI fusion biopsy combines an MRI scan (see below) with TRUS. The patient first receives an MRI scan to identify suspicious areas of the prostate that require further evaluation. The patient then has an ultrasound of the prostate. Computer software combines these images to produce a 3D image that helps target the precise area to be biopsied. Although it may not eliminate the need for repeat biopsies, an MRI fusion biopsy can better identify areas that are more likely to be cancerous than other methods. MRI fusion biopsy should only be performed by someone with expertise in the procedure.

Finding out if the cancer has spread

To find out if cancer has spread outside of the prostate, doctors may perform the imaging tests listed below. Doctors are able to estimate the risk of spread, called metastasis, based on PSA levels, tumor grade, and other factors. Learn more about when these tests are recommended to find out if the cancer has spread.

  • Bone scan. A bone scan uses a radioactive tracer to look at the inside of the bones. The tracer is injected into a patient’s vein. It collects in areas of the bone and is detected by a special camera. Healthy bone appears gray to the camera, and areas of injury, such as those caused by cancer, appear dark.

  • Computed tomography (CT or CAT) scan. A CT scan creates a 3-dimensional picture of the inside of the body using x-rays taken from different angles. A computer then combines these images into a detailed, cross-sectional view that shows any abnormalities or tumors. A CT scan can also be used to measure the tumor’s size. Sometimes, a special dye called a contrast medium is given before the scan to provide better detail on the image. This dye can be injected into a patient’s vein or given as a liquid to swallow.

  • Magnetic resonance imaging (MRI). An MRI uses magnetic fields, not x-rays, to produce detailed images of the body. MRI can also be used to measure the tumor’s size. A special dye called contrast medium is given before the scan to create a clearer picture. This dye can be injected into a patient’s vein or given as a liquid to swallow.

After diagnostic tests are done, your doctor will review all of the results with you. If the diagnosis is cancer, these results also help the doctor describe the cancer. This is called staging.

The next section in this guide is Stages and Grades. It explains the system doctors use to describe the extent of the disease and how the cancer cells look under a microscope. Or, use the menu to choose another section to continue reading this guide.

Prostate Cancer - Stages and Grades

This section has been reviewed and approved by the Cancer.Net Editorial Board, 01/2017

ON THIS PAGE: You will learn about how doctors describe a cancer’s growth or spread, as well as what the cancer cells look like under a microscope. This is called the stage and grade. To see other pages, use the menu.

Staging is a way of describing where the cancer is located, if or where it has spread, and whether it is affecting other parts of the body.

Doctors use diagnostic tests to find out the cancer's stage, so staging may not be complete until all of the tests are finished. Staging for prostate cancer also involves looking at test results to find out if the cancer has spread from the prostate to other parts of the body. Knowing the stage helps the doctor to decide what kind of treatment is best and can help predict a patient's prognosis, which is the chance of recovery. There are different stage descriptions for different types of cancer.

There are 2 types of staging for prostate cancer:

  • The clinical stage is based on the results of tests done before surgery, which includes DRE, biopsy, x-rays, CT and/or MRI scans, and bone scans. X-rays, bone scans, CT scans, and MRI scans may not always be needed. They are recommended based on the PSA level; the size of the cancer, which includes its grade and volume; and the clinical stage of the cancer.

  • The pathologic stage is based on information found during surgery, plus the laboratory results, referred to as pathology, of the prostate tissue removed during surgery. The surgery often includes the removal of the entire prostate and some lymph nodes.

TNM staging system

One tool that doctors use to describe the stage is the TNM system. Doctors use the results from diagnostic tests and scans to answer these questions:

  • Tumor (T): How large is the primary tumor? Where is it located?

  • Node (N): Has the tumor spread to the lymph nodes? If so, where and how many?

  • Metastasis (M): Has the cancer metastasized to other parts of the body? If so, where and how much?

The results are combined to determine the stage of cancer for each person. There are 5 stages: stage 0 (zero) and stages I through IV (1 through 4). The stage provides a common way of describing the cancer, so doctors can work together to plan the best treatments.

Here are more details about each part of the TNM system for prostate cancer.

Tumor (T)

Using the TNM system, the "T" plus a letter or number (0 to 4) is used to describe the size and location of the tumor. Some stages are also divided into smaller groups that help describe the tumor in even more detail. Specific tumor stage information is listed below.

TX: The primary tumor cannot be evaluated.

T0 (T plus zero): There is no evidence of a tumor in the prostate.

T1: The tumor cannot be felt during a DRE and is not seen during imaging tests. It may be found when surgery is done for another reason, usually for BPH or an abnormal growth of noncancerous prostate cells.

  • T1a: The tumor is in 5% or less of the prostate tissue removed during surgery.

  • T1b: The tumor is in more than 5% of the prostate tissue removed during surgery.

  • T1c: The tumor is found during a needle biopsy, usually because the patient has an elevated PSA level.

T2: The tumor is found only in the prostate, not other parts of the body. It is large enough to be felt during a DRE.

  • T2a: The tumor involves one-half of 1 lobe (part or side) of the prostate.

  • T2b: The tumor involves more than one-half of 1 lobe of the prostate but not both lobes.

  • T2c: The tumor has grown into both lobes of the prostate.

T3: The tumor has grown through the prostate capsule on 1 side and into the tissue just outside the prostate.

  • T3a: The tumor has grown through the prostate capsule either on 1 side or on both sides of the prostate, or it has spread to the neck of the bladder. This is also known as an extraprostatic extension (EPE).

  • T3b: The tumor has grown into the seminal vesicle(s), the tube(s) that carry semen.

T4: The tumor is fixed, or it is growing into nearby structures other than the seminal vesicles, such as the external sphincter, the part of the muscle layer that helps to control urination; the rectum; levator muscles; or the pelvic wall.

Node (N)

The “N” in the TNM staging system stands for lymph nodes. These tiny, bean-shaped organs help fight infection. Lymph nodes near the prostate in the pelvic region are called regional lymph nodes. Lymph nodes in other parts of the body are called distant lymph nodes.

NX: The regional lymph nodes cannot be evaluated.

N0 (N plus zero): The cancer has not spread to the regional lymph nodes.

N1: The cancer has spread to the regional (pelvic) lymph node(s).

Metastasis (M)

The "M" in the TNM system indicates whether the prostate cancer has spread to other parts of the body, such as the lungs or the bones. This is called distant metastasis.

MX: Distant metastasis cannot be evaluated.

M0 (M plus zero): The disease has not metastasized.

M1: There is distant metastasis.

  • M1a: The cancer has spread to nonregional, or distant, lymph node(s).

  • M1b: The cancer has spread to the bones.

  • M1c: The cancer has spread to another part of the body, with or without spread to the bone.

Cancer stage grouping

Doctors assign the stage of the cancer by combining the T, N, and M classification. See the table below the stage descriptions for all of the TNM combinations for each stage.

Stage I: Cancer is found in the prostate only, usually during another medical procedure. It cannot be felt during the DRE or seen on imaging tests. A stage I cancer is usually made up of cells that look more like healthy cells and is usually slow growing. 

Stage I Prostate Cancer

Stage IIA and IIB: This stage describes a tumor that is too small to be felt or seen on imaging tests. Or, it describes a slightly larger tumor that can be felt during a DRE. The cancer has not spread outside of the prostate gland, but the cells are usually more abnormal and may tend to grow more quickly. A stage II cancer has not spread to lymph nodes or distant organs. 

Stage IIA Prostate Cancer

Stage IIB Prostate Cancer

Stage III: The cancer has spread beyond the outer layer of the prostate into nearby tissues. It may also have spread to the seminal vesicles. 

Stage I Prostate Cancer

Stage IV: This stage describes any tumor that has spread to other parts of the body, such as the bladder, rectum, bone, liver, lungs, or lymph nodes. 

Stage IV Prostate Cancer

Recurrent: Recurrent prostate cancer is cancer that has come back after treatment. It may come back in the prostate area again or in other parts of the body. If the cancer does return, there will be another round of tests to learn about the extent of the recurrence. These tests and scans are often similar to those done at the time of the original diagnosis.

Stage Grouping Chart

Stage

T

N

M

I

T1a, T1b, or T1c

N0

M0

 

T2a

N0

M0

 

Any T1 or T2a

N0

M0

 

 

 

 

IIA

T1a, T1b, or T1c

N0

M0

 

T1a, T1b, or T1c

N0

M0

 

T2a

N0

M0

 

T2b

N0

M0

 

T2b

N0

M0

 

 

 

 

IIB

T2c

N0

M0

 

Any T1 or T2

N0

M0

 

Any T1 or T2

N0

M0

 

 

 

 

III

T3a or T3b

N0

M0

 

 

 

 

 

 

 

 

IV

T4

N0

M0

 

Any T

N1

M0

 

Any T

Any N

M1

Used with permission of the AJCC, Chicago, Illinois. The original source for this material is the AJCC Cancer Staging Manual, Seventh Edition, published by Springer-Verlag New York, www.cancerstaging.org

Gleason score for grading prostate cancer

Prostate cancer is also given a grade called a Gleason score. This score is based on how much the cancer looks like healthy tissue when viewed under a microscope. Less aggressive tumors generally look more like healthy tissue. Tumors that are more aggressive are likely to grow and spread to other parts of the body. They look less like healthy tissue.

