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Prostate Cancer - Introduction

Approved by the Cancer.Net Editorial Board, 09/2020

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. Use the menu to see other pages. Think of that menu as a roadmap for this complete guide.

About the prostate

The prostate is a walnut-sized gland located behind the base of the 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.

The prostate continues to enlarge as people age. This can lead to a condition called benign prostatic hypertrophy (BPH), which is when the urethra becomes blocked. BPH is a common condition associated with growing older, and it has not been associated with a greater risk of having prostate cancer.

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 quickly to other parts of the body. Some prostate cancers grow very slowly and may not cause symptoms or problems for years or ever. Even when prostate cancer has spread to other parts of the body, it often can be managed for a long time. So people with prostate cancer, and even those with advanced prostate cancer, may live with good health and quality of life for many years. However, if the cancer cannot be well controlled with existing treatments, it can cause symptoms like pain and fatigue and can sometimes lead to death. An important part of managing prostate cancer is monitoring it for growth over time, in order to find out if it is growing slowly or quickly. Based on the pattern of growth, your doctor can decide the best available treatment options and when to give them.

Histology is how cancer cells look under a microscope. The most common histology found in prostate cancer is called adenocarcinoma. Other, less common histologic types include neuroendocrine prostate cancer and small cell prostate cancer. These rare variants tend to be more aggressive, produce much less PSA, and spread outside the prostate earlier. Read more about neuroendocrine tumors.

About prostate-specific antigen (PSA)

Prostate-specific antigen (PSA) is a protein produced by cells in the prostate gland and released into the bloodstream. PSA levels are measured using a blood test. Although there is no such thing as a “normal PSA” for anyone at any given age, a higher-than-normal level of PSA can be found in people with prostate cancer. Other non-cancerous prostate conditions, such as BPH (see above) or prostatitis can also lead to an elevated PSA level. Prostatitis is the inflammation or infection of the prostate. In addition, some activities like ejaculation can temporarily increase PSA levels. Ejaculations should be avoided before a PSA test to avoid falsely elevated tests. People should discuss with their primary care doctor the pros and cons of PSA testing before using it to screen for prostate cancer. See the Screening section for more information.

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 the number of people who are diagnosed with prostate cancer and general survival rates. Use the menu to choose a different section to read in this guide.

Prostate Cancer - Statistics

Approved by the Cancer.Net Editorial Board, 02/2021

ON THIS PAGE: You will find information about the number of people who are diagnosed with prostate cancer each year. You will also read general 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 248,530 men in the United States will be diagnosed with prostate cancer.

Prostate cancer incidence rates rose sharply in the late 1980s and early 1990s due increased screening with the PSA test. But from 2013 to 2017, incidence rates have stayed steady. Around 60% of cases are diagnosed in men age 65 or older. The average age of diagnosis is 66 years. The disease rarely occurs in those younger than 40. The number of new cases diagnosed in Black men is nearly 80% higher than the number of new cases diagnosed in white men.

The 5-year survival rate tells you what percent of people live at least 5 years after the cancer is found. Percent means how many out of 100. The 5-year survival rate for people with prostate cancer is 98%. The 10-year survival rate is also 98%.

Most prostate cancers (89%) are found when the disease is in only the prostate and nearby organs. This is referred to as the local or regional stage. The 5-year survival rate for most people with local or regional prostate cancer is nearly 100%. For people diagnosed with prostate cancer that has spread to other parts of the body, the 5-year survival rate is 30%.

Prostate cancer is the second leading cause of cancer death in men in the United States. It is estimated that 34,130 deaths from this disease will occur this year.

However, the death rate dropped by around half from the mid-1990s to the mid-2010s as a result of advances in screening and treatment. From 2014 to 2018, the death rate stayed steady. A person’s individual survival depends on the type of prostate cancer and the stage of the disease. There are more than 3.1 million survivors of prostate cancer in the United States today.

It is important to remember that statistics on the survival rates for people with prostate cancer are an estimate. The estimate comes from annual data based on the number of people 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. Talk with your doctor if you have any questions about this information. Learn more about understanding statistics.

Statistics adapted from the American Cancer Society's (ACS) publication, Cancer Facts & Figures 2021, and the ACS website (sources accessed February 2021).

The next section in this guide is Medical Illustrations. It offers drawings of body parts often affected by prostate cancer. Use the menu to choose a different section to read in this guide.

Prostate Cancer - Medical Illustrations

Approved by the Cancer.Net Editorial Board, 09/2020

ON THIS PAGE: You will find a drawing of the main body parts affected by prostate cancer. Use the menu to see other pages.

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.

The next section in this guide is Risk Factors and PreventionIt explains the factors that may increase the chance of developing prostate cancer and what people can do to lower their risk. Use the menu to choose a different section to read in this guide.

Prostate Cancer - Risk Factors and Prevention

Approved by the Cancer.Net Editorial Board, 09/2020

ON THIS PAGE: You will find out more about the factors that increase the chance of developing prostate cancer. Use the menu to see other pages.

A risk factor is anything that increases a person’s chance of developing cancer. Although risk factors often influence the chance to develop cancer, most do not directly or by themselves cause cancer. Some people with several known risk factors never develop cancer, while others with no known risk factors do. 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. Around 60% of prostate cancers are diagnosed in people who are 65 or older. Older adults who are diagnosed with prostate cancer can face unique challenges, specifically with regard to cancer treatment. For more information, please visit Cancer.Net’s section about aging and cancer.

  • Race. Black men in the United States, and other men of African ancestry, are diagnosed with prostate cancer more than men of other races. Black men are more likely to die from prostate cancer than white men.

  • North American or northern European location. Prostate cancer occurs most often in North America and northern Europe. It also appears that prostate cancer is increasing among Asian people 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, makes up about 20% of all prostate cancers. This type of prostate cancer develops because of a combination of shared genes and shared environmental or lifestyle factors.

    Hereditary prostate cancer, which is inheriting the risk from a relative, is rare and accounts for about 5% of all cases. Hereditary prostate cancer occurs when changes in genes, or mutations, are passed down within a family from 1 generation to the next. Hereditary prostate cancer may be suspected if a 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 parent, sibling, child, grandparent, uncle, or nephew, on the same side of the family diagnosed with prostate cancer before age 55

    If someone has a first-degree relative—meaning a parent, sibling, or child—with prostate cancer, their risk of developing prostate cancer is 2 to 3 times higher than the average risk. This risk increases even further with the number of relatives diagnosed with prostate cancer.

  • Hereditary breast and ovarian cancer (HBOC) syndrome. HBOC is associated with germline, or inherited, DNA-repair 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, people 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 inherited prostate cancers. Those 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. If you are concerned about this based on your own family history, please 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, CAPB, ATM, FANCA, HOXB13, and mismatch repair genes. However, none of them has been directly 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. At present, there are no genetic tests available to determine someone's chance of developing prostate cancer.

  • Agent Orange exposure. The U.S. Department of Veterans Affairs (VA) lists prostate cancer as a disease associated with exposure to Agent Orange, a chemical used during the Vietnam War. If you are a veteran who may have been exposed to Agent Orange, please talk to your doctor in the VA system. Learn more about the link with Agent Orange on the U.S. Department of Veterans Affairs’ website.

  • Eating habits. 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. For example, obesity is associated with many cancers, including prostate cancer, and a healthy diet to avoid weight gain is recommended (See “Dietary changes” below).

Prevention

Different factors cause different types of cancer. Researchers continue to look into what factors cause prostate cancer, including ways to prevent it. Although there is no proven way to completely prevent prostate cancer, you may be able to lower your risk. Talk with your health care team for more information about your personal risk of cancer.

Chemoprevention

A class of drugs called 5-alpha-reductase inhibitors (5-ARIs), which includes dutasteride (Avodart) and finasteride (Proscar), are often used to treat BPH. They may also lower a man’s risk of developing prostate cancer. Some previous clinical trials suggested that 5-ARIs were linked to more aggressive prostate cancers, but newer studies have suggested that this is not true. According to the results of a long-term follow-up study published in 2013, 78% of people either taking finasteride or a placebo were still alive 15 years later. These results suggest that taking finasteride does not lower the risk of death for those with prostate cancer. The U.S. Food and Drug Administration (FDA) has not approved these drugs for the prevention of prostate cancer. However, a 5-ARI is approved by the FDA for the treatment of lower urinary tract symptoms associated with BPH.

The decision to take a 5-ARI is different for each person. Anyone considering taking this class of medication should discuss the possible benefits and side effects with their doctor.

Dietary changes

There is not enough information right now to make clear recommendations about the exact role eating behaviors play in prostate cancer. Dietary changes may need to be made many years earlier in a person’s life to reduce the risk of developing prostate cancer later in life.

Here is a brief summary of the current research:

  • In some studies, regularly eating foods high in fat, especially animal fat, has been associated with increased prostate cancer risk. However, no prospective studies have yet proven that diets high in animal fat raise the risk of prostate cancer. Prospective studies look at people who follow either high-fat or low-fat diets and then measure the total number of people in each group who are diagnosed with prostate cancer.

