Many men with prostate cancer want to take an active part in making decisions about their care. It is natural to want to learn all you can about prostate cancer and your treatment choices. However, shock and stress after the diagnosis can make it hard to think of everything you want to ask your doctor. It often helps to make a list of questions before an appointment.

 

To help remember what the doctor says, you may take notes or ask whether you may use a tape recorder. You may also want to have a family member or friend with you when you talk to the doctor – to take part in the discussion, to take notes, or just to listen.

 

You do not need to ask all your questions at once. You will have other chances to ask your doctor or nurse to explain things that are not clear and to ask for more details.

 

Your doctor may refer you to a specialist, or you may ask for a referral. Specialists who treat prostate cancer include urologists, urologic oncologists, medical oncologists, and radiation oncologists.

 

Getting a second opinion

Before starting treatment, you might want a second opinion about your diagnosis and treatment plan. Many insurance companies cover a second opinion if you or your doctor requests it. It may take some time and effort to gather medical records and arrange to see another doctor. Usually it is not a problem to take several weeks to get a second opinion. In most cases, the delay in starting treatment will not make treatment less effective. To make sure, you should discuss this delay with your doctor. Some men with prostate cancer need treatment right away.

 

There are a number of ways to find a doctor for a second opinion:

 

Your doctor may refer you to one or more specialists. At cancer centers, several specialists often work together as a team.

NCI's Cancer Information Service (in the U.S.), at 1-800-4-CANCER, can tell you about nearby treatment centers.

A local or state medical society, a nearby hospital, or a medical school can usually provide the names of specialists.

The American Board of Medical Specialties (ABMS) has a list of doctors who have had training and passed exams in their specialty. You can find this list in the Official ABMS Directory of Board Certified Medical Specialists. This Directory is in most public libraries.

 

Treatment methods

Men with prostate cancer have many treatment options. The treatment that is best for one man may not be best for another.

 

Treatment may involve surgery, radiation therapy, or hormone therapy. You may have a combination of treatments. If your doctor recommends watchful waiting, your health will be monitored closely. You will have treatment only if symptoms occur or get worse.

 

Cancer treatment is either local therapy or systemic therapy:

 

Local therapy. Surgery and radiation therapy are local treatments. They remove or destroy cancer in the prostate. When prostate cancer has spread to other parts of the body, local therapy may be used to control the disease in those specific areas.

Systemic therapy. Hormone therapy is systemic therapy. Hormones are given to control cancer that has spread.

 

The treatment that is right for you depends on the stage of the cancer, the grade of the tumor, your symptoms, and your general health. Your doctor will describe your treatment choices and the expected results.

 

Because cancer treatments often damage healthy cells and tissues, side effects are common. Side effects depend mainly on the type and extent of the treatment. Side effects may not be the same for each man, and they may change from one treatment session to the next.

 

You should consider both the expected benefits and possible side effects of each treatment option. You may want to discuss with your doctor the possible effects on sexual activity. You can work with your doctor to create a treatment plan that reflects your medical needs and personal values.

 

At any stage of disease, supportive care is available to control pain and other symptoms, to relieve the side effects of treatment, and to ease emotional concerns.

 

You may want to talk to your doctor about taking part in a clinical trial, a research study of new treatment methods. The section on "The promise of cancer research" has more information about clinical trials.

 

You may want to ask your doctor these questions before your treatment begins:

 

What is the stage of the disease? Do any lymph nodes show signs of cancer? Has the cancer spread?

What is the grade of the tumor?

What is the goal of treatment? What are my treatment choices? Which do you recommend for me? Why?

What are the expected benefits of each kind of treatment?

What are the risks and possible side effects of each treatment? How can side effects be managed?

What can I do to prepare for treatment?

Will I need to stay in the hospital? If so, for how long?

How will treatment affect my normal activities? Will it affect my sex life? Will I have urinary problems? Will I have bowel problems?

What will the treatment cost? Will my insurance cover it?

Would a clinical trial (research study) be appropriate for me?

 

Surgery

Surgery is a common treatment for early stage prostate cancer. Your doctor may remove the whole prostate or only part of it. In some cases, your doctor can use a method known as nerve-sparing surgery. This type of surgery may save the nerves that control erection. But if you have a large tumor or a tumor that is very close to the nerves, you may not be able to have this surgery.

 

Each type of surgery has benefits and risks. Your doctor can further describe these types:

 

Radical retropubic prostatectomy. The doctor removes the entire prostate and nearby lymph nodes through an incision (cut) in the abdomen.

Radical perineal prostatectomy. The doctor removes the entire prostate through a cut between the scrotum and the anus. Nearby lymph nodes may be removed through a separate cut in the abdomen.

Laparoscopic prostatectomy. The doctor removes the entire prostate and nearby lymph nodes through small incisions, rather than a single long cut in the abdomen. A thin, lighted tube (a laparoscope) is used to help remove the prostate.