The Gleason scoring system is the most common prostate cancer grading system used. The pathologist looks at how the cancer cells are arranged in the prostate and assigns a score on a scale of 1 to 5. Cancer cells that look similar to healthy cells receive a low score. Cancer cells that look less like healthy cells or look more aggressive receive a higher score. To assign the numbers, the doctor determines the main pattern of cell growth, which is the area where the cancer is most obvious; looks for any other less common pattern of growth; and gives each 1 a score. The scores are added together to come up with an overall score between 2 and 10.

The interpretation of the Gleason score by doctors has changed recently. Originally, doctors used a wide range of scores. Today, doctors no longer use Gleason scores of 5 or lower for cancer found with a biopsy. The lowest score used is 6, which is a low-grade cancer. A Gleason score of 7 is a medium-grade cancer, and a score of 8, 9, or 10 is a high-grade cancer. A lower-grade cancer grows more slowly and is less likely to spread than a high-grade cancer.

Doctors look at the Gleason score in addition to stage to help plan treatment. For example, active surveillance, described in the Treatment Options section, may be an option for a patient with a small tumor, low PSA level, and a Gleason score of 6. Patients with high Gleason score may need treatment that is more intensive, even if it does not appear that the cancer has spread.

Gleason X: The Gleason score cannot be determined.

Gleason 6 or lower: The cells are well differentiated, meaning they look similar to healthy cells.

Gleason 7: The cells are moderately differentiated, meaning they look somewhat similar to healthy cells.

Gleason 8, 9, or 10: The cells are poorly differentiated or undifferentiated, meaning they look very different from healthy cells.

Recently, pathologists have begun to adopt a new Gleason grouping system that arranges the scores into simplified groups that are translated as follows:

  • Gleason Group I = Former Gleason 6

  • Gleason Group II = Former Gleason 3 + 4 = 7

  • Gleason Group III = Former Gleason 4 + 3 = 7

  • Gleason Group IV = Former Gleason 8

  • Gleason Group V = Former Gleason 9 or 10

Prostate Cancer Risk Groups

In addition to stage, doctors use other prognostic factors to help plan the best treatment and predict how successful treatment will be. Two such risk assessment methods come from the National Comprehensive Cancer Network (NCCN) and the University of California, San Francisco (UCSF).

NCCN

The NCCN developed 4 risk-group categories based on PSA level, prostate size, needle biopsy findings, and the stage of cancer. The lower your risk, the lower the chance that the prostate cancer will grow and spread.

  • Very low risk. The tumor cannot be felt during a DRE and is not seen during imaging tests but was found during a needle biopsy (T1c). PSA is less than 10 ng/mL. The Gleason score is 6 or less. Cancer was found in fewer than 3 samples taken during a core biopsy. The cancer was found in half or less of any core.

  • Low risk. The tumor is classified as T1a, T1b, T1c, or T2a (see above). PSA is less than 10 ng/mL. The Gleason score is 6 or less.

  • Intermediate risk. The tumor has 2 or more of these characteristics:

    • Classified as T2b or T2c (see above)

    • PSA is between 10 and 20 ng/mL

    • Gleason score of 7

  • High risk. The tumor has 2 or more of these characteristics:

    • Classified as T3a (see above)

    • PSA level is higher than 20 ng/mL

    • Gleason score is between 8 and 10

  • Very high risk. The tumor is classified as T3b or T4 (see above). The histologic grade is 5 for the main pattern of cell growth, or more than 4 biopsy cores have Gleason scores between 8 and 10.

Source: Risk group information is adapted from the NCCN.

UCSF Cancer of the Prostate Risk Assessment (UCSF-CAPRA) score

The UCSF-CAPRA score predicts a man’s chances of having the cancer spread and of dying. This score can be used to help make decisions about the treatment plan. Points are assigned according to a person’s age at diagnosis, PSA at diagnosis, Gleason score of the biopsy, T classification from the TNM system, and the percentage of biopsy cores involved with cancer. These categories are then used to assign a score between 0 and 10.

  • CAPRA score 0 to 2 indicates low risk.

  • CAPRA score 3 to 5 indicates intermediate risk.

  • CAPRA score 6 to 10 indicates high risk.   

Information about the cancer’s stage and other prognostic factors will help the doctor recommend a specific treatment plan. The next section in this guide is Treatment Options. Or, use the menu to choose another section to continue reading this guide.

Prostate Cancer - Treatment Options

This section has been reviewed and approved by the Cancer.Net Editorial Board, 01/2017

ON THIS PAGE: You will learn about the different ways doctors use to treat men with prostate cancer. To see other pages, use the menu.

This section tells you the treatments that are the standard of care for this type of cancer. “Standard of care” means the best treatments known. When making treatment plan decisions, patients are also encouraged to consider clinical trials as an option. A clinical trial is a research study that tests a new approach to treatment. Doctors want to learn if it is safe, effective, and possibly better than the standard treatment. Clinical trials can test a new drug, a new combination of standard treatments, or new doses of standard drugs or other treatments. Your doctor can help you consider all your treatment options. To learn more about clinical trials, see the About Clinical Trials and Latest Research sections.

Treatment overview

In cancer care, different types of doctors often work together to create an overall treatment plan that may combine different type of treatments. This is called a multidisciplinary team. Cancer care teams also include a variety of other health care professionals, including physician assistants, oncology nurses, social workers, pharmacists, counselors, dietitians, and others.

Descriptions of the most common treatment options for prostate cancer are listed below, followed by an outline of general approaches to treatment according to stage. Treatment options and recommendations depend on several factors, including the type and stage of cancer, possible side effects, and the patient’s preferences and overall health. Your care plan may also include treatment for symptoms and side effects, an important part of cancer care.

Take time to learn about your treatment options and be sure to ask questions if something is unclear. Also, talk with your doctor about the goals of each treatment, the likelihood that the treatment will work, what you can expect while receiving the treatment, and the possible urinary, bowel, sexual, and hormone-related side effects of treatment. Men should also discuss with their doctor how the various treatment options affect recurrence, survival, and quality of life. In addition, the success of any treatment often depends on the skill and expertise of the physician or surgeon, so it is important to find doctors who have experience treating prostate cancer. Learn more about making treatment decisions.

Active surveillance and watchful waiting

If prostate cancer is found at an early stage, is growing slowly, and treating the cancer would cause more discomfort than the disease, a doctor may recommend active surveillance or watchful waiting.

  • Active surveillance. Prostate cancer treatments can cause side effects, such as erectile dysfunction, which is the inability to get and maintain an erection, and incontinence, which is the inability to control urine flow. These treatments for prostate cancer may seriously affect a man’s quality of life. For this reason, many men with very early prostate cancer and their doctors consider postponing cancer treatment rather than starting treatment immediately. During active surveillance, the cancer is closely monitored for signs that it is worsening.

    Active surveillance is usually preferred for men with a long life expectancy who may benefit from curative local therapy (see below) if the cancer shows signs of getting worse. ASCO endorses recommendations from CancerCare Ontario concerning active surveillance, which recommend active surveillance for most patients with a Gleason score of 6 or below with cancer that has not spread beyond the prostate. Sometimes, active surveillance may be an option for men with a Gleason score of 7.

    ASCO encourages the following testing schedule for active surveillance:

    • A PSA test every 3 to 6 months

    • A DRE at least once every year

    • Another prostate biopsy within 6 to 12 months, then a biopsy at least every 2 to 5 years

    A patient should receive treatment if the results of the tests done during active surveillance show signs of the cancer becoming more aggressive or spreading, causes pain, or blocks the urinary tract.

  • Watchful waiting. Watchful waiting may be an option for much older men and those with other serious or life-threatening illnesses who are expected to live less than 5 years. With watchful waiting, routine PSA tests, DRE, and biopsies are not usually performed. If a patient develops symptoms from the prostate cancer, such as pain or blockage of the urinary tract, then treatment may be recommended. This may include ADT (see “Systemic treatments” below). Men who start on active surveillance who later have a shorter life expectancy may switch to watchful waiting at some point to avoid repeated tests and biopsies.