  • A diet high in vegetables, fruits, and legumes, such as beans and peas, may lower the risk of prostate cancer. It is unclear which nutrients are directly responsible. Although lycopene, a nutrient found in tomatoes and other vegetables, has been shown to be associated with a lower risk of prostate cancer, the data have not proven that there is a relationship between lycopene and preventing cancer.

  • Currently no specific vitamins, minerals, or other supplements have been shown in clinical trials to prevent prostate cancer. Talk with your doctor before taking any supplements to prevent prostate cancer.

  • Specific changes to eating behaviors may not stop or slow the development of prostate cancer. 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. Use the menu to choose a different section to read in this guide.

Prostate Cancer - Screening

Approved by the Cancer.Net Editorial Board, 09/2020

ON THIS PAGE: You will find out more about screening for prostate cancer. You will also learn the risks and benefits of screening. Use the menu to see other pages.

Screening is used to look for cancer before you have any symptoms or signs. When cancer is found earlier in its development, it is often at an earlier stage. This means that there is a better chance of successfully treating the cancer. 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 adults. 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 the rectum and feels the surface of the prostate through the bowel wall for any irregularities.

  • PSA blood test. There is controversy about using the PSA test to look for prostate cancer in people with no symptoms of the disease. On the one hand, the PSA test is useful for detecting early-stage prostate cancer, especially in those with many risk factors, which helps some get the treatment they need before the cancer grows and spreads. On the other hand, PSA screening may find very-slow-growing prostate cancers that would never threaten someone's life. As a result, screening for prostate cancer using PSA may lead to treatments that are not needed, which can cause side effects and seriously affect a person's quality of life.

ASCO recommends that people with no symptoms of prostate cancer and who are expected to live less than 10 years do not receive PSA screening. For those expected to live longer than 10 years, ASCO recommends that they talk with their doctor to find out if the test is appropriate for them.

Other organizations have different recommendations for screening:

  • The U.S. Preventive Services Task Force (USPSTF) recommends that adults between 55 and 69 should discuss the pros and cons of PSA screening with their doctor before making a decision about screening. People who are 70 and older should not have routine PSA screenings for prostate cancer.

  • Both the American Urological Association and the American Cancer Society recommend that people be told the risks and benefits of testing before PSA screening occurs and then make an informed decision in consultation with their doctor.

  • The National Comprehensive Cancer Network (NCCN) 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. Everyone should discuss with their doctor the pros and cons of prostate cancer screening based on their situation and personal risk of prostate cancer, so they can work together to make an informed decision.

The next section in this guide is Symptoms and Signs. It explains what body changes or medical problems prostate cancer can cause. Use the menu to choose a different section to read in this guide.

Prostate Cancer - Symptoms and Signs

Approved by the Cancer.Net Editorial Board, 09/2020

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

The symptoms and signs of prostate cancer may include:

  • Frequent urination

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

  • The urge to urinate frequently at night

  • Blood in the urine

  • New onset of erectile dysfunction

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

  • Discomfort or pain when sitting, caused by an enlarged prostate

Other noncancerous conditions of the prostate, such as BPH or an enlarged prostate, can cause similar symptoms. Or, the cause of a symptom may be a different medical condition that is also not related to cancer. Urinary symptoms also can be caused by an infection of the bladder or other conditions.

If cancer has spread outside of the prostate gland, symptoms may include:

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

  • Swelling or fluid buildup 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 figure 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 be called palliative care or supportive care. It is often started soon after diagnosis and continued throughout treatment. Be sure to talk with your health care team about the 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. Use the menu to choose a different section to read in this guide.

Prostate Cancer - Diagnosis

Approved by the Cancer.Net Editorial Board, 09/2020

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. Use the menu to see other pages.

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 if an area of the body has cancer. In a biopsy, the doctor takes a small sample of tissue for testing in a laboratory.

This section describes options for diagnosing prostate 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 general health

  • The results of earlier medical tests

Early tests

If prostate cancer is suspected, a physical examination and the following tests may be used to decide if more diagnostic tests are needed:

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 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 to decide if a biopsy is needed, such as absolute level, change over time (also known as “PSA velocity”), and level in relation to prostate size.

Free PSA test. There is a version of the PSA test that allows the doctor to measure a specific component, called the “free” PSA. Free PSA is found in the bloodstream and is not bound to proteins. A standard PSA test measures total PSA, which includes both PSA that is and is not bound to proteins. The free PSA test measures the ratio of free PSA to total PSA. Knowing this ratio or percent can sometimes help find out if an elevated PSA level is more likely to be caused by a malignant condition like prostate cancer.

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 and not every doctor has expertise in the technique; therefore, DRE does not usually detect early prostate cancer. 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 someone will develop high-risk prostate cancer, and the Prostate Health Index (PHI), which predicts the chances someone will develop prostate cancer.

For people diagnosed with prostate cancer by biopsy, there are times when a genomic test, such as Oncotype Dx Prostate, Prolaris, Decipher, and ProMark, can provide additional information to inform a decision about how the prostate cancer is managed. This includes when those with certain low-risk or intermediate-risk localized prostate cancer are considering active surveillance (see Types of Treatment). It also may include using the Decipher test to help decide whether more treatment should be considered in certain patients following surgical removal of the prostate, called prostatectomy. If a biomarker test is used, the results should always be evaluated in combination with all other available information.

Talk with your doctor for more information about biomarker tests, what they mean, and how the results might or might not affect your treatment plan.

This information is based on the ASCO guideline, "Molecular Biomarkers in Localized Prostate Cancer." Please note that this link takes you to another ASCO website.

Making a diagnosis

If the PSA or DRE test results are abnormal, then further tests will be used to confirm whether a person has prostate cancer. Many tests can suggest that cancer is present, but only a biopsy can make a definite diagnosis.

Biopsy. A biopsy is the removal of a small amount of tissue for examination under a microscope. To get a tissue sample, a surgeon most often uses transrectal ultrasound (TRUS, see below) and a biopsy tool to take very small slivers of prostate tissue. Biopsy specimens will be taken from several areas of the prostate. This is done to make sure that a good sample is taken for examination. Most people will have 12 to 14 pieces of tissue removed, and the procedure can take 20 to 30 minutes to complete.

This procedure is usually done 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. The ultrasound tool is inserted into the rectum and then the biopsy needle is passed through the rectum and into the prostate gland to collect tissue samples.

There is a risk of infection associated with transrectal prostate biopsy, which is why some doctors choose to use transperineal prostate biopsy instead. This biopsy is also guided by TRUS, but the biopsy needle goes through the skin of the perineum and into the prostate gland. The perineum is the space between the scrotum and the anus. By passing the needle through the skin instead of the rectum, this procedure lowers the risk of infection.

A pathologist then analyzes the sample(s) under a microscope. A pathologist is a doctor who specializes in interpreting laboratory tests and evaluating cells, tissues, and organs to diagnose disease.

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. Evaluation with a prostate MRI scan has become a routine procedure in clinical practice. 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 a precise area for the biopsy. 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. An MRI fusion biopsy should only be performed by someone with expertise in the procedure.

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.

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, but an imaging test can confirm and provide information about the cancer’s location.

Imaging tests may not always be needed. A CT scan or bone scan may not be necessary for those with no symptoms and low-risk, early-stage prostate cancer, as determined with information from the PSA test and biopsy. Learn more about when these tests are recommended to find out if the cancer has spread.

For people with advanced prostate cancer, ASCO recommends that 1 or more of the imaging tests below be done to provide more information about the disease and help plan the best treatment. This includes when there is a newly diagnosed, high-risk cancer; if metastasis is suspected or confirmed; if the cancer has returned following treatment; or when the cancer grows during the treatment period. Learn more about this guideline on the ASCO website.

Whole-body bone scan. A bone scan uses a radioactive tracer (Technetium-99) to look at the inside of the bones. The tracer is injected into a patient’s vein. It collects in areas of the bone where metabolic activity has occurred. Healthy bone appears lighter to the camera, and areas of injury, such as those caused by cancer, stand out on the image. It is important to know that structural changes to the bone, such arthritis or bone injuries like fractures, can also be interpreted as abnormal and need to be evaluated by a doctor to make sure they are not cancer.

Computed tomography (CT or CAT) scan. A CT scan takes pictures of the inside of the body using x-rays taken from different angles. A computer combines these pictures into a detailed, 3-dimensional image that shows any abnormalities or tumors. A CT scan can 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 pill or liquid to swallow.

Magnetic resonance imaging (MRI). An MRI scan uses magnetic fields, not x-rays, to produce detailed images of the body. An MRI can be used to measure the tumor’s size, and a scan can focus specifically on the area of the prostate or on the whole body. A special dye called contrast medium is given before the scan to create a clearer picture, which is injected into a patient’s vein.