Transurethral resection of the prostate (TURP). The doctor removes part of the prostate with a long, thin device that is inserted through the urethra. The cancer is cut from the prostate. TURP may not remove all of the cancer. But it can remove tissue that blocks the flow of urine.

Cryosurgery. This type of surgery for prostate cancer is under study at some medical centers.

Pelvic lymphadenectomy. This is routinely done during prostatectomy. The doctor removes lymph nodes in the pelvis to see if cancer has spread to them. If there are cancer cells in the lymph nodes, the disease may have spread to other parts of the body. In this case, the doctor may suggest other types of treatment.

 

The time it takes to heal after surgery is different for each man and depends on the type of surgery he has had. You may be uncomfortable for the first few days. However, medicine can help control the pain. Before surgery, you should discuss the plan for pain relief with your doctor or nurse. After surgery, your doctor can adjust the plan if you need more pain relief.

 

After surgery, the urethra needs time to heal. You will have a catheter. A catheter is a tube put through the urethra into the bladder to drain urine. You will have the catheter for 5 days to 3 weeks. Your nurse or doctor will show you how to care for it.

 

Surgery may cause short-term problems, such as incontinence. After surgery, some men may lose control of the flow of urine (urinary incontinence). Most men regain bladder control after a few weeks.

 

Some men may become impotent. Nerve-sparing surgery is an attempt to avoid the problem of impotence. If a man can have nerve-sparing surgery and the operation is a success, impotence may not last. In some cases, men become permanently impotent. You can talk with your doctor about medicine and other ways to help manage the sexual effects of cancer treatment.

 

If your prostate is removed, you will no longer produce semen. You will have dry orgasms. If you wish to father children, you may consider sperm banking or a sperm retrieval procedure.

 

You may want to ask your doctor these questions before choosing surgery:

 

What kinds of surgery can I consider? Is nerve-sparing surgery an option for me? Which operation do you recommend for me? Why?

How will I feel after the operation?

If I have pain, how can we control it?

Will I have any lasting side effects?

Is there someone I can talk with who has had the same surgery I'll be having?

 

Radiation therapy

Radiation therapy (also called radiotherapy) uses high-energy rays to kill cancer cells. It affects cells only in the treated area.

 

For early stage prostate cancer, radiation treatment may be used instead of surgery. It also may be used after surgery to destroy any cancer cells that remain in the area. In later stages of prostate cancer, radiation treatment may be used to help relieve pain.

 

Doctors use two types of radiation therapy to treat prostate cancer. Some men receive both types:

 

External radiation. The radiation comes from a large machine outside the body. Men go to a hospital or clinic for treatment. Treatments are usually 5 days a week for several weeks. Many men receive 3-dimensional conformal radiation therapy. This type of treatment more closely targets the cancer. It spares healthy tissue.

Internal radiation (implant radiation or brachytherapy). The radiation comes from radioactive material usually contained in small seeds. The seeds are put into the tissue. They give off radiation for months. The seeds are harmless and do not need to be removed.

 

Side effects depend mainly on the dose and type of radiation. You are likely to be very tired during radiation therapy, especially in the later weeks of treatment. Resting is important, but doctors usually advise patients to try to stay as active as they can.

 

If you have external radiation, you may have diarrhea or frequent and uncomfortable urination. Some men have lasting bowel or urinary problems. Your skin in the treated area may become red, dry, and tender. You may lose hair in the treated area. The hair may not grow back.

 

Internal radiation treatment may cause incontinence. This side effect usually goes away. Lasting side effects from internal radiation are not common.

 

Both internal and external radiation can cause impotence. Internal radiation is less likely to have this effect.

 

You may want to ask your doctor these questions before choosing radiation therapy:

 

How will radiation be given?

When will treatment start? When will it end? How often will I have treatments?

What can I do to take care of myself before, during, and after treatment?

How will I feel during treatment? Will I be able to drive myself to and from treatment?

How will we know the treatment is working?

How will I feel after the radiation?

Are there any lasting effects?

What is the chance that the cancer will come back in my prostate?

How often will I need checkups?

 

Hormone therapy

Hormone therapy keeps prostate cancer cells from getting the male hormones (androgens) they need to grow. The testicles are the body's main source of the male hormone testosterone. The adrenal gland makes a small amount of testosterone.

 

Hormone treatment uses drugs or surgery:

 

Drugs. Your doctor may suggest a drug that can block natural hormones.

      - Luteinizing hormone-releasing hormone (LH-RH) agonists. These drugs can prevent the testicles from making testosterone. Examples are leuprolide and goserelin.

      - Antiandrogens. These drugs can block the action of male hormones. Examples are flutamide, bicalutamide, and nilutamide.

