Prostate cancer



Prostate cancer is the most common type of cancer in men in the United
States (other than skin cancer). Of all the men who are diagnosed with
cancer each year, more than one-fourth have prostate cancer.

Research is increasing our understanding of prostate cancer. Scientists are
learning more about the possible causes of prostate cancer and are looking
for new ways to prevent, detect, diagnose, and treat this disease. Because
of this research, men with prostate cancer now have a lower chance of dying
from the disease.

The Prostate

The prostate is a gland in a man's reproductive system. It makes and stores
seminal fluid, a milky fluid that nourishes sperm. This fluid is released to
form part of semen.

The prostate is about the size of a walnut. It is located below the bladder
and in front of the rectum. It surrounds the upper part of the urethra, the
tube that empties urine from the bladder. If the prostate grows too large,
the flow of urine can be slowed or stopped.

To work properly, the prostate needs male hormones (androgens). Male
hormones are responsible for male sex characteristics. The main male hormone
is testosterone, which is made mainly by the testicles. Some male hormones
are produced in small amounts by the adrenal glands.

Understanding the Cancer Process

Cancer is a group of many related diseases. These diseases begin in cells,
the body's basic unit of life. Cells have many important functions
throughout the body.

Normally, cells grow and divide to form new cells in an orderly way. They
perform their functions for a while, and then they die. This process helps
keep the body healthy.

Sometimes, however, cells do not die. Instead, they keep dividing and
creating new cells that the body does not need. They form a mass of tissue,
called a growth or tumor.

Tumors can be benign or malignant:

   * Benign tumors are not cancer. They can usually be removed, and in most
     cases, they do not come back. Cells from benign tumors do not spread to
     other parts of the body. Most important, benign tumors of the prostate
     are not a threat to life. Benign prostatic hyperplasia (BPH) is the
     abnormal growth of benign prostate cells. In BPH, the prostate grows
     larger and presses against the urethra and bladder, interfering with
     the normal flow of urine. More than half of the men in the United
     States between the ages of 60 and 70 and as many as 90 percent between
     the ages of 70 and 90 have symptoms of BPH. For some men, the symptoms
     may be severe enough to require treatment.

   * Malignant tumors are cancer. Cells in these tumors are abnormal. They
     divide without control or order, and they do not die. They can invade
     and damage nearby tissues and organs. Also, cancer cells can break away
     from a malignant tumor and enter the bloodstream and lymphatic system.
     This is how cancer spreads from the original (primary) cancer site to
     form new (secondary) tumors in other organs. The spread of cancer is
     called metastasis.

When prostate cancer spreads (metastasizes) outside the prostate, cancer
cells are often found in nearby lymph nodes. If the cancer has reached these
nodes, it means that cancer cells may have spread to other parts of the body
-- other lymph nodes and other organs, such as the bones, bladder, or
rectum. When cancer spreads from its original location to another part of
the body, the new tumor has the same kind of abnormal cells and the same
name as the primary tumor. For example, if prostate cancer spreads to the
bones, the cancer cells in the new tumor are prostate cancer cells. The
disease is metastatic prostate cancer; it is not bone cancer.

This article deals with prostate cancer. For information about prostate
changes that are not cancer, read NCI's booklet, Understanding Prostate
Changes: A Health Guide for All Men.

Prostate Cancer: Who's at Risk

The causes of prostate cancer are not well understood. Doctors cannot
explain why one man gets prostate cancer and another does not.

Researchers are studying factors that may increase the risk of this disease.
Studies have found that the following risk factors are associated with
prostate cancer:

   * Age. In the United States, prostate cancer is found mainly in men over
     age 55. The average age of patients at the time of diagnosis is 70.
   * Family history of prostate cancer. A man's risk for developing prostate
     cancer is higher if his father or brother has had the disease.
   * Race. This disease is much more common in African American men than in
     white men. It is less common in Asian and American Indian men.
   * Diet and dietary factors. Some evidence suggests that a diet high in
     animal fat may increase the risk of prostate cancer and a diet high in
     fruits and vegetables may decrease the risk. Studies are in progress to
     learn whether men can reduce their risk of prostate cancer by taking
     certain dietary supplements.