Positron emission tomography (PET) or PET-CT scan. A PET scan is usually combined with a CT scan (see above), called a PET-CT scan. However, you may hear your doctor refer to this procedure just as a PET scan. A PET scan is a way to create pictures of organs and tissues inside the body. A small amount of a radioactive substance is injected into the patient’s body. This substance is taken up by cells that use the most energy or are more biologically active. Because cancer tends to use energy and is biologically active, it absorbs more of the radioactive substance. A scanner then detects this substance to produce images of the inside of the body. For many types of cancer, a PET-CT scan uses fluorodeoxyglucose (FDG) as the substance that is imaged; however, FDG is not a useful substance for initial imaging in prostate cancer and should not be routinely used. In people with a high risk of metastasis or who are suspected to have a biochemical or PSA recurrence (see Types of Treatment), a PET scan using gallium-68 PSMA-11 may be recommended. In this type of scan, the gallium-68 binds to prostate specific membrane antigen (PSMA), which is often in higher levels in prostate cancer cells, and shows places where the cancer has spread.

Researchers are investigating using different substances with PET scans to find prostate cancer. For example, sodium fluoride is absorbed by bones, and its use in a PET scan may improve the chances of finding prostate cancer that has spread to the bone. Other substances being studied include choline acetate and fluciclovine.

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. Use the menu to choose a different section to read in this guide.

Prostate Cancer - Stages and Grades

Approved by the Cancer.Net Editorial Board, 09/2020

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. Use the menu to see other pages.

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:

  • Clinical staging. This is based on the results of DRE, PSA testing, and Gleason score (see “Gleason score for grading prostate cancer” below). These test results will help determine whether x-rays, bone scans, CT scans, or MRI are also needed. If scans are needed, they can add more information to help the doctor figure out the clinical stage.

  • Pathologic staging. This is based on information found during surgery, plus the laboratory results of the prostate tissue removed during surgery, also called the pathology. The surgery often includes the removal of the entire prostate and some lymph nodes. Examination of the removed lymph nodes can provide more information for pathologic staging.

TNM staging system

One tool that doctors use to describe the stage is the TNM system. This system is developed by the American Joint Committee on Cancer. (Please note that this link takes you to a different website.) 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 spread 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.

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 3 to 5 from 2 different locations. 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 pathologist determines the main pattern of cell growth, which is the area where the cancer is most obvious, and then looks for another area of growth. The doctor then gives each area a score from 3 to 5. The scores are added together to come up with an overall score between 6 and 10.

Gleason scores of 5 or lower are not used. The lowest Gleason score 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 (see Types of Treatment) may be an option for someone with a small tumor, low PSA level, and a Gleason score of 6. People with a higher Gleason score may need treatment that is more intensive, even if the cancer is not large or has not spread.

  • Gleason X: The Gleason score cannot be determined.

  • Gleason 6 or lower: The cells look similar to healthy cells, which is called well differentiated.

  • Gleason 7: The cells look somewhat similar to healthy cells, which is called moderately differentiated.

  • Gleason 8, 9, or 10: The cells look very different from healthy cells, which is called poorly differentiated or undifferentiated.

Cancer stage grouping

Doctors assign the stage of the cancer by combining the T, N, and M classifications. Staging also includes the PSA level (see Screening) and Grade Group.

Stage I: Cancer in this early stage is usually slow growing. The tumor cannot be felt and involves one-half of 1 side of the prostate or even less than that. PSA levels are low. The cancer cells look like healthy cells.

Stage II: The tumor is found only in the prostate. PSA levels are medium or low. Stage II prostate cancer is small but may have an increasing risk of growing and spreading.

  • Stage IIA: The tumor cannot be felt and involves half of 1 side of the prostate or even less than that. PSA levels are medium, and the cancer cells are well differentiated. This stage also includes larger tumors found only in the prostate, as long as the cancer cells are still well differentiated.

  • Stage IIB: The tumor is found only inside the prostate, and it may be large enough to be felt during DRE. The PSA level is medium. The cancer cells are moderately differentiated.

  • Stage IIC: The tumor is found only inside the prostate, and it may be large enough to be felt during DRE. The PSA level is medium. The cancer cells may be moderately or poorly differentiated.

Stage III: PSA levels are high, the tumor is growing, or the cancer is high grade. These all indicate a locally advanced cancer that is likely to grow and spread.

  • Stage IIIA: The cancer has spread beyond the outer layer of the prostate into nearby tissues. It may also have spread to the seminal vesicles. The PSA level is high.

  • Stage IIIB: The tumor has grown outside of the prostate gland and may have invaded nearby structures, such as the bladder or rectum.

  • Stage IIIC: The cancer cells across the tumor are poorly differentiated, meaning they look very different from healthy cells.

Stage IV: The cancer has spread beyond the prostate.

  • Stage IVA: The cancer has spread to the regional lymph nodes.

  • Stage IVB: The cancer has spread to distant lymph nodes, other parts of the body, or to the bones.

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.

Used with permission of the American College of Surgeons, Chicago, Illinois. The original and primary source for this information is the AJCC Cancer Staging Manual, Eighth Edition (2017), published by Springer International Publishing.

Prostate cancer risk groups

In addition to stage, doctors may use other prognostic factors to help plan the best treatment and predict how successful treatment will be. Examples of these include the National Comprehensive Cancer Network (NCCN) risk group categories and the Cancer of the Prostate Risk Assessment (CAPRA) risk score from University of California, San Francisco.

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 Types of Treatment. Use the menu to choose a different section to read in this guide.

Prostate Cancer - Types of Treatment

Approved by the Cancer.Net Editorial Board, 09/2020

ON THIS PAGE: You will learn about the different types of treatments doctors use for people with prostate cancer. Use the menu to see other pages.

This section explains the types of treatments that are the standard of care for prostate cancer. “Standard of care” means the best treatments known. When making treatment plan decisions, you are 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 whether the new treatment 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. Clinical trials are an option to consider for treatment and care for all stages of cancer. Your doctor can help you consider all your treatment options. Learn more about clinical trials in the About Clinical Trials and Latest Research sections of this guide.

Treatment overview

In cancer care, different types of doctors—including medical oncologists, surgeons, and radiation oncologists—often work together to create an overall treatment plan that may combine different types of treatments to treat the cancer. This is called a multidisciplinary team. Cancer care teams include a variety of other health care professionals, such as palliative care experts, physician assistants, nurse practitioners, oncology nurses, social workers, pharmacists, counselors, dietitians, physical therapists, and others.

Descriptions of the common types of treatments used for prostate cancer are listed below. Your care plan may also include treatment for symptoms and side effects, an important part of cancer care.

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.

Cancer treatment can affect older adults in different ways. More information on the specific effects of surgery, chemotherapy, and radiation therapy on older patients can be found in this article in another section of this website.

Take time to learn about your treatment options and be sure to ask questions if something is unclear. 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. Discuss with your doctor how the treatment options may affect recurrence, survival, and quality of life. In addition, it is important to discuss your doctor's experience with treating prostate cancer. These types of talks are called "shared decision making." Shared decision making is when you and your doctors work together to choose treatments that fit the goals of your care. Shared decision making is particularly important for prostate cancer because there are different treatment options. Learn more about making treatment decisions.

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 you have symptoms or PSA levels are rising rapidly

  • Whether the cancer has spread to the bones

  • Your health history

  • Your quality of life

  • Your current urinary and sexual function

  • 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 by stage. These are described in "Treatments by stage of prostate cancer," later in this section.

Active surveillance and watchful waiting

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

Active surveillance. Prostate cancer treatments may seriously affect a person's quality of life. These treatments can cause side effects, such as erectile dysfunction, which is when someone is unable to get and maintain an erection, and incontinence, which is when a person cannot control their urine flow or bowel function. In addition, many prostate cancers grow slowly and cause no symptoms or problems. For this reason, many people may consider delaying cancer treatment rather than starting treatment right away. This is called active surveillance. During active surveillance, the cancer is closely monitored for signs that it is worsening. If the cancer is found to be worsening, treatment will begin.

Active surveillance is usually preferred for those with very-low-risk and low-risk prostate cancer that can be treated with surgery or radiation therapy if it shows signs of getting worse. ASCO endorses recommendations from CancerCare Ontario on active surveillance, which recommend active surveillance for most patients with cancer that has not spread beyond the prostate, with a Gleason score of 6 or below. Sometimes, active surveillance may be an option for prostate cancer with a Gleason score of 7. There is also growing use of genomic testing to help find out if active surveillance is the best choice for a person with prostate cancer (see more in Latest Research).

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

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

Watchful waiting. Watchful waiting may be an option for older adults 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 done. If the prostate cancer causes symptoms, such as pain or blockage of the urinary tract, then treatment may be recommended to relieve those symptoms. This may include hormonal therapy (see “Systemic treatments” below). Patients 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 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 person. 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 someone who is otherwise healthy. New information is becoming available all the time, and it is important to discuss these issues with the doctor to make the best decisions about treatment. Learn more about ASCO’s endorsement of recommendations for active surveillance on a separate ASCO website.