Doctors must be cautious that they do not make errors in judging the disease. In other words, doctors must collect as much information as possible about the patient’s other illnesses and life expectancy to determine whether active surveillance or watchful waiting is appropriate for each patient. In addition, many doctors recommend a repeat biopsy shortly after diagnosis to confirm that the cancer is in an early stage and growing slowly before considering active surveillance for an otherwise healthy man. New information is becoming available all the time, and it is important for men to discuss these issues with their doctor to make the best decisions about treatment. Learn more about ASCO’s endorsement of recommendations for active surveillance on asco.org.

Local treatments

Local treatments get rid of cancer from a specific, limited area of the body. Such treatments include surgery and radiation therapy. For men diagnosed with early-stage prostate cancer, local treatments may get rid of the cancer completely. However, if the cancer has spread outside the prostate gland, other types of treatment called systemic treatments (see next section, below) may be needed to destroy cancer cells located in other parts of the body.

Surgery

Surgery is the removal of the tumor and some surrounding healthy tissue during an operation. It is used to try to eliminate a tumor before it spreads outside the prostate. A surgical oncologist is a doctor who specializes in treating cancer using surgery. For prostate cancer, an urologist or urologic oncologist is the surgical oncologist involved in treatment. The type of surgery depends on the stage of the disease, the man’s overall health, and other factors.

Surgical options include:

  • Radical (open) prostatectomy. A radical prostatectomy is the surgical removal of the entire prostate and the seminal vesicles. Lymph nodes in the pelvic area may also be removed. This operation has the risk of interfering with sexual function. Nerve-sparing surgery, when possible, increases the chance that a man can maintain his sexual function after surgery by avoiding surgical damage to the nerves that allow erections and orgasm to occur. Orgasm can occur even if some nerves are cut because these are 2 separate processes. Urinary incontinence is also a possible side effect of radical prostatectomy. To help resume normal sexual function, men can receive drugs, penile implants, or injections. Sometimes, another surgery can fix urinary incontinence.

  • Robotic or laparoscopic prostatectomy. This type of surgery is possibly much less invasive than a radical prostatectomy and may shorten recovery time. A camera and instruments are inserted through small keyhole incisions in the patient’s abdomen. The surgeon then directs the robotic instruments to remove the prostate gland and some surrounding healthy tissue. In general, robotic prostatectomy causes less bleeding and less pain, but the sexual and urinary side effects can be similar to those of a radical (open) prostatectomy. Talk with your doctor about whether your treatment center offers this procedure and how it compares with the results of the conventional radical (open) prostatectomy.

Learn more about the basics of cancer surgery.

Radiation therapy

Radiation therapy is the use of high-energy rays to destroy cancer cells. A doctor who specializes in giving radiation therapy to treat cancer is called a radiation oncologist. A radiation therapy regimen (schedule) usually consists of a specific number of treatments given over a set period of time.

The types of radiation therapy used to treat prostate cancer include:

  • External-beam radiation therapy. External-beam radiation therapy is the most common type of radiation treatment. The radiation oncologist uses a machine located outside the body to focus a beam of x-rays on the area with the cancer. Some cancer centers use conformal radiation therapy (CRT), in which computers help precisely map the location and shape of the cancer. CRT reduces radiation damage to healthy tissues and organs around the tumor by directing the radiation therapy beam from different directions to focus the dose on the tumor.

  • Intensity-modulated radiation therapy (IMRT). IMRT is a type of external-beam radiation therapy that uses CT scans to form a 3-dimensional (3D) picture of the prostate before treatment. A computer uses this information about the size, shape, and location of the prostate cancer to determine how much radiation is needed to destroy it. With IMRT, high doses of radiation can be directed at the prostate without increasing the risk of damaging nearby organs.

  • Proton therapy. Proton therapy, also called proton beam therapy, is a type of external-beam radiation therapy that uses protons rather than x-rays. At high energy, protons can destroy cancer cells. Current research has not shown that proton therapy provides any more benefit to men with prostate cancer than traditional radiation therapy. It is also more expensive.

  • Brachytherapy. Brachytherapy, or internal radiation therapy, is the insertion of radioactive sources directly into the prostate. These sources, called seeds, give off radiation just around the area where they are inserted and may be left for a short time (high-dose rate) or for a longer time (low-dose rate). Low-dose rate seeds are left in the prostate permanently and work for up to 1 year after they are inserted. However, how long they work depends on the source of radiation used. High-dose rate brachytherapy is usually left in the body for less than 30 minutes, but may need to be given more than once.

    Brachytherapy may be used with other treatments, such as external-beam radiation therapy and/or androgen deprivation therapy. ASCO recommends the following brachytherapy options:

    • Men with low-risk prostate cancer who need or choose an active treatment may consider low-dose rate brachytherapy. Other options include external-beam radiation therapy or a radical prostatectomy.

    • Men with intermediate-risk prostate cancer who choose external-beam radiation therapy (with or without androgen deprivation therapy) should be offered either a low-dose rate or high-dose rate brachytherapy boost. For a brachytherapy boost, a lower dose of radiation is given for a shorter period of time. Some men with intermediate-risk prostate cancer may be able to receive only brachytherapy without external-beam radiation therapy or androgen deprivation therapy.

    • Men with high-risk prostate cancer who are receiving external-beam radiation therapy and androgen deprivation therapy should be offered a low-dose rate or high-dose rate brachytherapy boost.

    Read ASCO’s recommendations for brachytherapy for prostate cancer, located on ASCO’s website.

Radiation therapy may cause immediate side effects such as diarrhea or other problems with bowel function, such as gas, bleeding, and loss of control of bowel movements; increased urinary urge or frequency; fatigue; erectile dysfunction; and rectal discomfort, burning, or pain. Most of these side effects usually go away after treatment, but erectile dysfunction is usually permanent. Many side effects of radiation therapy may not show up until months or years after treatment. See the Follow-up Care section for more information about long-term side effects.

Learn more about the basics of radiation therapy.

Focal therapies

Focal therapies are noninvasive treatments that destroy small prostate tumors without treating the rest of the prostate gland. These treatments use heat, cold, and other methods to treat cancer, primarily for men with low-risk or intermediate-risk prostate cancer. They are still being studied at this time and have not been endorsed as standard treatment options. Focal therapies are done as part of clinical trials.

An example of focal therapy is cryosurgery, also called cryotherapy or cryoablation. It is the freezing of cancer cells with a metal probe inserted through a small incision in the area between the rectum and the scrotum, the skin sac that contains the testicles. It is not an established therapy or standard of care for men newly diagnosed with prostate cancer. Cryosurgery has not been compared with radical prostatectomy or radiation therapy, so doctors do not know if it is a comparable treatment option. Its effects on urinary and sexual function are also not well defined.

Systemic treatments

Doctors use treatments such as ADT, chemotherapy, and novel agents to reach cancer cells throughout the body. This is called systemic treatment.

Androgen deprivation therapy (ADT)

Because prostate cancer growth is driven by male sex hormones called androgens, lowering levels of these hormones can help slow the growth of the cancer. The most common androgen is testosterone. Testosterone levels in the body can be lowered either by surgically removing the testicles, known as surgical castration, or by taking drugs that turn off the function of the testicles, called medical castration. Which ADT method is used is less important than the main goal: that testosterone levels are lowered.

ADT is used to treat prostate cancer in different situations, including locally advanced, recurrent prostate cancer, and metastatic prostate cancer. Metastatic prostate cancer is cancer that has spread to another part of the body. Some of the situations in which ADT may be used include:

  • Men with NCCN-based intermediate-risk and high-risk prostate cancer who are having definitive therapy with radiation therapy are candidates for ADT. Definitive therapy is a treatment given with the intent to cure the cancer. Men with intermediate-risk prostate cancer should receive ADT for at least 6 months. Those with high-risk prostate cancer should receive ADT for 24 to 36 months.

  • ADT may also be given to men who have had surgery and microscopic cancer cells were found in the removed lymph nodes. ADT is done to eliminate any remaining cancer cells and reduce the chance the cancer will return. This is known as adjuvant therapy. Although the use of adjuvant ADT is controversial, some specific patients appear to benefit from this approach.

  • ADT should also be considered as adjuvant therapy if prostate cancer has been found in the lymph nodes after a radical prostatectomy.

Specific types of ADT

  • Bilateral orchiectomy. Bilateral orchiectomy is the surgical removal of both testicles and was the first treatment used for metastatic prostate cancer more than 70 years ago. Even though this is an operation, it is considered an ADT because it removes the main source of testosterone production, the testicles. The effects of this surgery are permanent and cannot be reversed.

  • LHRH agonists. LHRH stands for luteinizing hormone-releasing hormone. Medications known as LHRH agonists prevent the testicles from receiving messages sent by the body to make testosterone. By blocking these signals, LHRH agonists reduce a man’s testosterone level just as well as removing his testicles. Unlike surgical castration, the effects of LHRH agonists are often reversible, so testosterone production usually begins again once a patient stops treatment. However, testosterone recovery can take any time from 6 months to 24 months, and for a small proportion of patients testosterone recovery does not happen.