Although a few studies suggested that having a vasectomy might increase a
man's risk for prostate cancer, most studies do not support this finding.
Scientists have studied whether benign prostatic hyperplasia, obesity, lack
of exercise, smoking, radiation exposure, or a sexually transmitted virus
might increase the risk for prostate cancer. At this time, there is little
evidence that these factors contribute to an increased risk.

Detecting Prostate Cancer

A man who has any of the risk factors described in the "Prostate Cancer:
Who's at Risk" section may want to ask a doctor whether to begin screening
for prostate cancer (even though he does not have any symptoms), what tests
to have, and how often to have them. The doctor may suggest either of the
tests described below. These tests are used to detect prostate
abnormalities, but they cannot show whether abnormalities are cancer or
another, less serious condition. The doctor will take the results into
account in deciding whether to check the patient further for signs of
cancer. The doctor can explain more about each test.

   * Digital rectal exam -- the doctor inserts a lubricated, gloved finger
     into the rectum and feels the prostate through the rectal wall to check
     for hard or lumpy areas.
   * Blood test for prostate-specific antigen(PSA) -- a lab measures the
     levels of PSA in a blood sample. The level of PSA may rise in men who
     have prostate cancer, BPH, or infection in the prostate.

Recognizing Symptoms

Early prostate cancer often does not cause symptoms. But prostate cancer can
cause any of these problems:

   * A need to urinate frequently, especially at night;
   * Difficulty starting urination or holding back urine;
   * Inability to urinate;
   * Weak or interrupted flow of urine;
   * Painful or burning urination;
   * Difficulty in having an erection;
   * Painful ejaculation;
   * Blood in urine or semen; or
   * Frequent pain or stiffness in the lower back, hips, or upper thighs.

Any of these symptoms may be caused by cancer or by other, less serious
health problems, such as BPH or an infection. A man who has symptoms like
these should see his doctor or a urologist (a doctor who specializes in
treating diseases of the genitourinary system).

Diagnosing Prostate Cancer

If a man has symptoms or test results that suggest prostate cancer, his
doctor asks about his personal and family medical history, performs a
physical exam, and may order laboratory tests. The exams and tests may
include a digital rectal exam, a urine test to check for blood or infection,
and a blood test to measure PSA. In some cases, the doctor also may check
the level of prostatic acid phosphatase (PAP) in the blood, especially if
the results of the PSA indicate there might be a problem.

The doctor may order exams to learn more about the cause of the symptoms.
These may include:

   * Transrectal ultrasonography -- sound waves that cannot be heard by
     humans (ultrasound) are sent out by a probe inserted into the rectum.
     The waves bounce off the prostate, and a computer uses the echoes to
     create a picture called a sonogram.
   * Intravenous pyelogram -- a series of x-rays of the organs of the
     urinary tract.
   * Cystoscopy -- a procedure in which a doctor looks into the urethra and
     bladder through a thin, lighted tube.

Biopsy

If test results suggest that cancer may be present, the man will need to
have a biopsy. During a biopsy, the doctor removes tissue samples from the
prostate, usually with a needle. A pathologist looks at the tissue under a
microscope to check for cancer cells. If cancer is present, the pathologist
usually reports the grade of the tumor. The grade tells how much the tumor
tissue differs from normal prostate tissue and suggests how fast the tumor
is likely to grow. One way of grading prostate cancer, called the Gleason
system, uses scores of 2 to 10. Another system uses G1 through G4. Tumors
with higher scores or grades are more likely to grow and spread than tumors
with lower scores.

If the physical exam and test results do not suggest cancer, the doctor may
recommend medicine to reduce the symptoms caused by an enlarged prostate.
Surgery is another way to relieve these symptoms. The surgery most often
used in such cases is called transurethral resection of the prostate (TURP
or TUR). In TURP, an instrument is inserted through the urethra to remove
prostate tissue that is pressing against the upper part of the urethra and
restricting the flow of urine. (Patients may want to ask whether other
procedures might be appropriate.)

Stages of Prostate Cancer

If cancer is found in the prostate, the doctor needs to know the stage, or
extent, of the disease. Staging is a careful attempt to find out whether the
cancer has spread and, if so, what parts of the body are affected. The
doctor may use various blood and imaging tests to learn the stage of the
disease. Treatment decisions depend on these findings.