      - Other drugs. Some drugs can prevent the adrenal gland from making testosterone. Examples are ketoconazole and aminoglutethimide.

Surgery. Surgery to remove the testicles is called orchiectomy.

 

After orchiectomy or treatment with an LH-RH agonist, your body no longer gets testosterone from the testicles. However, the adrenal gland still produces a small amount of male hormones. You may receive an antiandrogen to block the action of the male hormones that remain. This combination of treatments is known as total androgen blockade. Studies have not shown whether total androgen blockade is more effective than surgery or an LH-RH agonist alone.

 

Doctors can usually control prostate cancer that has spread to other parts of the body with hormone therapy. The cancer often does not grow for several years. But in time, most prostate cancers can grow with very little or no male hormones. Hormone therapy is no longer helpful. At that time, your doctor may suggest other forms of treatment that are under study.

 

Hormone therapy is likely to affect your quality of life. It often causes side effects such as impotence, hot flashes, loss of sexual desire, and weaker bones. An LH-RH agonist may make your symptoms worse for a short time when you first take it. This temporary problem is called "flare." The treatment gradually causes your testosterone level to fall. Without testosterone, tumor growth slows. Your condition may improve. (To prevent flare, your doctor may give you an antiandrogen for a while along with the LH-RH agonist.)

 

Antiandrogens (such as nilutamide) can cause nausea, diarrhea, or breast growth or tenderness. Rarely, they may cause liver problems (pain in the abdomen, yellow eyes, or dark urine). Some men who use nilutamide may have difficulty breathing. Some may have trouble adjusting to sudden changes in light.

 

If used for a long time, ketoconazole may cause liver problems, and aminoglutethimide can cause skin rashes. If you receive total androgen blockade, you may have more side effects than if you have just one type of hormone treatment.

 

Any treatment that lowers hormone levels can weaken your bones. Your doctor can suggest medicines or dietary supplements that can reduce your risk of bone fractures.

 

You may want to ask your doctor these questions before choosing hormone therapy:

 

What kind of hormone therapy will I have? Would you recommend drugs or surgery? Why?

When will treatment start? How often will I have treatments? When will it end?

Where will I go for treatment? Will I be able to drive home afterward?

If I have surgery, how long will I need to stay in the hospital?

How will I feel during treatment?

What can I do to take care of myself during treatment?

How will we know the treatment is working?

Which side effects should I tell you about?

Will there be lasting side effects?

 

Watchful waiting

You may choose watchful waiting if the risks and possible side effects of treatment outweigh the possible benefits. Your doctor may offer this choice if you are older or have other serious health problems. Your doctor may also suggest watchful waiting if you are diagnosed with early stage prostate cancer that seems to be slowly growing. Your doctor will offer you treatment if symptoms occur or get worse.

 

Watchful waiting avoids or delays the side effects of surgery and radiation, but this choice has risks. It may reduce the chance to control cancer before it spreads. Also, it may be harder to cope with surgery and radiation therapy as you age.

 

You may decide against watchful waiting if you do not want to live with an untreated cancer. If you choose watchful waiting but grow concerned later, you should discuss your feelings with your doctor. A different approach is nearly always available.

 

Complementary and alternative medicine

Some men with prostate cancer use complementary and alternative medicine (CAM):

 

An approach is generally called complementary medicine when it is used along with standard treatment.

An approach is called alternative medicine when it is used instead of standard treatment.

 

Acupuncture, massage therapy, herbal products, vitamins or special diets, visualization, meditation, and spiritual healing are types of CAM.

 

Many men say that CAM helps them feel better. However, some types of CAM may change the way standard treatment works. These changes could be harmful. And some types of CAM could be harmful even if used alone.

 

Nutrition and physical activity

It is important for men with prostate cancer to take care of themselves. Taking care of yourself includes eating well and staying as active as you can.

 

You need the right amount of calories to maintain a good weight. You also need enough protein to keep up your strength. Eating well may help you feel better and have more energy. Your doctor, dietitian, or other health care provider can suggest a healthy diet.

 

Many men find they feel better when they stay active. Walking, yoga, swimming, and other exercise can keep you strong and increase your energy. Exercise may reduce pain and make treatment easier to handle. It also can help relieve stress. Whatever physical activity you choose, be sure to talk to your doctor before you start. Also, if your activity causes you pain or other problems, be sure to let your doctor or nurse know about it.

 

Follow-up care

Follow-up care after treatment for prostate cancer is important. Even when the cancer seems to have been completely removed or destroyed, the disease sometimes returns because undetected cancer cells remained somewhere in the body after treatment. Your doctor will monitor your recovery and check for recurrence of the cancer. Checkups help ensure that any changes in your health are noted and treated if needed. Checkups may include lab tests, X-rays, biopsies, or other tests. Between scheduled visits, you should contact your doctor if you have any health problems.