    LHRH agonists are injected or placed as small implants under the skin. Depending on the drug used, they may be given once a month or once a year. When LHRH agonists are first given, testosterone levels briefly increase before falling to very low levels. This effect is known as a “flare.” Flares occur because the testicles temporarily release more testosterone in response to the way LHRH agonists work in the body. This flare may increase the activity of prostate cancer cells and cause symptoms and side effects, such as bone pain in men with cancer that has spread to the bone.

  • LHRH antagonist. This class of drugs, also called a gonadotropin-releasing hormone (GnRH) antagonist, stops the testicles from producing testosterone like LHRH agonists, but they reduce testosterone levels more quickly and do not cause a flare. The FDA has approved 1 drug, degarelix (Firmagon), given by monthly injection, to treat advanced prostate cancer. One side effect of this drug is that it may cause a severe allergic reaction.

  • Anti-androgens. While LHRH agonists and antagonists lower testosterone levels in the blood, anti-androgens block testosterone from binding to so-called “androgen receptors,” which are chemical structures in cancer cells that allow testosterone and other male hormones to enter the cells. These drugs include bicalutamide (Casodex), flutamide (Eulexin), and nilutamide (Nilandron) and are taken as pills. Anti-androgens are usually given to men who have “hormone-sensitive” prostate cancer, which means that the prostate cancer still responds to testosterone suppression therapy. Anti-androgens are not usually used by themselves in prostate cancer treatment.

  • Combined androgen blockade. Sometimes anti-androgens are combined with bilateral orchiectomy or LHRH agonist treatment to maximize the blockade of male hormones. This is because even after the testicles are no longer producing hormones, the adrenal glands still make small amounts of androgens. Many doctors also feel that this combined approach is the safest way to start ADT, as it prevents the possible flare that sometimes happens in response to LHRH agonist treatment. Some, but not all, research has shown that combined androgen blockade can help patients live longer than treatment with just ADT, surgery, or LHRD agonists or antagonists. Therefore, some doctors prefer to give combined drug treatment, while others may only give the combination early in the treatment to prevent the flare.

Side effects of ADT

Traditionally, ADT was given for the patient’s lifetime or until it stopped controlling the cancer. Then the cancer was called castration-resistant, meaning that ADT has stopped working, and other treatment options were considered. During the past 2 decades, researchers have studied the use of intermittent ADT, which is ADT that is given for specific times and then stopped temporarily according to a schedule. Using ADT in this way may lower the side effects and improve a patient’s quality of life. Only patients without evidence of metastases are candidates for this approach. Intermittent ADT has not been shown to be equivalent or superior to lifelong ADT in men with metastatic disease.

ADT will cause side effects that will generally go away after treatment has finished, except in men who have had an orchiectomy. General side effects of ADT include:

  • Erectile dysfunction

  • Loss of sexual desire

  • Hot flashes with sweating

  • Gynecomastia, which is growth of breast tissue that sometimes can lead to discomfort

  • Depression

  • Cognitive dysfunction and memory loss

  • Weight gain

  • Loss of muscle mass

  • Osteopenia or osteoporosis, which is thinning of bones

Although testosterone levels may recover after stopping ADT, some men who have had medical castration with LHRH agonists for many years may continue to have hormonal effects, even if they are no longer taking these drugs.

Another serious side effect of ADT is the risk of developing metabolic syndrome. Metabolic syndrome is a set of conditions, such as obesity, high levels of blood cholesterol, and high blood pressure that increases a person’s risk of heart disease, stroke, and diabetes. Currently, it is not certain how often this happens or exactly why it happens, but it is quite clear that patients who receive a surgical or medical castration with ADT have an increased risk of developing metabolic syndrome. The risk is increased even if the medical castration is temporary. Find out more about the symptoms of hormone deprivation and how to manage them.

The risks and benefits of castration should be carefully discussed with your doctor. For men with metastatic prostate cancer, especially if it is advanced and causing symptoms, most doctors believe that the benefits of castration far outweigh the risks of side effects. Aggressive management of side effects is very important for patients receiving ADT. These include getting regular exercise, quitting smoking, following a healthy diet, supplementing vitamin D and calcium intake, and receiving aggressive, preventive cardiovascular follow-up care.

Chemotherapy

Chemotherapy is the use of drugs to destroy cancer cells, usually by stopping their ability to grow and divide. Chemotherapy is usually given by a medical oncologist, a doctor who specializes in treating cancer with medication.

Systemic chemotherapy gets into the bloodstream to reach cancer cells throughout the body. Chemotherapy for prostate cancer is given through an intravenous (IV) tube placed into a vein using a needle. It may help patients with advanced or castration-resistant prostate cancer. A chemotherapy regimen usually consists of a specific number of cycles given over a set period of time.                                                                                                             

There are several standard drugs used for prostate cancer. In general, standard chemotherapy begins with docetaxel (Taxotere) combined with a steroid called prednisone (multiple brand names). This chemotherapy has been shown to help men with metastatic castration-resistant prostate cancer live longer when compared with another chemotherapy drug, mitoxantrone (Novantrone). Mitoxantrone was one of the first chemotherapies approved for metastatic castration-resistant prostate cancer, but it is not commonly used. Mitoxantrone is most useful for controlling pain from the cancer and is sometimes considered in specific situations.

The FDA has also approved another drug, cabazitaxel (Jevtana), based on research that showed it improved survival when compared with mitoxantrone for patients whose disease progressed after having docetaxel. In clinical trials, cabazitaxel was compared with docetaxel in patients who had not received chemotherapy. In these patients, treatment with cabazitaxel was not better than treatment with standard docetaxel. Another study compared the standard dose with a lower dose of cabazitaxel in people whose tumors grew after treatment with docetaxel. This study did not find that the lower dose helped patients live longer; however, they did have fewer side effects.

Recent research shows that adding chemotherapy after the completion of 2 years of ADT for men with high-risk prostate cancer who are having definitive radiation therapy is an effective approach to reduce recurrence and improve survival. Although these results are interesting, longer follow-up is required to see if this treatment helps people with prostate cancer.

In general, the side effects of chemotherapy depend on the individual, the type of chemotherapy received, the dose used, and the length of treatment, but they can include fatigue, sores in the mouth and throat, diarrhea, nausea and vomiting, constipation, blood disorders, nervous system effects, changes in thinking and memory, sexual and reproductive issues, appetite loss, pain, and hair loss. The side effects of chemotherapy usually go away once treatment has finished. However, some side effects may continue, come back, or develop later. Ask your doctor which side effects you may experience, based on your treatment plan. Your health care team will work with you to manage or prevent many of these side effects.

Learn more about the basics of chemotherapy and preparing for treatment. The medications used to treat cancer are continually being evaluated. Talking with your doctor is often the best way to learn about the medications prescribed for you, their purpose, and their potential side effects or interactions with other medications. Learn more about your prescriptions by using searchable drug databases.

Chemotherapy and ADT

New research shows a role for chemotherapy and ADT in the treatment of metastatic prostate cancer. For example, 2 recent clinical trials showed that men with metastatic, hormone-sensitive prostate cancer who received docetaxel with ADT survived longer than men who received only ADT. All patients should have a thorough discussion with their doctor about the potential benefits and risks of receiving chemotherapy.

Immunotherapy

Sipuleucel-T (Provenge) is an immunotherapy. Immunotherapy is designed to boost the body’s natural defenses to fight the cancer. It uses materials made either by the body or in a laboratory to improve, target, or restore immune system function.

Sipuleucel-T is adapted for each patient. Before treatment, blood is removed from the patient in a process called leukapheresis. Special immune cells are separated from the patient’s blood, modified in the laboratory, and then put back into the patient. At this point, the patient’s immune system may recognize and destroy prostate cancer cells. When this treatment is used, it is difficult to know if the treatment is working to treat the cancer because treatment with Sipuleucel-T does not lead to PSA reductions, shrinking of the tumor, or keeping the cancer from getting worse. However, results from clinical trials have shown that treatment with sipuleucel-T can increase survival in men with castration-resistant metastatic prostate cancer with few or no symptoms.

Learn more about the basics of immunotherapy and cancer vaccines.

Getting care for symptoms and side effects

Cancer and its treatment often cause side effects. In addition to treatment to slow, stop, or eliminate the cancer, an important part of cancer care is relieving a person’s symptoms and side effects. This approach is called palliative or supportive care, and it includes supporting the patient with his physical, emotional, and social needs.

Palliative care is any treatment that focuses on reducing symptoms, improving quality of life, and supporting patients and their families. Any person, regardless of age or type and stage of cancer, may receive palliative care. It works best when palliative care is started as early as needed in the cancer treatment process.