Prostate cancer staging is a complex process. The doctor may describe the
stage using a Roman number (I-IV) or a capital letter (A-D). These are the
main features of each stage:

   * Stage I or Stage A -- The cancer cannot be felt during a rectal exam.
     It may be found by accident when surgery is done for another reason,
     usually for BPH. There is no evidence that the cancer has spread
     outside the prostate.
   * Stage II or Stage B -- The tumor involves more tissue within the
     prostate, it can be felt during a rectal exam, or it is found with a
     biopsy that is done because of a high PSA level. There is no evidence
     that the cancer has spread outside the prostate.
   * Stage III or Stage C -- The cancer has spread outside the prostate to
     nearby tissues.
   * Stage IV or Stage D -- The cancer has spread to lymph nodes or to other
     parts of the body.

Treatment for Prostate Cancer

Getting a Second Opinion

Decisions about prostate cancer treatment involve many factors. Before
making a decision, a man may want to get a second opinion by asking another
doctor to review the diagnosis and treatment options. A short delay will not
reduce the chance that treatment will be successful. Some health insurance
companies require a second opinion; many others will cover a second opinion
if the patient requests it. There are a number of ways to find a doctor who
can give a second opinion:

   * The patient's doctor may be able to recommend a specialist or team of
     specialists to consult. Doctors who treat prostate cancer are
     urologists, radiation oncologists, and medical oncologists. Patients
     may find it helpful to talk to a specialist in each of these areas.
     Different types of specialists may have different thoughts about how
     best to manage prostate cancer.
   * The Cancer Information Service, at 1-800-4-CANCER, can tell callers
     about treatment facilities, including cancer centers and other programs
     supported by the National Cancer Institute.
   * People can get the names of doctors from their local medical society, a
     nearby hospital, or a medical school.
   * The Official ABMS Directory of Board Certified Medical Specialists
     lists doctors' names along with their speciality and their educational
     background. This resource, produced by the American Board of Medical
     Specialities (ABMS), is available in most public libraries. The ABMS
     also has an online service that lists many board-certified physicians
     (http://www.certifieddoctor.org).

Preparing for Treatment

The doctor develops a treatment plan to fit each man's needs. Treatment for
prostate cancer depends on the stage of the disease and the grade of the
tumor (which indicates how abnormal the cells look, and how likely they are
to grow or spread). Other important factors in planning treatment are the
man's age and general health and his feelings about the treatments and their
possible side effects.

Many men with prostate cancer want to learn all they can about their
disease, their treatment choices, and the possible side effects of
treatment, so they can take an active part in decisions about their medical
care. Prostate cancer can be managed in a number of ways (with watchful
waiting, surgery, radiation therapy, and hormonal therapy). If the doctor
recommends watchful waiting, the man's health will be monitored closely, and
he will be treated only if symptoms occur or worsen. Patients considering
surgery, radiation therapy, or hormonal therapy may want to consult doctors
who specialize in these types of treatment.

The patient and his doctor may want to consider both the benefits and
possible side effects of each option, especially the effects on sexual
activity and urination, and other concerns about quality of life. Men with
prostate cancer may find helpful information in the sections "Methods of
Treatment," "Side Effects of Treatment," and "Support for Men with Prostate
Cancer." Also, the patient may want to talk with his doctor about taking
part in a research study to help determine the best approach or to study new
kinds of treatment. "The Promise of Prostate Cancer Research" section has
more information about such studies, called clinical trials.

Methods of Treatment

Treatment for prostate cancer may involve watchful waiting, surgery,
radiation therapy, or hormonal therapy. Some patients receive a combination
of therapies. In addition, doctors are studying other methods of treatment
to find out whether they are effective against this disease. (The "Promise
of Cancer Research" section has information about research studies.)

Watchful waiting may be suggested for some men who have prostate cancer that
is found at an early stage and appears to be slow growing. Also, watchful
waiting may be advised for older men or men with other serious medical
problems. For these men, the risks and possible side effects of surgery,
radiation therapy, or hormonal therapy may outweigh the possible benefits.
Men with early stage prostate cancer are taking part in a study to determine
when or whether treatment may be necessary and effective. (See "The Promise
of Prostate Cancer Research" section for information about this study.)