Local treatments

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

Surgery

Surgery involves the removal of the prostate and some surrounding lymph nodes during an operation. A surgical oncologist is a doctor who specializes in treating cancer using surgery. For prostate cancer, a urologist or urologic oncologist is the surgical oncologist involved in treatment. The type of surgery depends on the stage of the disease, the patient’s overall health, and other factors.

  • 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 affecting 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 separate processes. Urinary incontinence is also a possible side effect of radical prostatectomy. To help resume normal sexual function, drugs, penile implants, or injections may be recommended. Sometimes, another surgery can fix urinary incontinence.

  • Robotic or laparoscopic prostatectomy. This type of surgery is 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. In general, robotic prostatectomy causes less bleeding and less pain, but the sexual and urinary side effects are 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 radical (open) prostatectomy.

  • Bilateral orchiectomy. Bilateral orchiectomy is the surgical removal of both testicles. It is described in detail in “Systemic treatments” below.

  • 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.

Before surgery, talk with your health care team about the possible side effects from the specific surgery you will have. Typically, younger or healthier patients may benefit more from a prostatectomy. Younger patients are also less likely to develop permanent erectile dysfunction and urinary incontinence after a prostatectomy than older patients. Learn more about coping with the sexual side effects of prostate cancer in the Coping With Treatment section.

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, or schedule, usually consists of a specific number of treatments given over a set period of time.

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.

One method of external-beam radiation therapy used to treat prostate cancer is called hypofractionated radiation therapy. This is when a person receives a higher daily dose of radiation therapy given over a shorter period, instead of lower doses given over a longer period. Extreme hypofraction radiation therapy is when the entire treatment is delivered in 5 or fewer treatments. This is also called stereotactic body radiation therapy (SBRT) or stereotactic ablative radiation therapy (SABR).

According to recommendations from ASCO, the American Society for Radiation Oncology, and the American Urological Association, hypofractionated radiation therapy may be an option for the following people with early-stage prostate cancer that has not spread to other parts of the body:

  • People with low-risk prostate cancer who need or prefer treatment instead of active surveillance.

  • People with intermediate or high-risk prostate cancer receiving external-beam radiation therapy to the prostate but not to the pelvic lymph nodes.

People who receive hypofractionated radiation therapy may have a slightly higher risk of some short-term side effects after treatment compared with those who receive regular external-beam radiation therapy. This may include gastrointestinal side effects. Based on current research, people who receive hypofractionated radiation therapy are not at a higher risk of side effects in the long term. Talk with your health care team if you have questions about your risk for side effects.

Learn more about these recommendations for hypofractionated radiation therapy for prostate cancer on a different ASCO website.

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. High-dose-rate brachytherapy is usually left in the body for less than 30 minutes, but it may need to be given more than once.

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

  • People 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.

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

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

Read ASCO’s recommendations for brachytherapy for prostate cancer, found on a separate ASCO website.

Intensity-modulated radiation therapy (IMRT). IMRT is a type of external-beam radiation therapy that uses CT scans to form a 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 people with prostate cancer than traditional radiation therapy. It can also be more expensive.

Side effects of radiation therapy

Radiation therapy may cause side effects during treatment, including increased urinary urge or frequency; problems with sexual function; problems with bowel function, including diarrhea, rectal discomfort or rectal bleeding; and fatigue. Most of these side effects usually go away after treatment.

To help resume normal sexual function, drugs, penile implants, or injections may be recommended. Learn more about coping with the sexual side effects of prostate cancer in the Coping With Treatment section. While uncommon, some side effects of radiation therapy may not show up until years after treatment. See Follow-up Care for more information about long-term side effects.

Learn more about the basics of radiation therapy.

Focal therapies

Focal therapies are less-invasive 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, mostly for low-risk or intermediate-risk prostate cancer. Focal therapies are being studied in clinical trials. Most have not been approved as standard treatment options.

Cryosurgery, also called cryotherapy or cryoablation, involves freezing 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 to treat newly diagnosed 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 known.

High-intensity focused ultrasound (HIFU) is a heat-based type of focal therapy. During HIFU treatment, an ultrasound probe is inserted into the rectum and then sound waves are directed at cancerous parts of the prostate gland. This treatment is designed to destroy cancer cells while limiting damage to the rest of the prostate gland. The FDA approved HIFU for the treatment of prostate tissue in 2015. HIFU may be an attractive option for some people, but knowing who may benefit most from this treatment is still unknown. HIFU should only be performed by a specialist with a lot of expertise. You will need to carefully discuss with your doctor if HIFU is the best treatment for you.

Systemic treatments

Systemic therapy is the use of medication to destroy cancer cells. Systemic therapies are generally prescribed by a medical oncologist, a doctor who specializes in treating cancer with medication.

Common ways to give systemic therapies include an intravenous (IV) tube placed into a vein using a needle or in a pill or capsule that is swallowed (orally).

The types of systemic therapies used for prostate cancer include:

  • Hormonal therapy

  • Targeted therapy

  • Chemotherapy

  • Immunotherapy

  • Radiopharmaceuticals

  • Bone-modifying drugs

Each of these types of therapies is discussed below in more detail. A person may receive 1 type of systemic therapy at a time or a combination of systemic therapies given at the same time. They can also be given as part of a treatment plan that includes surgery and/or radiation therapy.

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. It is also important to let your doctor know if you are taking any other prescription or over-the-counter medications or supplements. Herbs, supplements, and other drugs can interact with cancer medications. Learn more about your prescriptions by using searchable drug databases.

Hormonal therapy

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. Hormonal therapy is used to lower testosterone levels in the body, 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 hormonal therapy is used is less important than the main goal of lowering testosterone levels. This treatment can be referred to with other names, including androgen-deprivation therapy (ADT).

Another way to stop testosterone from driving the growth of prostate cancer is to treat it with a type of medication called an androgen axis inhibitor. These medications can stop the body from making testosterone or stop testosterone from working. Androgen axis inhibitors include androgen receptor inhibitors and androgen synthesis inhibitors, which are both described in more detail below.

Treatment with hormonal therapy is used to treat prostate cancer in many different situations, including localized, locally advanced, and metastatic prostate cancer, as well as rising PSA level after surgery and/or radiation therapy for localized prostate cancer. Some of the situations in which this therapy may be used include:

  • People with NCCN-based intermediate-risk and high-risk, localized prostate cancer who are having definitive therapy with radiation therapy are candidates for hormonal therapy. Definitive therapy is a treatment given with the intent to cure the cancer. People with intermediate-risk prostate cancer should receive hormonal therapy for at least 4 to 6 months. Those with high-risk prostate cancer should receive it for 24 to 36 months.

  • Hormonal therapy may also be given to those who have had surgery and microscopic cancer cells were found in the removed lymph nodes. It 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 hormonal therapy is controversial, some specific patients appear to benefit from this approach.

Types of hormonal therapy

Bilateral orchiectomy. Bilateral orchiectomy is the surgical removal of both testicles. It was the first treatment used for metastatic prostate cancer more than 70 years ago. Even though this is a surgical procedure, it is considered hormonal therapy because it removes the main source of testosterone production, the testicles. The effects of this surgery are permanent and cannot be reversed. Bilateral orchiectomy is not commonly used in practice.

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 orchiectomy, the effects of LHRH agonists are often reversible, so testosterone production usually begins again once treatment stops. However, testosterone recovery can take from 6 months to 24 months, and for a small number of patients, testosterone production does not return.

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 if the cancer 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 the flare associated with LHRH agonists. The FDA has approved 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. An oral LHRH antagonist, relugolix (Orgovyx), is also approved by the FDA for the treatment of advanced prostate cancer. Relugolix is different from other LHRH antagonists in 2 ways. First, it has a lower risk of causing serious heart problems in patients with preexisting heart disease. Second, when treatment with relugolix is stopped, testosterone production is restored within weeks, rather than months, which may be helpful for those undergoing intermittent hormonal therapy (see below).

Androgen receptor (AR) inhibitors. While LHRH agonists and antagonists lower testosterone levels in the blood, androgen receptor (AR) inhibitors 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. In effect, AR inhibitors stop testosterone from working. Older AR inhibitors include bicalutamide (Casodex), flutamide (available as a generic drug), and nilutamide (Nilandron) and are taken as pills. Newer AR inhibitors include apalutamide (Erleada), darolutamide (Nubeqa), and enzalutamide (Xtandi).

These medications are also sometimes called anti-androgens. AR inhibitors are usually given to people who have “castration-sensitive” prostate cancer, which means that the prostate cancer still responds to treatments that lower testosterone levels. AR inhibitors are not usually used by themselves to treat prostate cancer.

  • Apalutamide. Apalutamide is approved by the FDA for the treatment of non-metastatic castration-resistant prostate cancer and for metastatic castration-sensitive prostate cancer in combination with hormonal therapy.

  • Darolutamide. Darolutamide is approved for the treatment of non-metastatic castration-resistant prostate cancer.

  • Enzalutamide. Enzalutamide is a nonsteroidal AR inhibitor that is approved to treat metastatic and non-metastatic castration-resistant prostate cancer as well as metastatic castration-sensitive prostate cancer.