People often receive treatment for the cancer and treatment to ease side effects at the same time. In fact, patients who receive both often have less severe symptoms, better quality of life, and report they are more satisfied with treatment.

Palliative treatments vary widely and often include medication, nutritional changes, relaxation techniques, emotional support, and other therapies. You may also receive palliative treatments similar to those meant to eliminate the cancer, such as chemotherapy, surgery, or radiation therapy. Talk with your doctor about the goals of each treatment in your treatment plan.

Urinary blockage

Transurethral resection of the prostate (TURP). TURP is most often used to relieve symptoms of a urinary blockage, not to treat prostate cancer. In this procedure, with the patient under full anesthesia, which is medication to block the awareness of pain, a surgeon inserts a narrow tube with a cutting device called a cystoscope into the urethra and then into the prostate to remove prostate tissue.

Bone pain and weakness

  • Strontium and samarium. These radioactive substances (beta-emitters) are given by injection and absorbed near the area of bone pain. The radiation that is released helps relieve the pain, probably by causing the tumor in the bone to shrink. Neither substance helps patients live longer.

  • Radium-223. This is a different class of radioactive substance (alpha-emitter). It mimics calcium and targets areas in the bone affected by prostate cancer. A recent clinical trial in men with metastatic castration-resistant prostate cancer with disease largely in the bone demonstrated that men receiving radium-223 plus the best supportive care lived longer compared with those receiving only the best supportive care. Radium-223 is given by injection every month for 6 months. This treatment is given by a radiation oncologist or a nuclear medicine doctor. Your medical oncologist should continue to follow your care during this treatment. Some people should not receive this treatment, so discuss with your doctor whether this medication is best for your situation.  

  • Bone-modifying drugs. Prostate cancer that has spread to the bone or ADT for prostate cancer can weaken a patient’s bones and lead to bone pain and an increased risk of breaks known as fractures. Therefore, bone-modifying drugs like denosumab (Prolia) and zoledronic acid (Zometa) may be given to men diagnosed with metastatic castration-resistant prostate cancer to help reduce bone complications. Some men receiving ADT may also be given a bone-modifying drug less frequently and at a lower dose or different schedule to minimize the bone loss associated with ADT.

    A possible condition associated with bone-modifying drugs is osteonecrosis of the jaw. It is an uncommon but serious condition. The symptoms of osteonecrosis of the jaw include pain, swelling, and infection of the jaw; loose teeth; and exposed bone.

Before treatment begins, talk with your health care team, including your dentist, about the possible side effects of your specific treatment plan and palliative care options. And during and after treatment, be sure to tell your doctor or another health care team member if you are experiencing a problem so it can be addressed as quickly as possible. Learn more about palliative care.

Developing a Treatment Plan (updated 04/2017)

Because most prostate cancers are found in the early stages when they are growing slowly, you usually do not have to rush to make treatment decisions. During this time, it is important to talk with your doctor about the risks and benefits of all your treatment options and when treatment should begin. This discussion should also address the current state of the cancer, such as:

  • Whether PSA levels are rising or steady

  • Whether the cancer has spread to the bones

  • Your health history

  • Any other medical conditions you may have

 Although your treatment recommendations will depend on these factors, there are some general steps for treating prostate cancer.

Early-stage prostate cancer

Early-stage prostate cancer means that cancer cells are found only in the prostate. If the cancer has a Gleason score of 6 or less and a PSA level less than 10, it usually grows very slowly and may take a number of years to cause any symptoms or other health problems, if it ever does at all. As a result, active surveillance may be recommended. Alternatively, radiation therapy (external-beam or brachytherapy) or surgery may be suggested depending on your age and overall health. Clinical trials testing new types of treatment may also be an option.

For men with an early-stage cancer that has a higher Gleason score, the cancer may be faster growing, so radical prostatectomy and radiation therapy are often appropriate. Your doctor will consider your age and general health before recommending either or both as a treatment option.

Locally advanced prostate cancer

For some patients with a larger tumor, local treatments, like surgery and radiation therapy, are less likely to eliminate the cancer by themselves. Radical prostatectomy is often done with removal of the pelvic lymph nodes. Some men are given neoadjuvant ADT, meaning the ADT is given before surgery, or have radiation therapy (external-beam and/or brachytherapy) afterward. Research has shown that adjuvant radiation therapy may improve survival for men with locally advanced prostate cancer or those with positive margins, extracapsular extension, or seminal vesicle invasion after prostatectomy. Having positive margins means that cancer cells were found in the area of tissue surrounding the prostate that was removed during surgery.

For men who receive radiation therapy as their primary treatment, it is generally combined with several months of ADT if there is a greater chance of recurrence based on disease extent, PSA level, and/or Gleason score. For older men who are not expected to live for a long time and whose cancer is not causing symptoms, or for those who have another, more serious illness, watchful waiting may be considered.

Non-metastatic castration-resistant prostate cancer

Prostate cancer that no longer responds to ADT, such as LHRH agonists or anti-androgens, is considered castration resistant. If it has not spread to other parts of the body, it is called non-metastatic castration-resistant prostate cancer. 

The American Society of Clinical Oncology (ASCO) recommends that men who develop castration-resistant prostate cancer should continue treatment that lowers androgen levels. This may include a permanent treatment such as surgery to remove the testicles or it may include medicines that lower hormone levels (see above).

Second-line hormonal therapy may be an option for men who have not already received chemotherapy and have a high risk of developing metastatic prostate cancer. Second-line hormonal therapy is not recommended for men who have not had chemotherapy and have a low risk of developing metastatic disease. Talk with your doctor about your personal risk level.

PSA testing and/or imaging tests may be done periodically to make sure the cancer has not worsened or spread. For men with a low risk of developing metastatic disease, ASCO recommends PSA testing every 4 to 6 months. For men with a high risk of metastatic disease, ASCO recommends PSA testing every 3 months. Imaging tests, such as a bone scan, CT scan, or MRI, may be done if a man has symptoms or signs that the cancer is worsening.

Metastatic prostate cancer (updated 04/2017)

If cancer spreads to another part in the body from where it started, doctors call it metastatic cancer. If this happens, it is a good idea to talk with doctors who have experience in treating it. Doctors can have different opinions about the best standard treatment plan. Also, clinical trials might be an option. Learn more about getting a second opinion before starting treatment, so you are comfortable with your chosen treatment plan.

For most patients, a diagnosis of metastatic cancer is very stressful and, at times, difficult to bear. Patients and their families are encouraged to talk about the way they are feeling with doctors, nurses, social workers, or other members of the health care team. It may also be helpful to talk with other patients, including through a support group.

Although there is no cure for metastatic prostate cancer, it is often treatable. Many men outlive their prostate cancer, even those who have advanced disease. Often, the prostate cancer grows slowly, and there are now effective treatment options that extend life even further.

At this stage, surgery to remove the prostate and pelvic lymph nodes cannot eliminate the cancer. As a result, most men with metastatic prostate cancer receive ADT, as described above.

Metastatic castration-resistant prostate cancer

Prostate cancer that no longer responds to ADT and has spread to other parts of the body is called metastatic castration-resistant prostate cancer. This type of cancer can be difficult to treat. The American Society of Clinical Oncology (ASCO) recommends that men with metastatic castration-resistant prostate cancer continue treatment that lowers androgen levels, such as orchiectomy or hormone-lowering medicines (see above). ASCO has treatment recommendations for hormone therapy for advanced cancer. Read more about these recommendations, side effects of treatment, and questions to ask your doctor.

ASCO recommends second-line hormonal therapy for men with metastatic castration-resistant prostate cancer who have not received chemotherapy. Recommended treatment options include:

  • Abiraterone acetate (Zytiga) plus prednisone (multiple brand names).Abiraterone acetate (Zytiga) is a drug that blocks an enzyme called CYP17 and prevents these cells from making certain hormones, including adrenal androgens. Although the testicles are the main producers of testosterone, other cells in the body can still make small amounts of testosterone that may drive cancer growth. These include the adrenal glands and some prostate cancer cells themselves. Abiraterone acetate is taken in the form of a pill. Men take 4 pills per day along with prednisone twice a day. Abiraterone acetate has been approved by the FDA as a treatment for progressive, metastatic castration-resistant prostate cancer.

    Abiraterone acetate may cause serious side effects, such as high blood pressure, low blood potassium levels, and fluid retention. Other common side effects include weakness, joint swelling or pain, swelling in the legs or feet, hot flushes, diarrhea, vomiting, shortness of breath, and anemia.

  • Enzalutamide (Xtandi). Enzalutamide is an anti-androgen that is approved by the FDA for men who have developed progressive metastatic prostate cancer despite testosterone suppression. Enzalutamide may also cause serious side effects, such as headaches, confusion, loss of vision, and seizures. Other common side effects include weakness, back pain, decreased appetite, constipation, joint pain, diarrhea, hot flashes, upper respiratory tract infection, swelling, weight loss, high blood pressure, dizziness, and vertigo.