Surgery is a common treatment for early stage prostate cancer. The doctor
may remove all of the prostate (a type of surgery called radical
prostatectomy) or only part of it. In some cases, the doctor can use a new
technique known as nerve-sparing surgery. This type of surgery may save the
nerves that control erection. However, men with large tumors or tumors that
are very close to the nerves may not be able to have this surgery.

The doctor can describe the types of surgery and can discuss and compare
their benefits and risks.

   * In radical retropubic prostatectomy, the doctor removes the entire
     prostate and nearby lymph nodes through an incision in the abdomen.
   * In radical perineal prostatectomy, the doctor removes the entire
     prostate through an incision between the scrotum and the anus. Nearby
     lymph nodes are sometimes removed through a separate incision in the
     abdomen.
   * In transurethral resection of the prostate (TURP), the doctor removes
     part of the prostate with an instrument that is inserted through the
     urethra. The cancer is cut from the prostate by electricity passing
     through a small wire loop on the end of the instrument. This method is
     used mainly to remove tissue that blocks urine flow.

If the pathologist finds cancer cells in the lymph nodes, it is likely that
the disease has spread to other parts of the body. Sometimes, the doctor
removes the lymph nodes before doing a prostatectomy. If the prostate cancer
has not spread to the lymph nodes, the doctor then removes the prostate. But
if cancer has spread to the nodes, the doctor usually does not remove the
prostate, but may suggest other treatment.

Radiation therapy (also called radiotherapy) uses high-energy x-rays to kill
cancer cells. Like surgery, radiation therapy is local therapy; it can
affect cancer cells only in the treated area. In early stage prostate
cancer, radiation can be used instead of surgery, or it may be used after
surgery to destroy any cancer cells that may remain in the area. In advanced
stages, it may be given to relieve pain or other problems.

Radiation may be directed at the body by a linear accelerator, or it may
come from tiny radioactive seeds placed inside or near the tumor (internal
or implant radiation, or brachytherapy). Men who receive radioactive seeds
alone usually have small tumors. Some men with prostate cancer receive both
kinds of radiation therapy.

For external radiation therapy, patients go to the hospital or clinic,
usually 5 days a week for several weeks. Patients may stay in the hospital
for a short time for implant radiation.

Hormonal therapy keeps cancer cells from getting the male hormones they need
to grow. It is called systemic therapy because it can affect cancer cells
throughout the body. Systemic therapy is used to treat cancer that has
spread. Sometimes this type of therapy is used to try to prevent the cancer
from coming back after surgery or radiation treatment.

There are several forms of hormonal therapy:

   * Orchiectomy is surgery to remove the testicles, which are the main
     source of male hormones.
   * Drugs known as luteinizing hormone-releasing hormone (LH-RH) agonists
     can prevent the testicles from producing testosterone. Examples are
     leuprolide, goserelin, and buserelin.
   * Drugs known as antiandrogens can block the action of androgens. Two
     examples are flutamide and bicalutamide.
   * Drugs that can prevent the adrenal glands from making androgens include
     ketoconazole and aminoglutethimide.

After orchiectomy or treatment with an LH-RH agonist, the body no longer
gets testosterone from the testicles. However, the adrenal glands still
produce small amounts of male hormones. Sometimes, the patient is also given
an antiandrogen, which blocks the effect of any remaining male hormones.
This combination of treatments is known as total androgen blockade (TAB),
combined hormonal therapy (CHT), combined androgen blockade (CAB), or
maximal androgen deprivation (MAD). Doctors do not know for sure whether
total androgen blockade is more effective than orchiectomy or LH-RH agonist
alone.

Prostate cancer that has spread to other parts of the body usually can be
controlled with hormonal therapy for a period of time, often several years.
Eventually, however, most prostate cancers are able to grow with very little
or no male hormones. When this happens, hormonal therapy is no longer
effective, and the doctor may suggest other forms of treatment that are
under study.

Side Effects of Treatment

It is hard to limit the effects of treatment so that only cancer cells are
removed or destroyed. Because healthy cells and tissues may be damaged,
treatment often causes unwanted side effects. Doctors and nurses will
explain the possible side effects of treatment.