Androgen synthesis inhibitors. Although the testicles produce most of the body's testosterone, other cells in the body can still make small amounts of the hormone that may drive cancer growth. These include the adrenal glands and some prostate cancer cells. Androgen synthesis inhibitors target an enzyme called CYP17 and stop cells from making testosterone.

  • Abiraterone acetate (Zytiga). Abiraterone acetate is taken in the form of a pill. Patients take 4 pills per day along with prednisone (multiple brand names) or prednisolone (multiple brand names) twice a day. Prednisone or prednisolone helps prevent some of the side effects of abiraterone. Abiraterone acetate may cause serious side effects, such as high blood pressure, low blood potassium levels, fatigue, and fluid retention. Common side effects include weakness, joint swelling or pain, swelling in the legs or feet, hot flushes, diarrhea, vomiting, shortness of breath, and anemia.

  • Ketoconazole (Nizoral). Ketoconazole is an androgen synthesis inhibitor that is no longer widely used because of multiple drug interactions. However, ketoconazole may be an option for some patients.

Combined androgen blockade. Sometimes androgen receptor inhibitors are combined with bilateral orchiectomy or LHRH agonist treatment to maximize the blockade of male hormones or to prevent the flare associated with treatment with LHRH agonists (see above).

Intermittent hormonal therapy. Traditionally, hormonal therapy was given for the patient’s lifetime. During the past 2 decades, researchers have studied the use of intermittent hormonal therapy, which is when therapy is given for specific times (most commonly 6 months) and then stopped temporarily to allow for testosterone levels to recover. For these patients, hormonal therapy is restarted when the PSA begins to rise again. When to restart therapy (that is, at which PSA levels) is still a topic of debate. Using hormonal therapy in this way may lower the side effects related to the lack of testosterone and improve a person’s quality of life. ASCO recommends this approach only for people with high-risk PSA recurrence (see below) and with no evidence of metastatic disease after radical prostatectomy and/or radiation therapy. However, intermittent hormonal therapy has not been studied with newer hormonal treatments, such as abiraterone or enzalutamide, or chemotherapy, so ASCO cannot recommend intermittent hormonal therapy with them.

Side effects of hormonal therapy

These treatments will cause side effects that generally go away after treatment has finished, except in those who have had an orchiectomy. General side effects 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

  • Heart problems and heart disease

  • Weight gain

  • Loss of muscle mass

  • Osteopenia or osteoporosis, which is thinning of bones

Learn more about coping with the sexual side effects of prostate cancer treatment in the Coping With Treatment section.

Although testosterone levels may recover after stopping treatment, some who have received 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 these treatments 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 hormonal therapy have an increased risk of developing metabolic syndrome. The risk is increased even if temporary medical castration is used. Find out more about the symptoms of hormone deprivation and how to manage them.

The risks and benefits of treatment should be carefully discussed with your doctor. For people with metastatic prostate cancer, especially if it is advanced and causing symptoms, most doctors believe that the benefits far outweigh the risks of side effects. It is highly encouraged that people receiving hormonal therapy take steps that help manage or avoid possible side effects. These include getting regular exercise, quitting smoking, eating a balanced diet, making sure to get enough vitamin D and calcium, and receiving comprehensive, preventive cardiovascular follow-up care.

Targeted therapy

Targeted therapy is a treatment that targets the cancer’s specific genes, proteins, or the tissue environment that contributes to cancer growth and survival. This type of treatment blocks the growth and spread of cancer cells and limits damage to healthy cells.

Not all tumors have the same targets. To find the most effective treatment, your doctor may run tests to identify the genes, proteins, and other factors in your tumor. This helps doctors better match each patient with the most effective treatment whenever possible. In addition, research studies continue to find out more about specific molecular targets and new treatments directed at them. Learn more about the basics of targeted treatments.

Targeted therapy for prostate cancer includes:

  • Olaparib (Lynparza). Olaparib is a type of targeted therapy called a PARP inhibitor. It is approved for patients with metastatic castration-resistant prostate cancer whose disease has continued to grow and spread during treatment with abiraterone and/or enzalutamide and who have DNA-repair gene defects, which may be inherited or in the tumor. DNA-repair gene defects make it harder for cancer cells to repair damaged DNA. Certain genes, such as BRCA1, BRCA2, and several others, are linked with DNA-repair gene defects, and the presence of any of these can allow treatment with olaparib. The FDA has also approved 2 specific tests to select patients for treatment with olaparib.

  • Rucaparib (Rubraca). Rucaparib is another PARP inhibitor approved to treat metastatic castration-resistant prostate cancer in patients whose disease has not been stopped by treatment with abiraterone and/or enzalutamide and chemotherapy, and who have a BRCA1 or BRCA2 mutation that is either inherited or in the tumor.

One or more tests must be given to determine whether a patient may receive olaparib or rucaparib:

  • Testing for germline mutation after discussion with a genetic counselor

  • Genomic sequencing of tumor tissue

  • Genomic sequencing of the tumor DNA floating in the bloodstream

Genomic sequencing may be performed on tissue that was previously collected or on tissue from a new biopsy. Germline mutation testing alone identifies about half of the patients eligible for this treatment. People with metastatic prostate cancer who are considering targeted therapy are encouraged to talk with their doctors about all 3 tests mentioned above.

Talk with your doctor about possible side effects for a specific medication and how they can be managed.

Chemotherapy

Chemotherapy is the use of drugs to destroy cancer cells, usually by keeping the cancer cells from growing, dividing, and making more cells.

Chemotherapy may help those with advanced or castration-resistant prostate cancer and those with newly diagnosed or castration-sensitive metastatic prostate cancer. A chemotherapy regimen, or schedule, 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 prednisone.

Recent research shows adding docetaxel to hormonal therapy in those with newly diagnosed or castration-sensitive metastatic prostate cancer significantly helps people live longer and stops the disease from growing and spreading.

Cabazitaxel (Jevtana) is approved to treat metastatic castration-resistant prostate cancer that has been previously treated with docetaxel. It is a microtubule inhibitor.

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 after 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.

Immunotherapy

Immunotherapy, also called biologic therapy, 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.

For some people 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 (Provenge) may be an option.

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 lower PSA levels, shrinking of the tumor, or keeping the cancer from getting worse. However, results from clinical trials have shown that treatment with sipuleucel-T can lengthen lives by about 4 months in people with metastatic castration-resistant prostate cancer with few or no symptoms.

Different types of immunotherapy can cause different side effects. Common side effects include skin reactions, flu-like symptoms, diarrhea, and weight changes. Talk with your doctor about possible side effects for the immunotherapy recommended for you. Learn more about the basics of immunotherapy.

Radiation therapy by infusion

Radium-223 (Xofigo) is a radioactive substance used to treat castration-resistant prostate cancer that has spread to the bone. Radium-223 is an alpha-emitter radionucleotide that mimics calcium and targets areas in the bone where the cancer is causing changes. This treatment delivers radiation particles directly to tumors found in the bone, limiting damage to healthy tissue, including the bone marrow, where normal blood cells are made. Radium-223 is given by intravenous injection (IV) once a 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 progress during this treatment to make sure the treatment is helping and that any potential side effects are managed. Treatment with radium-233 does not dependably lower PSA, so patients should not expect to see big decreases in PSA levels during treatment and, in fact, often PSA levels may rise.

Some people should not receive this treatment, especially those who have prostate cancer that has spread to the liver and/or lungs and/or those with enlarged lymph nodes (3 or more cm in diameter). Radium-223 should not be used in combination with abiraterone and prednisone because that combination increases the risk of bone fractures. Discuss with your doctor whether this medication is an option for you.

Bone-modifying drugs

Bone health is an important issue in the lives of people with prostate cancer. Osteopenia and osteoporosis are bone conditions that can be caused or worsened by hormonal therapy (see “Systemic therapies,” above). Patients receiving hormonal therapy for non-metastatic prostate cancer should be evaluated for risk of fractures. The most common way to find a person’s risk is with a dual-energy X-ray absorptiometry (DEXA) scan to measure the strength of the bones. Patients who are found to be at high risk for a fracture should receive treatment to lower the risk. Bone-modifying drugs that can be used in this situation include denosumab (Prolia), zoledronic acid (Reclast), alendronate (Fosamax), risedronate (Actonel), ibandronate (Boniva), and pamidronate (Aredia). These medications can have side effects, so talk with your doctor about when to take the medication and which would be best based on your situation.

Bone-modifying drugs have not been shown to prevent the spread of prostate cancer to the bone in patients who do not currently have evidence of bone metastases.

In patients with prostate cancer that has spread to the bone, there is always some risk of bone problems, such as fracture, pain, and spinal cord compression. These are called “skeletal-related events.” When prostate cancer has spread to bone and has also become resistant to standard hormonal therapy (this is called metastatic castration-resistant prostate cancer, see below), bone-modifying drugs may be recommended to reduce the risk of these problems. Specifically, denosumab (Xgeva) or zoledronic acid (Zometa) can be given once per month to reduce that risk.