Other treatment options for metastatic castration-resistant prostate cancer are listed below. Treatment in a clinical trial may also be an option.

  • Chemotherapy. Doctors may recommend chemotherapy for patients with this type of prostate cancer, especially those with bone pain or cancer-related symptoms. Research studies of chemotherapy treatment plans that include docetaxel have been shown to improve survival by several months. Cabazitaxel can be used after docetaxel stops working.

  • Immunotherapy. For some men with castration-resistant metastatic prostate cancer who have no or very few cancer symptoms and generally have not had chemotherapy, vaccine therapy with sipuleucel-T may be an option (see “Immunotherapy” above). In research studies, sipuleucel-T increased survival by about 4 months compared with men who did not receive it.

  • Radium-223 dichloride (Xofigo). Radium-223 is a radioactive substance used to treat men with castration-resistant prostate cancer that has spread to the bone. It is naturally attracted to areas of high bone turnover, which are areas where bone is being destroyed and replaced more than normal. Radium-223 delivers radiation directly to tumors found in the bone, limiting damage to healthy tissue. According to the results of a clinical trial published in 2013, treatment with radium-223 reduced bone-related complications and improved survival.

  • Palliative care.  Treatment to relieve a patient’s symptoms and side effects continues to be an important part of the overall treatment plan.

For men with metastatic castration-resistant prostate cancer, ASCO recommends PSA testing every 3 months. Imaging tests may also be done.

ASCO has recommendations for the treatment of metastatic castration-resistant prostate cancer. Learn more about these recommendations, the side effects, and questions to ask your doctor.

Palliative treatment for metastatic cancer

As mentioned above and in the Coping with Treatment section, palliative care is important to help relieve symptoms and side effects. This includes people with metastatic prostate cancer. Palliative care options include:

  • TURP to manage symptoms such as bleeding or urinary obstruction

  • Bone-modifying drugs, such as denosumab or zoledronic acid, may be used to strengthen bones and reduce the risk of pain progression and fractures for men with prostate cancer that has spread to the bone

  • Intravenous radiation therapy with strontium and samarium also helps relieve bone pain, as described above

Remission and the chance of recurrence

A remission is when cancer cannot be detected in the body and there are no symptoms. This may also be called having “no evidence of disease” or NED.

A remission can be temporary or permanent. This uncertainty causes many people to worry that the cancer will come back. Although there are treatments to help prevent a recurrence, such as ADT and radiation therapy, which are described above, it is important to talk with your doctor about the possibility of the cancer returning. There are tools your doctor can use, called nomograms, to estimate risk of recurrence. Understanding your risk of recurrence and the treatment options may help you feel more prepared if the cancer does return. Learn more about coping with the fear of recurrence.

In general, following surgery or radiation therapy, the PSA level in the blood usually drops. If the PSA level starts to rise again, it may be a sign that the cancer has come back. If the cancer does return after the original treatment, it is called recurrent cancer.

When this occurs, a cycle of testing will begin again to learn as much as possible about the recurrence, including where the recurrence is located. The cancer may come back in the prostate (called a local recurrence), in the tissues or lymph nodes near the prostate (a regional recurrence), or in another part of the body, such as the bones, lungs, or liver (a distant or metastatic recurrence). Sometimes the doctor cannot find a tumor even though the PSA level has increased. This is known as a PSA-only recurrence.

After testing is done, you and your doctor will talk about your treatment options. The choice of treatment plan is based on the type of recurrence and the treatment(s) you have already received, and may include the treatments described above, such as radiation therapy, prostatectomy for men first treated with radiation therapy, or ADT. Your doctor may also suggest clinical trials that are studying new ways to treat this type of recurrent cancer.

Whichever treatment plan you choose, palliative care will be important for relieving symptoms and side effects. Palliative care usually includes pain medication, external-beam radiation therapy, brachytherapy with strontium or samarium, or other treatments to reduce bone pain. See above for more information.

People with recurrent cancer often experience emotions such as disbelief or fear. Patients are encouraged to talk with their health care team about these feelings and ask about support services to help them cope. Learn more about dealing with cancer recurrence.

If treatment fails

Recovery from cancer is not always possible. If the cancer cannot be cured or controlled, the disease may be called advanced or terminal.

This diagnosis is stressful, and advanced cancer may be difficult to discuss. However, it is important to have open and honest conversations with your doctor and health care team to express your feelings, preferences, and concerns. The health care team is there to help, and many team members have special skills, experience, and knowledge to support patients and their families. Making sure a person is physically comfortable and free from pain is extremely important.

Patients who have advanced cancer and who are expected to live less than 6 months may want to consider a type of palliative care called hospice care. Hospice care is designed to provide the best possible quality of life for people who are near the end of life. You and your family are encouraged to think about where you would be most comfortable: at home, in the hospital, or in a hospice environment. Nursing care and special equipment can make staying at home a workable alternative for many families. Learn more about advanced cancer care planning.

After the death of a loved one, many people need support to help them cope with the loss. Learn more about grief and loss.

The next section in this guide is About Clinical Trials. It offers more information about research studies that are focused on finding better ways to care for people with cancer. Or, use the menu to choose another section to continue reading this guide.

Prostate Cancer - About Clinical Trials

This section has been reviewed and approved by the Cancer.Net Editorial Board, 01/2017

ON THIS PAGE: You will learn more about clinical trials, which are the main way that new medical approaches are tested to see how well they work. To see other pages, use the menu.

What are clinical trials?

Doctors and scientists are always looking for better ways to care for men with prostate cancer. To make scientific advances, doctors create research studies involving volunteers, called clinical trials. In fact, every FDA-approved drug was tested in clinical trials.

Many clinical trials focus on new treatments. Researchers want to learn if a new treatment is safe, effective, and possibly better than the treatment doctors use now. These types of studies evaluate new drugs, different combinations of existing treatments, new approaches to radiation therapy or surgery, and new methods of treatment. Patients who participate in clinical trials can be some of the first to get a treatment before it is available to the public. However, there is no guarantee that the new treatment will be safe, effective, or better than what doctors use now. If they do not receive the treatment being studied, patients will still receive the current standard treatment.

Some clinical trials study new ways to relieve symptoms and side effects during treatment. Others study ways to manage the late effects that may happen a long time after treatment. Talk with your doctor about clinical trials for symptoms and side effects. There are also clinical trials studying ways to prevent cancer.

Deciding to join a clinical trial

Patients decide to participate in clinical trials for many reasons. For some patients, a clinical trial is the best treatment option available. Because standard treatments are not perfect, patients are often willing to face the added uncertainty of a clinical trial in the hope of a better result. Other patients volunteer for clinical trials because they know that these studies are the only way to make progress in treating prostate cancer. Even if they do not benefit directly from the clinical trial, their participation may benefit future men with prostate cancer.

Sometimes people have concerns that, in a clinical trial, they may receive no treatment by being given a placebo or a “sugar pill.” However, placebos are usually combined with standard treatment in most cancer clinical trials. When a placebo is used in a study, it is done with the full knowledge of the participants. Find out more about placebos in cancer clinical trials.

Patient safety and informed consent

To join a clinical trial, patients participate in a process known as informed consent. During informed consent, the doctor should list all of the patient’s options, so that the person understands how the new treatment differs from the standard treatment. The doctor must also list all of the risks of the new treatment, which may or may not be different from the risks of standard treatment. Finally, the doctor must explain what will be required of each patient in order to participate in the clinical trial, including the number of doctor visits, tests, the schedule of treatment, and the costs they may need to pay.

Patients who participate in a clinical trial may stop participating at any time for any personal or medical reason. This may include that the new treatment is not working or there are serious side effects. Clinical trials are also closely monitored by experts who watch for any problems with each study. It is important that patients participating in a clinical trial talk with their doctor and researchers about who will be providing their treatment and care during the clinical trial, after the clinical trial ends, and/or if the patient chooses to leave the clinical trials before it ends.

Finding a clinical trial

Research through clinical trials is ongoing for all types of cancer. For specific topics being studied for prostate cancer, learn more in the Latest Research section.

Cancer.Net offers a lot of information about cancer clinical trials in other areas of the website, including a complete section on clinical trials and places to search for clinical trials for a specific type of cancer.

PRE-ACT, Preparatory Education About Clinical Trials

In addition, this website offers free access to a video-based educational program about cancer clinical trials, located outside of this guide.

The next section in this guide is Latest Research. It explains areas of scientific research currently going on for this type of cancer. Or, use the menu to choose another section to continue reading this guide.

Prostate Cancer - Latest Research

This section has been reviewed and approved by the Cancer.Net Editorial Board, 01/2017

ON THIS PAGE: You will read about the scientific research being done now to learn more about this type of cancer and how to treat it. To see other pages, use the menu.