The side effects of cancer treatment depend mainly on the type and extent of
the treatment. Also, each patient reacts differently. The NCI provides
helpful, informative booklets about cancer treatments and coping with side
effects, such as Understanding Treatment Choices for Prostate Cancer: Know
Your Options and Radiation Therapy and You. Patients also may want to read
Eating Hints for Cancer Patients. See "National Cancer Institute Information
Resources" and "Other Information Resources" for additional sources of
information about side effects.

Watchful Waiting

Although men who choose watchful waiting avoid the side effects of surgery
and radiation, there can be some negative aspects to this choice. Watchful
waiting may reduce the chance of controlling the disease before it spreads.
Also, older men should keep in mind that it may be harder to manage surgery
and radiation therapy as they age.

Some men may decide against watchful waiting because they feel they would be
uncomfortable living with an untreated cancer, even one that appears to be
growing slowly or not at all. A man who chooses watchful waiting but later
becomes concerned or anxious should discuss his feelings with his doctor. A
different treatment approach is nearly always available.

Surgery

Patients are often uncomfortable for the first few days after surgery. Their
pain usually can be controlled with medicine, and patients should discuss
pain relief with the doctor or nurse. The patient will wear a catheter (a
tube inserted into the urethra) to drain urine for 10 days to 3 weeks. The
nurse or doctor will show the man how to care for the catheter.

It is also common for patients to feel extremely tired or weak for a while.
The length of time it takes to recover from an operation varies. Surgery to
remove the prostate may cause long-term problems, including rectal injury or
urinary incontinence. Some men may have permanent impotence. Nerve-sparing
surgery is an attempt to avoid the problem of impotence. When the doctor can
use nerve-sparing surgery and the operation is fully successful, impotence
may be only temporary. Still, some men who have this procedure may be
permanently impotent.

Men who have a prostatectomy no longer produce semen, so they have dry
orgasms. Men who wish to father children may consider sperm banking or a
sperm retrieval procedure.

Radiation Therapy

Radiation therapy may cause patients to become extremely tired, especially
in the later weeks of treatment. Resting is important, but doctors usually
encourage men to try to stay as active as they can. Some men may have
diarrhea or frequent and uncomfortable urination.

When men with prostate cancer receive external radiation therapy, it is
uncommon for the skin in the treated area to become red, dry, or tender,
however there may be hair loss in the treated area. The loss is usually
temporary.

Both types of radiation therapy may cause impotence in some men. While
internal radiation therapy may cause temporary urinary incontinence,
external radiation therapy causes temporary bowel inflammation. Long-term
side effects from internal radiation therapy are uncommon.

Hormonal Therapy for Prostate Cancer

The side effects of hormonal therapy depend largely on the type of
treatment. Orchiectomy and LH-RH agonists often cause side effects such as
impotence, hot flashes, and loss of sexual desire. When first taken, an
LH-RH agonist may make a patient's symptoms worse for a short time. This
temporary problem is called "flare." Gradually, however, the treatment
causes a man's testosterone level to fall. Without testosterone, tumor
growth slows down and the patient's condition improves. (To prevent flare,
the doctor may give the man an antiandrogen for a while along with the LH-RH
agonist.)

Antiandrogens can cause nausea, vomiting, diarrhea, or breast growth or
tenderness. If used a long time, ketoconazole may cause liver problems, and
aminoglutethimide can cause skin rashes. Men who receive total androgen
blockade may experience more side effects than men who receive a single
method of hormonal therapy. Any method of hormonal therapy that lowers
androgen levels can contribute to weakening of the bones in older men.

Followup Care

During and after treatment, the doctor will continue to follow the patient.
The doctor will examine the man regularly to be sure that the disease has
not returned or progressed, and will decide what other medical care may be
needed. Followup exams may include x-rays, scans, and lab tests, such as the
PSA blood test.

Support for Men with Prostate Cancer

Ejaculatory Duct Obstruction Foundation
Ejaculatory duct obstruction is a problem unique to men. The duct, which passes through the prostate, becomes blocked. This can cause pain, inflammation, and infertility.