A rare but serious possible side effect of bone-modifying drugs is osteonecrosis of the jaw. The symptoms of osteonecrosis of the jaw include pain, swelling, and infection of the jaw; loose teeth; and exposed bone. The most prominent risk factor for this side effect is the need for invasive dental work (for example, tooth extraction) in a person who is already receiving a potent bone-modifying drug such as denosumab or zoledronic acid. It is important to have a dental evaluation before starting these drugs in order to assess safety and address problem areas before starting a bone-modifying drug. If someone taking these drugs needs dental work, treatment should be stopped until the dental work is completed and the patient has healed. Learn more about dental health and cancer.

This information is based on an ASCO endorsement of the Cancer Care Ontario guideline, “Bone Health and Bone-targeted Therapies for Prostate Cancer.” Note that this link takes you to a different ASCO website.

Physical, emotional, and social effects of cancer

Cancer and its treatment cause physical symptoms and side effects, as well as emotional, social, and financial effects. Managing all of these effects is called palliative care or supportive care. It is an important part of your care that is included along with treatments intended to slow, stop, or eliminate the cancer.

Palliative care focuses on improving how you feel during treatment by managing symptoms and supporting patients and their families with other, non-medical needs. Any person, regardless of age or type and stage of cancer, may receive this type of care. And it often works best when it is started right after a cancer diagnosis. People who receive palliative care along with treatment for the cancer often have less severe symptoms, better quality of life, and report that they are more satisfied with treatment.

Palliative treatments vary widely and often include medication, nutritional changes, relaxation techniques, emotional and spiritual support, and other therapies. You may also receive palliative treatments similar to those meant to get rid of the cancer, such as chemotherapy, surgery, or radiation therapy.

Before treatment begins, talk with your doctor about the goals of each treatment in the treatment plan. You should also talk about the possible side effects of the specific treatment plan and palliative care options.

During treatment, your health care team may ask you to answer questions about your symptoms and side effects and to describe each problem. Be sure to tell the health care team if you are experiencing a problem. This helps the health care team treat any symptoms and side effects as quickly as possible. It can also help prevent more serious problems in the future.

Learn more about the importance of tracking side effects in another part of this guide. Learn more about palliative care in a separate section of this website.

Treatment by stage of prostate cancer

Different treatments may be recommended for each stage of prostate cancer. Your doctor will recommend a specific treatment plan for you based on the cancer’s stage and other factors. Detailed descriptions of each type of treatment are provided earlier on this same page. Clinical trials may also be a treatment option for each stage.

Early-stage prostate cancer (stages I and II)

Early-stage prostate cancer usually grows very slowly and may take years to cause any symptoms or other health problems, if it ever does at all. As a result, active surveillance or watchful waiting may be recommended. Radiation therapy (external-beam or brachytherapy) or surgery may also be suggested, as well as treatment in clinical trials. For those with a higher Gleason score, the cancer may be faster growing, so radical prostatectomy and radiation therapy are often recommended. Your doctor will consider your age and general health before recommending a treatment plan.

ASCO, the American Urological Association, American Society of Radiation Oncology, and the Society of Urologic Oncology recommend that patients with high-risk early-stage prostate cancer that has not spread to other areas of the body should receive radical prostatectomy or radiation therapy with hormonal therapy as standard treatment options.

Locally advanced prostate cancer (stage III)

Locally advanced prostate cancer may be treated with external-beam radiation therapy and concurrent hormonal therapy or with surgery alone. ASCO recommends that doctors consider hormonal therapy to stop testosterone production plus abiraterone and prednisolone when patients can receive this approach. If abiraterone is not an option, combined androgen blockade using an AR inhibitor may be recommended. Treatments may be given in different combinations to stop the cancer from growing and spreading. Active surveillance is also an option. For those who have not received previous local treatment, including surgery, and who are unwilling or unable to receive radiation therapy, early (immediate) hormonal therapy may be offered.

It is widely accepted that at least 24 months of hormonal therapy is needed to control the disease, but 18 months may also be enough. For those who have a radical prostatectomy, radiation therapy is given after the surgery. This is called adjuvant or salvage radiation therapy. It is a standard of care for prostate cancer with extraprostatic extension (pT3a or pT3b, see “Stages and Grades”). Those with a high risk of bone fractures may be given a bone-modifying drug on an osteoporosis treatment dose and schedule (see "Bone-modifying drugs” above).

Watchful waiting may be considered for older adults 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.

Advanced prostate cancer (stage IV)

If cancer spreads to another part in the body from where it started, doctors call it metastatic cancer. High-risk or locally advanced prostate cancers have a higher chance of becoming metastatic cancer. If prostate cancer has a high risk of becoming metastatic or is already metastatic, 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. Clinical trials might also be an option. Learn more about getting a second opinion before starting treatment, so you are comfortable with your chosen treatment plan.

For most people, a diagnosis of advanced cancer is very stressful and difficult. You and your family are encouraged to talk about how you feel 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.

There is no cure for metastatic prostate cancer, but it is often treatable for quite some time. Many people 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. In this way, it can be like living with a chronic disease like heart disease or diabetes, requiring ongoing treatment to minimize symptoms and maintain well-being.

Supportive, or palliative, care to help relieve symptoms and side effects is an important part of the care of advanced prostate cancer. Supportive care options include:

  • TURP to manage symptoms such as bleeding or urinary obstruction (see "Surgery").

  • Bone-modifying drugs may be used to strengthen bones, reduce the risk of bone fractures, and reduce the risk of skeletal-related events for prostate cancer that has spread to the bone (see "Bone-modifying drugs").

  • Intravenous radiation therapy with radium-223, strontium, and samarium can also help relieve bone pain (see "Radiation therapy").

  • Palliative radiation therapy to specific bone areas can also be used to reduce bone pain when medications do not help.

Researchers are using other methods to better understand metastatic prostate cancer and identify new treatment approaches. For example, the Metastatic Prostate Cancer Project allows people with metastatic prostate cancer to enroll themselves. Please note that the link above takes you to another, independent website.

Biochemical or PSA recurrence

Many people treated with surgery or radiation therapy are cured. However, some will develop a biochemical recurrence (BCR). The main signs of BCR are rising PSA levels and no metastases in scans. This is why BCR is also called "PSA recurrence" or “rising PSA syndrome.” The exact definition of BCR depends on the first treatment someone with prostate cancer has received.

For those who received a radical prostatectomy, BCR is defined as a rising PSA level that reaches a value of 0.2 ng/mL or more. Radiation therapy may be a treatment option for certain patients with BCR after surgery. This treatment is called “salvage radiation therapy.” Several factors are considered when deciding who can be treated with salvage radiation therapy, including Gleason score, pathologic stage, how long it took for BCR to happen, PSA level after surgery, and changes in PSA over time, also known as “PSA doubling time.”

For people who received radiation therapy as the main treatment for prostate cancer, BCR is defined as a normal testosterone level and a PSA value more than 2.0 ng/mL plus the lowest PSA value reached after the treatment with radiation therapy (this is called “nadir PSA”). Treating BCR after radiation therapy is more difficult. Treatment options can include surgery, called “salvage radical prostatectomy,” or cryosurgery, called “salvage cryotherapy” (see “Focal therapies,” above). You are encouraged to discuss the treatment options with the health care team.

Hormonal therapy may be recommended, especially if other local treatments are not possible. If hormonal therapy is going to be used to treat high-risk BCR, ASCO recommends intermittent hormonal therapy (see above).

Metastatic castration-sensitive prostate cancer

Prostate cancer that has spread to other parts of the body and still responds to treatment that suppresses testosterone is called metastatic castration-sensitive prostate cancer. The best treatment option depends on the patient's health and the extent of the cancer. It is important to talk with the health care team about the risks and benefits of each option. The following treatment options can be used to treat people who are newly diagnosed and those who have received previous treatments, including radical prostatectomy or radiation therapy.

  • Docetaxel plus hormonal therapy. In those with very widespread disease who are able to receive chemotherapy, docetaxel combined with hormonal therapy may be recommended. Docetaxel with or without prednisolone is given by IV every 3 weeks for a total of 6 doses. The side effects of docetaxel may include low levels of blood cells, infection, nausea and vomiting, muscle aches, and hair and nail changes. It may also cause peripheral neuropathy, which is a type of nerve damage that causes a tingling or burning feeling in the hands and/or feet.

  • Abiraterone with prednisone or prednisolone plus hormonal therapy. This treatment is recommended for newly diagnosed, high-risk metastatic castration-sensitive prostate cancer, but it can also be offered to people with low-risk disease.

  • Apalutamide plus hormonal therapy. This combination was approved in 2019. It offers a treatment plan that does not need long-term treatment with steroids and frequent monitoring with laboratory tests. This treatment is recommended as an option for those with metastatic castration-sensitive prostate cancer regardless of the risk or volume of the disease.