 

Sources of support

Learning you have prostate cancer can change your life and the lives of those close to you. These changes can be hard to handle. It is normal for you, your family, and your friends to have many different and sometimes confusing feelings.

 

You may worry about caring for your family, keeping your job, or continuing daily activities. Concerns about treatments and managing side effects, hospital stays, and medical bills are also common. Doctors, nurses, and other members of your health care team can answer questions about treatment, working, or other activities. Meeting with a social worker, counselor, or member of the clergy can be helpful if you want to talk about your feelings or concerns. Often, a social worker can suggest resources for financial aid, transportation, home care, or emotional support.

 

Friends and relatives can be supportive. Support groups also can help. In these groups, patients or their family members meet with other patients or their families to share what they have learned about coping with the disease and the effects of treatment. Groups may offer support in person, over the telephone, or online. You may want to talk with a member of your health care team about finding a support group.

 

You and your partner may be concerned about the effects of prostate cancer on your sexual relationship. You may want to talk with your doctor about possible treatment side effects and whether these are likely to last. Whatever the outlook, you and your partner may find it helps to discuss your concerns. You can find ways to be intimate during and after treatment. For some couples, it helps to talk with a sex counselor.

 

Research

Doctors all over the country are conducting many types of clinical trials (research studies in which people volunteer to take part). They are studying new ways to prevent, detect, and treat prostate cancer.

 

Clinical trials are designed to answer important questions and to find out whether new approaches are safe and effective. Research already has led to many advances, and researchers continue to search for more effective methods for dealing with prostate cancer.

 

Men who join clinical trials may be among the first to benefit if a new approach is effective. And even if people in a trial do not benefit directly, they still make an important contribution by helping doctors learn more about prostate cancer and how to control it. Although clinical trials may pose some risks, researchers do all they can to protect their patients.

 

If you are interested in being part of a clinical trial, talk with your doctor.

 

Research on prevention

Researchers are looking for ways to prevent prostate cancer:

 

Diet. Some studies suggest that eating foods that have tomatoes in them may help protect men from prostate cancer. Lycopene is an antioxidant in tomatoes and some other fruits and vegetables. Research is in progress to see if lycopene can help prevent prostate cancer. A diet low in fat is also under study.

Dietary supplements. The Selenium and Vitamin E Cancer Prevention Trial (SELECT) is studying these two supplements. The goal of the study is to learn whether these supplements can reduce the risk of developing prostate cancer.

Drug. The Prostate Cancer Prevention Trial was a large study to test a drug that doctors thought might lower the risk of prostate cancer. The drug is finasteride. In the study, the drug did reduce the chance of developing prostate cancer. However, men who developed prostate cancer while taking the drug were more likely to have tumors that seemed to be high-grade. High-grade cancer grows and spreads more quickly than low-grade cancer. Researchers are now studying tumors from men in the study to see if they were really high-grade or only looked that way. If you are concerned about getting prostate cancer, you may want to talk with your doctor about the potential benefits and possible risks of taking finasteride. You also may consider taking part in another prostate cancer prevention trial.

 

Research on screening

Researchers are studying ways to check for prostate cancer in men who have no symptoms. Screening can help find prostate cancer at an early stage. But studies have not shown whether screening saves lives. The Prostate, Lung, Colorectal, and Ovarian Cancer Screening Trial (PLCO) is designed to show if certain screening tests can reduce the number of deaths from these cancers. NCI supports this study. The prostate screening tests that PLCO is studying are the PSA test and digital rectal exam. Researchers will screen the men in the study until 2007. The trial will assess the harms and potential benefits of routine screening for prostate cancer. The results of this trial may change the way men are screened for prostate cancer.

 

Research on treatment

Researchers are studying many types of treatment and their combinations:

 

Surgery. Different methods of surgery are being developed:

      - Robotic prostatectomy. The doctor uses a laparoscope and a surgical robot to help remove the prostate.

      - Cryosurgery. Surgeons use a tool that freezes and kills prostate tissue in men with early prostate cancer.

Radiation therapy. Doctors are studying different doses of radiation therapy. They are looking at the use of radioactive implants after external radiation. And they are combining radiation therapy with hormone therapy.

Hormone therapy. Researchers are studying different schedules of hormone therapy.

Biological therapy. Doctors are testing cancer vaccines that help the immune system kill cancer cells.

Chemotherapy. Researchers are testing anticancer drugs and combining them with hormone therapy.

Watchful waiting. Men with early prostate cancer usually do not have any symptoms of disease. For these men, researchers are comparing having surgery or radiation right away against watchful waiting. Men in the watchful waiting group do not receive treatment until they have symptoms. The results of the study will help doctors know whether to treat early stage prostate cancer right away, or only if symptoms appear or get worse.

 

Researchers also are looking at ways to lessen the side effects of treatment, such as bone thinning and impotence.