Doctors are working to learn more about prostate cancer, ways to prevent it, how to best treat it, and how to provide the best care to people diagnosed with this disease. The following areas of research may include new options for patients through clinical trials. Always talk with your doctor about the diagnostic and treatment options that are best for you.

  • Finding causes of prostate cancer. Researchers continue to explore the link between nutrition and lifestyle factors and the development of prostate cancer.

  • Early detection. Researchers are trying to develop a better PSA test, either a more specific and precise test or a different test. Researchers are also developing a urine test to find a gene called prostate cancer gene 3 (PCA3) to help find prostate cancer. Because PCA3 is made in larger amounts when a man has prostate cancer, doctors could use the test to decide if a man needs a prostate biopsy (see Diagnosis). With improved testing, more healthy men could be screened for prostate cancer, so more prostate cancers could be found and treated early.

  • Genomic tests. Genomics is the study of how genes behave. Genomic tests look at the genes in prostate cancer to help predict how quickly the cancer may grow and spread. The information from these tests can help the cancer care team make decisions about the treatment plan. Some of the genomic tests available now include Decipher, Oncotype DX, ProstaVysion, and the Prolaris Test.

  • Improved surgical techniques. Better techniques for nerve-sparing surgery can decrease the risk of urinary and sexual side effects for men who need a radical prostatectomy.

  • Shorter radiation therapy schedules. With better, more precise external-beam radiation therapy, researchers are exploring much shorter and more convenient treatment schedules. Instead of 40 treatments, researchers are evaluating using 28, 12, or only 5 treatments.

  • Tests to evaluate the success of treatment. Research continues to evaluate biomarkers that are found in the blood. These biomarkers can help determine the effectiveness of a treatment and be used to better assess the cancer’s response to treatment. Blood tests measuring circulating tumor cells (CTCs) are 1 such test. CTCs are cells that have broken free from the tumor.

  • Improved therapy for advanced prostate cancer. Researchers are exploring different treatment options for advanced prostate cancer in clinical trials, including special targeted drugs, chemotherapy, ADT, and immunotherapy.
  • Palliative care. Clinical trials are underway to find better ways of reducing symptoms and side effects of current prostate cancer treatments to improve patients’ comfort and quality of life.

Looking for More About the Latest Research?

If you would like additional information about the latest areas of research regarding prostate cancer, explore these related items that take you outside of this guide:

  • To find clinical trials specific to your diagnosis, talk with your doctor or search online clinical trial databases now.

  • Review research announced at ASCO's Annual Meetings and recent Genitourinary Cancers Symposia. Regularly visit the Cancer.Net Blog to see when new research has been released.

  • Visit the website of the Conquer Cancer Foundation to find out how to help support research for every cancer type. Please note that this link takes you to a separate ASCO website. 

The next section in this guide is Coping with Treatment. It offers some guidance in how to cope with the physical, emotional, and social changes that cancer and its treatment can bring. Or, use the menu to choose another section to continue reading this guide.

Prostate Cancer - Coping with Treatment

This section has been reviewed and approved by the Cancer.Net Editorial Board, 01/2017

ON THIS PAGE: You will learn more about coping with the physical, emotional, social, and financial effects of cancer and its treatment. This page includes several links outside of this guide to other sections of this website. To see other pages, use the menu.

Every cancer treatment can cause side effects or changes to your body and how you feel. For many reasons, people don’t experience the same side effects even when given the same treatment for the same type of cancer. This can make it hard to predict how you will feel during treatment.

As you prepare to start cancer treatment, it is normal to fear treatment-related side effects. It may help to know that your health care team will work to prevent and relieve side effects. Doctors call this part of cancer treatment “palliative care.” It is an important part of your treatment plan, regardless of your age or the stage of disease.

Coping with physical side effects

Common physical side effects from each treatment option for prostate cancer are described in the Treatment Options section. Learn more about side effects of cancer and its treatment, along with ways to prevent or control them. Changes to your physical health depend on several factors, including the cancer’s stage, the length and dose of treatment, and your general health. Any discussion of side effects should also cover fertility, sexual function, and bladder function.

Sometimes, physical side effects can last after treatment ends. Doctors call these long-term side effects. They call side effects that occur months or years after treatment late effects. Treating long-term side effects and late effects is an important part of survivorship care. Learn more by reading the Follow-up Care section of this guide or talking with your doctor.

Coping with emotional and social effects

You can have emotional and social effects as well as physical effects after a cancer diagnosis. This may include dealing with difficult emotions, such as anxiety or anger, or managing your stress level. Sometimes, patients have problems expressing how they feel to their loved ones, or people don’t know what to say in return.

Patients and their families are encouraged to share their feelings with a member of their health care team. You can also find coping strategies for emotional and social effects in a separate section of this website. This section includes many resources for finding support and information to meet your needs.

Coping with financial effects

Cancer treatment can be expensive. It is often a big source of stress and anxiety for people with cancer and their families. In addition to treatment costs, many people find they have extra, unplanned expenses related to their care. For some people, the high cost stops them from following or completing their cancer treatment plan. This can put their health at risk and may lead to higher costs in the future. Learn more about managing financial considerations, in a separate part of this website.

Caring for a loved one with cancer

Family members and friends often play an important role in taking care of a person with prostate cancer. This is called being a caregiver. Caregivers can provide physical, practical, and emotional support to the patient, even if they live far away.

Caregivers may have a range of responsibilities on a daily or as-needed basis. Below are some of the responsibilities caregivers take care of:

  • Providing support and encouragement

  • Giving medications

  • Helping manage symptoms and side effects

  • Coordinating medical appointments

  • Providing a ride to appointments

  • Assisting with meals

  • Helping with household chores

  • Handling insurance and billing issues

Learn more about caregiving.

Talking with your health care team about side effects

Before starting treatment, talk with your doctor about possible side effects. Ask:

  • Which side effects are most likely?

  • When are they are likely to happen?

  • What can we do to prevent or relieve them?

Be sure to tell your health care team about any side effects that happen during treatment and afterward, too. Tell them even if you don’t think the side effects are serious. This discussion should include physical, emotional, and social effects of cancer.

Also, ask how much care you may need at home and with daily tasks during and after treatment. This can help you make a caregiving plan.

The next section in this guide is Follow-up Care. It explains the importance of checkups after cancer treatment is finished. Or, use the menu to choose another section to continue reading this guide.

Prostate Cancer - Follow-Up Care

This section has been reviewed and approved by the Cancer.Net Editorial Board, 01/2017

ON THIS PAGE: You will read about your medical care after cancer treatment is completed, and why this follow-up care is important. To see other pages, use the menu.

Care for men diagnosed with prostate cancer doesn’t end when active treatment has finished. Your health care team will continue to check to make sure the cancer has not returned, manage any side effects, and monitor your overall health. This is called follow-up care.

Your follow-up care may include regular physical examinations, medical tests, or both. Doctors want to keep track of your recovery in the months and years ahead. Learn more about the importance of follow-up care.

Watching for recurrence

One goal of follow-up care is to check for a recurrence. Cancer recurs because small areas of cancer cells may remain undetected in the body. Over time, these cells may increase in number until they show up on test results or cause signs or symptoms. During follow-up care, a doctor familiar with your medical history can give you personalized information about your risk of recurrence. Your doctor will also ask specific questions about your health. Some people may have blood tests or imaging tests done as part of regular follow-up care, but testing recommendations depend on several factors, including the type and stage of cancer originally diagnosed and the types of treatment given.

Managing long-term and late side effects

Most people expect to experience side effects when receiving treatment. However, it is often surprising to survivors that some side effects may linger beyond the treatment period. These are called long-term side effects. In addition, other side effects called late effects may develop months or even years afterwards. Long-term and late effects can include both physical and emotional changes.

Talk with your doctor about your risk of developing late effects based on the stage of cancer, your individual treatment plan, and your overall health. If you had a treatment known to cause specific late effects, you may also have certain physical examinations, scans, or blood tests to help find and manage them. Learn more about self-image and cancer, fertility and cancer treatment, sexual health, and talking with your spouse or partner.

Keeping personal health records

You and your doctor should work together to develop a personalized follow-up care plan. Be sure to ask about any concerns you have about your future physical or emotional health. ASCO offers forms to help create a treatment summary to keep track of the cancer treatment you received and develop a survivorship care plan once treatment is completed.

This is also a good time to decide who will lead your follow-up care. Some survivors continue to see their oncologist, while others transition back to the general care of their family doctor or another health care professional. This decision depends on several factors, including the type and stage of cancer, side effects, health insurance rules, and your personal preferences.

If a doctor who was not directly involved in your cancer care will lead your follow-up care, be sure to share your cancer treatment summary and survivorship care plan forms with him or her, as well as all future health care providers. Details about your cancer treatment are very valuable to the health care professionals who will care for you throughout your lifetime.