  • Enzalutamide plus hormonal therapy. This combination was approved in late 2019. It does not need treatment with steroids and frequent monitoring with laboratory tests. This treatment is recommended as an option for those with metastatic castration-sensitive prostate cancer regardless of the risk or volume of the disease.

In addition to the above treatment options, treatment to relieve symptoms and side effects continues to be an important part of the overall treatment plan.

This information is based on the ASCO guideline, “Initial Management of Non-Castrate Advanced, Recurrent, or Metastatic Prostate Cancer.” Note that this link takes you to a different ASCO website.

A bone-modifying drug may be recommended to prevent bone fractures (see "Bone-modifying drugs” above).

Non-metastatic castration-resistant prostate cancer

Prostate cancer that is no longer stopped by low testosterone levels (less than 50 ng/mL) is called “castration resistant.” Castration-resistant prostate cancer is defined by a rising PSA level and/or worsening symptoms and/or growing cancer verified by scans. If the cancer has not spread to other parts of the body, it is called “non-metastatic castration-resistant prostate cancer.”

ASCO recommends that treatment for non-metastatic castration-resistant prostate cancer should continue to focus on lowering testosterone levels. This may include a permanent treatment, such as orchiectomy, or it may include continuing treatment with medications that lower hormone levels, such as apalutamide, darolutamide, or enzalutamide.

For those who have not had chemotherapy, additional hormonal therapy may be an option if there is a high risk that the disease will spread. Talk with your doctor about your personal risk level.

PSA testing and/or imaging tests may be done regularly to see if the cancer has worsened or spread. If there is a low risk of developing metastatic disease, ASCO recommends PSA testing every 4 to 6 months. If there is 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 there are symptoms or signs that the cancer is worsening.

Metastatic castration-resistant prostate cancer

If the cancer is no longer stopped by low testosterone levels (less than 50 ng/mL) and has spread to other parts of the body, it is called “metastatic castration-resistant prostate cancer.” Castration-resistant prostate cancer is defined by a rising PSA level and/or worsening symptoms and/or growing cancer verified by scans. ASCO recommends PSA testing every 3 months for metastatic castration-resistant prostate cancer. Imaging tests may also be done.

Metastatic castration-resistant prostate cancer can be difficult to treat. ASCO recommends continuing treatment that lowers hormone levels for metastatic castration-resistant prostate cancer. ASCO has treatment recommendations for hormone therapy for advanced cancer and for systemic treatment of metastatic castration-resistant prostate cancer.

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

  • AR inhibitors, such as abiraterone or enzalutamide

  • Targeted therapy with olaparib or rucaparib

  • Chemotherapy with docetaxel, especially if there is bone pain or other cancer-related symptoms

  • Chemotherapy with cabazitaxel if docetaxel stops working

  • Immunotherapy with sipuleucel-T

  • Radium-223 or a bone-modifying drug to treat cancer that has spread to the bone

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 hormonal therapy and radiation therapy, 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 someone's 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 returns after the original treatment, it is called recurrent cancer.

When this occurs, a new 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 or biochemical recurrence.

After this testing is done, you and your doctor will talk about the 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 people first treated with radiation therapy, or hormonal therapy. Your doctor may 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 radium-223, strontium, or samarium, or other treatments to reduce bone pain.

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

If treatment does not work

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

People who have advanced cancer and who are expected to live less than 6 months may want to consider 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 talk with the health care team about hospice care options, which include hospice care at home, a special hospice center, or other health care locations. Nursing care and special equipment, including a hospital bed, can make staying at home a workable option 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. Use the menu to choose a different section to read in this guide.

Prostate Cancer - About Clinical Trials

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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. Use the menu to see other pages.

What are clinical trials?

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

Clinical trials are used for all types and stages of prostate cancer. Many focus on new treatments to learn if a new treatment is safe, effective, and possibly better than the existing treatments. These types of studies evaluate new drugs, different combinations of treatments, new approaches to radiation therapy or surgery, and new methods of treatment.

People who participate in clinical trials can be some of the first to get a treatment many years before it is available to the public. However, there are some risks with a clinical trial, including possible side effects and the chance that the new treatment may not work. People are encouraged to talk with their health care team about the pros and cons of joining a specific study.

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.

Deciding to join a clinical trial

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

Insurance coverage and the costs of clinical trials differ by location and by study. In some programs, some of the expenses from participating in the clinical trial are reimbursed. In others, they are not. It is important to talk with the research team and your insurance company first to learn if and how your treatment in a clinical trial will be covered. Learn more about health insurance coverage of clinical trials.

Sometimes people have concerns that, in a clinical trial, they may receive no treatment by being given a placebo or a “sugar pill.” When used, placebos are usually combined with standard treatment in most cancer clinical trials. Study participants will always be told when a placebo is used in a study. Find out more about placebos in cancer clinical trials.

Patient safety and informed consent

To join a clinical trial, people participate in a process known as informed consent. During informed consent, the doctor should:

  • Describe all of the treatment options, so that the person understands how the new treatment differs from the standard treatment.

  • List all of the risks of the new treatment, which may or may not be different from the risks of standard treatment.

  • Explain what will be required of each person 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.

Clinical trials also have certain rules called “eligibility criteria” that help structure the research and keep patients safe. You and the research team will carefully review these criteria together.

People who participate in a clinical trial may stop participating at any time for personal or medical reasons. 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 people 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 they choose 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, you can find a free video-based educational program about cancer clinical trials in another section of this website.

The next section in this guide is Latest Research. It explains areas of scientific research for prostate cancer. Use the menu to choose a different section to read in this guide.

Prostate Cancer - Latest Research

Approved by the Cancer.Net Editorial Board, 09/2020

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

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 best diagnostic and treatment options for you.

  • Finding causes of prostate cancer. Researchers continue to explore the link between nutrition and other 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. With improved testing, more healthy people 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, such as whether active surveillance is an option for those with low-risk prostate cancer or by helping the health care team make a prognosis after surgery and choose the best adjuvant treatments. Some of the genomic tests available now include Decipher, Oncotype DX, ProstaVysion, and the Prolaris Test.

    NCCN recently updated their guidelines to include details about genomic testing in prostate cancer. They recommend that people with metastatic castration-resistant prostate cancer receive testing for inherited and tumor mutations, which could help direct treatment.

    Learn more about ASCO recommendations for genomic tests for prostate cancer in the Diagnosis section.

  • Advanced imaging scans. Research is ongoing to use different molecules in PET-CT scans (see Diagnosis) to gather important information about a prostate cancer diagnosis, such whether there is distant spread (metastasis).

  • Improved surgical techniques. Better techniques for nerve-sparing surgery can decrease the risk of urinary and sexual side effects for people 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 5 treatments instead.

  • 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, hormonal therapy, immunotherapy, and combinations of different types of therapies.

  • Palliative care/supportive care. Clinical trials are underway to find better ways of reducing symptoms and side effects of current prostate cancer treatments to improve comfort and quality of life for patients.

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:

The next section in this guide is Coping with Treatment. It offers some guidance on how to cope with the physical, emotional, social, and financial changes that cancer and its treatment can bring. Use the menu to choose a different section to read in this guide.

Prostate Cancer - Coping with Treatment

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ON THIS PAGE: You will learn more about coping with the physical, emotional, social, and financial effects of cancer and its treatment. Use the menu to see other pages.

Every cancer treatment can cause side effects or changes to your body and how you feel. For many reasons, people do not experience the same side effects even when they are 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" or "supportive 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 listed in the Types of Treatment 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 health and function, and bladder function.

Talk with your health care team regularly about how you are feeling. It is important to let them know about any new side effects or changes in existing side effects. If they know how you are feeling, they can find ways to relieve or manage your side effects to help you feel more comfortable and potentially keep any side effects from worsening.

You may find it helpful to keep track of your side effects so it is easier to explain any changes with your health care team. Learn more about why tracking side effects is helpful.

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 sexual side effects

The treatment for prostate cancer can affect your sexual health. Some sexual side effects may be temporary and go away within a year after treatment, but some can be long lasting. Side effects that change sexual health can affect a person mentally, emotionally, and physically. Talk with your health care team about how your treatment will affect your sexual health. If you have a sexual partner, it can help to have an honest conversation with them about what worries you and what you expect may happen.

  • Loss of sexual desire. Treatments that reduce testosterone can lower your sexual desire. This will make you less interested in physical intimacy and having sex. It can also cause erectile dysfunction. There are no medical treatments to increase sexual desire, but treatments that lower testosterone may be temporarily stopped to let testosterone levels rise again. Fortunately, sexual desire is also influenced by other factors, such as relationship satisfaction, self-esteem, and psychological health. Because desire can be significantly dampened by loss of testosterone, it is important to learn how to optimize these other elements. Read a Cancer.Net Blog post about coping with the loss of sexual desire.

  • Erectile dysfunction. Erectile dysfunction or ED is when you cannot have or keep a penile erection. There are medications to help treat this condition, as well as medical devices like suppositories and a penile pump or implant. Read a Cancer.Net Blog post about asking for help with erectile problems.

  • Less semen and dry orgasm. Treatment may cause your orgasms to have less semen. Some treatments may result in orgasm with no semen at all. When this happens, it is called a dry orgasm. Having less or no semen does not affect a person’s feelings of pleasure during orgasm. However, it does affect your chances of fathering a child.

  • A smaller penis. Some patients may find that their penis shrinks by up to an inch after treatment, particularly after prostatectomy. Some research has found that this side effect is temporary, and the penis regains its size after a year. If this happens to you, speak with your health care team about penile rehabilitation, which can help with the recovery of the health of your penis.

There are many ways you can manage or cope with the sexual side effects of prostate cancer. The first step is to speak with your health care team about your sexual health, even if it makes you feel uncomfortable. Sexual recovery is an important part of quality of life, and your health care team can direct you to sources of help.

It will also be important to think about sexual arousal and intimacy in different ways. It may take longer to become aroused, you may feel distracted or anxious about cancer, and you may be uncomfortable talking with your partner about changes in your body image or erectile function. Often, it is helpful to focus on other forms of intimacy and sensual touch, such as kissing and cuddling, in order to enhance connection and jumpstart a sense of closeness and satisfaction. Most importantly, make time to communicate with your partner and seek help if you need it.

Cancer.Net has a page on sexual health for men, as well as a podcast about sexual health in people with prostate cancer and a general fact sheet that provides an overview of the sexual side effects of cancer.

Coping with emotional and social effects

You can have emotional and social effects after a cancer diagnosis. This may include dealing with difficult emotions, such as sadness, anxiety, or anger, or managing your stress level. Sometimes, people find it difficult to express how they feel to their loved ones. Some have found that talking to an oncology social worker, counselor, or member of the clergy can help them develop more effective ways of coping and talking about cancer.

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 the costs of cancer care

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 of medical care 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. Patients and their families are encouraged to talk about financial concerns with a member of their health care team. 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, including:

  • Providing support and encouragement

  • Talking with the health care team

  • Giving medications

  • Helping manage symptoms and side effects

  • Coordinating medical appointments

  • Providing a ride to and from 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 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 do not think the side effects are serious. This discussion should include physical, emotional, social, and financial 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. Create a caregiving plan with this 1-page fact sheet that includes an action plan to help make caregiving a team effort. This free fact sheet is available as a PDF, so it is easy to print.

Looking for More on How to Track Side Effects?

Cancer.Net Mobile app symptom tracker

Cancer.Net offers several resources to help you keep track of your symptoms and side effects. Please note that these links will take you to other sections of Cancer.Net:

  • Cancer.Net Mobile: The free Cancer.Net mobile app allows you to securely record the time and severity of symptoms and side effects.

  • ASCO Answers Managing Pain: Get this 32-page booklet about the importance of pain relief that includes a pain tracking sheet to help patients record how pain affects them. The free booklet is available as a PDF, so it is easy to print out.

  • ASCO Answers Fact Sheets: Read 1-page fact sheets on anxiety and depression, diarrhea, rash, and immunotherapy side effects that provide a tracking sheet to record details about the side effect. These free fact sheets are available as a PDF, so they are easy to print, fill out, and give to your health care team.

The next section in this guide is Follow-up Care. It explains the importance of checkups after cancer treatment is finished. Use the menu to choose a different section to read in this guide.

Prostate Cancer - Follow-Up Care

Approved by the Cancer.Net Editorial Board, 09/2020

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

Care for people diagnosed with prostate cancer does not end when active treatment has finished. Your health care team will continue to check that the cancer has not come back, 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. Different people have different risks, so it is important to talk with your doctor about how your risk affects your schedule of follow-up care.

Cancer rehabilitation may 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. Learn more about cancer rehabilitation.

Learn more about the importance of follow-up care.

Watching for recurrence

One goal of follow-up care is to check for a recurrence, which means that the cancer has come back. 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 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 first diagnosed and the types of treatment given.

The anticipation before having a follow-up test or waiting for test results can add stress to you or a family member. This is sometimes called “scan-xiety.” Learn more about how to cope with this type of stress.

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. 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 have certain physical examinations, scans, or blood tests to help find and manage them.

Some common late effects of prostate cancer include:

  • Anemia, particularly for patients who have received or are receiving hormone therapy

  • Bowel problems, such as bleeding and needing to go to the bathroom urgently and/or frequently

  • Urinary problems, such as difficulty emptying the bladder or difficulty controlling the bladder, called incontinence

  • High blood pressure, high cholesterol, and blood sugar levels, particularly for patients who have received or are receiving hormone therapy

  • Depression

  • Anxiety

  • Bone problems, particularly for those who have received or are receiving hormonal therapy

  • Hot flashes, particularly for those who have received or are receiving hormonal therapy

  • Issues with sexual health, intimacy, and body image

Learn more about self-image and cancer, fertility and cancer treatment, sexual health, and talking with your spouse or partner.

General health recommendations

People recovering from prostate cancer are encouraged to follow established guidelines for good health, such as reaching and maintaining a healthy weight, exercising, not smoking, eating a balanced diet, and following cancer screening recommendations. Here are general recommendations for those recovering from prostate cancer:

  • Focus on eating more fruits, vegetables, and whole grains. Eat fewer high-calorie foods and beverages and less saturated fat.

  • Get at least 600 IU of vitamin D each day and no more than 1,200 milligrams of calcium per day from foods.

  • If you have problems that affect how well your body absorbs nutrients from foods, consider talking with a registered dietitian (RD).

  • Be physically active for at least 150 minutes each week.

  • Limit alcohol consumption to no more than 2 drinks per day.

  • Quit smoking or using other types of tobacco.

  • Follow recommendations for general cancer screening. Those who received radiation therapy for prostate cancer may have a higher risk of bladder and colorectal cancers and need more intensive screening.

Talk with your doctor or other member of your health care team to help you develop an exercise plan, eating plan, and cancer screening schedule that is best for you. In addition, if you smoke or use tobacco, talk with your health care team about resources to help you quit.

Keeping personal health records

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

This is also a good time to talk with your doctor about who will lead your follow-up care. Some survivors continue to see their oncologist, while others transition back to the 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 them and with 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. Use the menu to choose a different section to read in this guide.

Prostate Cancer - Survivorship

Approved by the Cancer.Net Editorial Board, 09/2020

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

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 continues during treatment and through the rest of a person's life.

Survivorship is one of the most complicated parts of having cancer. This is because it is different for everyone. Some people continue to receive cancer treatment for a long time to reduce the risk of recurrence or to manage the cancer as a chronic disease. Learn more about living with chronic cancer.

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 about coping with everyday life.

Survivors may feel some stress when their frequent visits to the health care team end after completing 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 when new worries and challenges surface over time, such as any late effects of treatment, emotional challenges including fear of recurrence, sexual health 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

  • 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 place 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.

A new perspective on your health

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

People recovering from prostate cancer are encouraged to follow established guidelines for good health, such as not smoking, limiting alcohol, eating well, maintaining a healthy weight, 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.

It is important to have recommended medical checkups and tests (see Follow-up Care) to take care of your health.

Talk with your health care team 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 free booklet is available as a PDF, so it is easy to print.

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

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

The next section offers Questions to Ask the Health Care Team to help start conversations with your cancer care team. Use the menu to choose a different section to read in this guide.

Prostate Cancer - Questions to Ask the Health Care Team

Approved by the Cancer.Net Editorial Board, 09/2020

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

Cancer.Net Mobile app question tracker

Talking often with the health care team 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. It may also be helpful to ask a family member or friend to come with you to appointments to help take notes.

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?

  • What are the risks and benefits of the PSA test?

  • 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?

  • How aggressive is the cancer?

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

  • What stage is the prostate cancer? What does this mean?

  • What is the Gleason score of the 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?

  • How will treatment affect my emotional well-being?

  • 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?

  • If I have questions or problems, who should I call?

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?

  • Who should I contact about any side effects I experience? And how soon?

  • 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?

  • Who should I contact about any side effects I experience? And how soon?

  • 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 hormonal therapy

  • What type of hormonal therapy do you recommend?

  • What is the goal of this treatment?

  • How will this treatment be given?

  • Will I receive this treatment at a hospital or clinic? Or will I take it at home?

  • How long will I need to continue this treatment?

  • What side effects can I expect during treatment?

  • Who should I contact about any side effects I experience? And how soon?

  • 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 therapy using medication

  • 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?

  • Will I receive this treatment at a hospital or clinic? Or will I take it at home?

  • What side effects can I expect during treatment?

  • Who should I contact about any side effects I experience? And how soon?

  • 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 those tests be needed?

  • 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 more resources on this website that may be helpful to you. Use the menu to choose a different section to read in this guide.

Prostate Cancer - Additional Resources

Approved by the Cancer.Net Editorial Board, 09/2020

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. Use the menu to go back and see other pages.

Cancer.Net includes many other sections about the medical and emotional aspects of cancer 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.

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 to choose a different section to read in this guide.