The next section in this guide is Survivorship. It describes how to cope with challenges in everyday life after a cancer diagnosis. Or, use the menu to choose another section to continue reading this guide.

Prostate Cancer - Survivorship

This section has been reviewed and approved by the Cancer.Net Editorial Board, 01/2017

ON THIS PAGE: You will read about how to cope with challenges in everyday life after a cancer diagnosis. To see other pages, use the menu.

What is survivorship?

The word “survivorship” means different things to different people. Common definitions include:

  • Having no signs of cancer after finishing treatment.

  • Living with, through, and beyond cancer. According to this definition, cancer survivorship begins at diagnosis and includes people who continue to have treatment over the long term, either to reduce the risk of recurrence or to manage chronic disease.

Survivorship is one of the most complicated parts of having cancer. This is because it is different for everyone.  

Survivors may experience a mixture of strong feelings, including joy, concern, relief, guilt, and fear. Some people say they appreciate life more after a cancer diagnosis and have gained a greater acceptance of themselves. Others become very anxious about their health and uncertain of how to cope with everyday life.

Survivors may feel some stress when frequent visits to the health care team end following treatment. Often, relationships built with the cancer care team provide a sense of security during treatment, and people miss this source of support. This may be especially true as new worries and challenges surface over time, such as any late effects of treatment, emotional challenges including fear of recurrence, sexuality and fertility concerns, and financial and workplace issues.

Every survivor has individual concerns and challenges. With any challenge, a good first step is being able to recognize your fears and talk about them. Effective coping requires:

  • Understanding the challenge you are facing,

  • Thinking through solutions,

  • Asking for and allowing the support of others, and

  • Feeling comfortable with the course of action you choose.

Many survivors find it helpful to join an in-person support group or an online community of survivors. This allows you to talk with people who have had similar first-hand experiences. Other options for finding support include talking with a friend or member of your health care team, individual counseling, or asking for assistance at the learning resource center of the center where you received treatment.

Changing role of caregivers

Family members and friends may also go through periods of transition. A caregiver plays a very important role in supporting a person diagnosed with cancer, providing physical, emotional, and practical care on a daily or as-needed basis. Many caregivers become focused on providing this support, especially if the treatment period lasts for many months or longer.

However, as treatment is completed, the caregiver's role often changes. Eventually, the need for caregiving related to the cancer diagnosis will become much less or come to an end. Caregivers can learn more about adjusting to life after caregiving in this article.

A new perspective on your health

For many people, survivorship serves as a strong motivator to make positive lifestyle changes.

Men recovering from prostate cancer are encouraged to follow established guidelines for good health, such as not smoking, limiting alcohol, eating well, and managing stress. Regular physical activity can help rebuild your strength and energy level. Your health care team can help you create an appropriate exercise plan based upon your needs, physical abilities, and fitness level. Learn more about making healthy lifestyle choices.

In addition, it is important to have recommended medical checkups and tests (see Follow-up Care) to take care of your health. Cancer rehabilitation may also be recommended, and this could mean any of a wide range of services such as physical therapy, career counseling, pain management, nutritional planning, and/or emotional counseling. The goal of rehabilitation is to help people regain control over many aspects of their lives and remain as independent and productive as possible.

Talk with your doctor to develop a survivorship care plan that is best for your needs.

Looking for More Survivorship Resources?

For more information about cancer survivorship, explore these related items. Please note that these links will take you to other sections of Cancer.Net:

  • ASCO Answers Cancer Survivorship Guide: Get this 44-page booklet that helps people transition into life after treatment. It includes blank treatment summary and survivorship care plan forms. The booklet is available as a PDF, so it is easy to print out.

  • Cancer.Net Patient Education Video: View a short video led by an ASCO expert that provides information about what comes next after finishing treatment.

  • Survivorship Resources: Cancer.Net offers an entire area of this website with resources to help survivors, including for survivors in different age groups.

The next section offers Questions to Ask the Doctor to help start conversations with your cancer care team. Or, use the menu to choose another section to continue reading this guide.

Prostate Cancer - Questions to Ask the Doctor

This section has been reviewed and approved by the Cancer.Net Editorial Board, 01/2017

ON THIS PAGE: You will find some questions to ask your doctor or other members of your health care team to help you better understand your diagnosis, treatment plan, and overall care. To see other pages, use the menu.

Talking often with the doctor is important to make informed decisions about your health care. These suggested questions are a starting point to help you learn more about your cancer care and treatment. You are also encouraged to ask additional questions that are important to you. You may want to print this list and bring it to your next appointment, or download Cancer.Net’s free mobile app for an e-list and other interactive tools to manage your care.

Questions to ask about prostate cancer risk and screening

  • What type of prostate cancer screening schedule do you recommend for me, based on my individual medical profile and family history?

  • Are there any changes I can make to my diet that can help lower my risk of prostate cancer?

Questions to ask after getting a diagnosis

  • What type of prostate cancer do I have, and how aggressive is it?

  • Can you explain my pathology report (laboratory test results) to me?

  • What stage is my prostate cancer, and what does this mean?

  • What is the Gleason score of my prostate cancer? What does this mean?

Questions to ask about choosing a treatment and managing side effects

  • How much experience do you have treating this type of cancer?

  • What are my treatment options?

  • What clinical trials are available for me? Where are they located, and how do I find out more about them?

  • Does this prostate cancer need to be treated? What would happen if I choose not to start treatment now?

  • What treatment plan do you recommend? Why?

  • What is the goal of each treatment? Is it to eliminate the cancer, help me feel better, or both?

  • What are the possible side effects of each treatment, both in the short term and the long term?

  • Who will be part of my health care team, and what does each member do?

  • Who will be leading my overall treatment?

  • How will this treatment affect my daily life? Will I be able to work, exercise, and perform my usual activities?

  • Will I have difficulty controlling my bladder or bowel function after treatment?

  • Could this treatment affect my sex life? If so, how and for how long?

  • Could this treatment affect my ability to have children? If so, should I talk with a fertility specialist before cancer treatment begins? Should I consider sperm banking?

  • If I’m worried about managing the costs of cancer care, who can help me?

  • What support services are available to me? To my family?

  • Whom should I call with questions or problems?

  • Is there anything else I should be asking?

Questions to ask about having surgery

  • What type of surgery will I have? Will lymph nodes be removed?

  • How long will the operation take?

  • How long will I be in the hospital?

  • Can you describe what my recovery from surgery will be like?

  • What are the possible long-term effects of having this surgery?

Questions to ask about having radiation therapy

  • What type of treatment is recommended?

  • Where will the radiation be focused?

  • What is the goal of this treatment?

  • How long will it take to give this treatment?

  • What side effects can I expect during treatment?

  • What are the possible long-term effects of having this treatment?

  • What can be done to relieve the side effects?

Questions to ask about having chemotherapy or immunotherapy

  • What type of treatment do you recommend?

  • What is the goal of this treatment?

  • How will this treatment be given?

  • How long will it take to give this treatment?

  • What side effects can I expect during treatment?

  • What are the possible long-term effects of having this treatment?

  • What can be done to relieve the side effects?

Questions to ask about having ADT

  • What type of ADT do you recommend?

  • What is the goal of this treatment?

  • How will this treatment be given?

  • How long will I need to continue this treatment?

  • What side effects can I expect during treatment?

  • What are the possible long-term effects of having this treatment?

  • What can be done to relieve the side effects?

Questions to ask about planning follow-up care

  • What is the chance that the cancer will come back? Should I watch for specific signs or symptoms?

  • What long-term side effects or late effects are possible based on the cancer treatment I received?

  • What follow-up tests will I need, and how often will I need them?

  • How do I get a treatment summary and survivorship care plan to keep in my personal records?

  • Who will be leading my follow-up care?

  • What survivorship support services are available to me? To my family?

The next section in this guide is Additional Resources. It offers some more resources on this website beyond this guide that may be helpful to you. Or, use the menu to choose another section to continue reading this guide.

Prostate Cancer - Additonal Resources

This section has been reviewed and approved by the Cancer.Net Editorial Board, 01/2017

ON THIS PAGE: You will find some helpful links to other areas of Cancer.Net that provide information about cancer care and treatment. This is the final page of Cancer.Net’s Guide to Prostate Cancer. To go back and review other pages, use the menu on the side of your screen.

Cancer.Net includes many other sections about the medical and emotional aspects of cancer, both for the person diagnosed and their family members and friends. This website is meant to be a resource for you and your loved ones from the time of diagnosis, through treatment, and beyond.

Beyond this guide, here are a few links to help you explore other parts of Cancer.Net:

This is the end of Cancer.Net’s Guide to Prostate Cancer. Use the menu on the side of your screen to select another section to continue reading this guide.