Living with a serious disease such as cancer is not easy. Some people find
they need help coping with the emotional as well as the practical aspects of
their disease. Patients often get together in support groups, where they can
share what they have learned about coping with their disease and the effects
of treatment. Patients may want to talk with a member of their health care
team about finding a support group.

People living with cancer may worry about caring for their families, keeping
their jobs, or continuing daily activities. Concerns about treatments and
managing side effects, hospital stays, and medical bills are also common.
Doctors, nurses, dietitians and other members of the 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 to those
who want to talk about their feelings or discuss their concerns. Often, a
social worker can suggest resources for help with rehabilitation, emotional
support, financial aid, transportation, or home care.

It is natural for a man and his partner to be concerned about the effects of
prostate cancer and its treatment on their sexual relationship. They may
want to talk with the doctor about possible side effects and whether these
are likely to be temporary or permanent. Whatever the outlook, it is usually
helpful for patients and their partners to talk about their concerns and
help one another find ways to be intimate during and after treatment.

Booklets and other useful materials are available from the Cancer
Information Service and through other sources listed in the "National Cancer
Institute Information Resources" section.

The Cancer Information Service can also provide information to help patients
and their families locate programs and services.


The Promise of Prostate Cancer Research

Doctors all over the country are conducting many types of clinical trials
(research studies) in which people take part voluntarily. These include
studies of ways to prevent, detect, diagnose, and treat prostate cancer;
studies of the psychological effects of the disease; and studies of ways to
improve comfort and quality of life. Research already has led to advances in
these areas, and researchers continue to search for more effective
approaches.

People who take part in clinical trials have the first chance to benefit
from new approaches. They also make important contributions to medical
science. Although clinical trials may pose some risks, researchers take very
careful steps to protect people who take part.

A man who is interested in being part of a clinical trial should talk with
his doctor. He may want to read Taking Part in Clinical Trials: What Cancer
Patients Need To Know and Taking Part in Clinical Trials: Cancer Prevention
Studies. These NCI booklets describe how research studies are carried out
and explain their possible benefits and risks. NCI's Web site at
http://cancer.gov provides general information about clinical trials. It
also offers detailed information about specific ongoing studies of prostate
cancer by linking to PDQ®, a cancer information database developed by the
NCI. Causes

Although researchers know several risk factors for prostate cancer, they
still are not sure why one man develops the disease and another doesn't.
(Known risk factors, which include aging, are listed in the "Prostate
Cancer: Who's at Risk?" section.)

Some aspects of a man's lifestyle may affect his chances of developing
prostate cancer. For example, some evidence suggests a link between diet and
this disease. These studies show that prostate cancer is more common in
populations that consume a high-fat diet (particularly animal fat), and in
populations that have diets lacking certain nutrients. Although it is not
known whether a diet low in fat will prevent prostate cancer, a low-fat diet
may have many other health benefits.

Some research suggests that high levels of testosterone may increase a man's
risk of prostate cancer. The difference between racial groups in prostate
cancer risk could be related to high testosterone levels, but it also could
result from diet or other lifestyle factors.

Researchers also are looking for changes in genes that may increase the risk
for developing prostate cancer. They are studying the genes of men who were
diagnosed with prostate cancer at a relatively young age (less than 55 years
old) and the genes of families who have several members with the disease.
Much more work is needed, however, before scientists can say exactly how
changes in these genes are related to prostate cancer. Men with a family
history of prostate cancer who are concerned about an inherited risk for
this disease should talk with their doctor. The doctor may suggest seeing a
health professional trained in genetics.

Prevention

Several studies are under way to explore how prostate cancer might be
prevented. These include the use of dietary supplements, such as vitamin E
and selenium. In addition, recent studies suggest that a diet that regularly
includes tomato-based foods may help protect men from prostate cancer.

The drug finasteride is being studied in the Prostate Cancer Prevention
Trial, which involves thousands of men across the country who are
participating for 7 years, until 2004.

Scientists are also looking at ways to prevent recurrence among men who have
been treated for prostate cancer. These approaches involve the use of drugs
such as finasteride, flutamide, and LH-RH agonists. Studies have shown that
hormonal therapy after radiation therapy or after radical prostatectomy can
benefit certain men whose cancer has spread to nearby tissues.

Researchers also are investigating whether diets that are low in fat and
high in soy, fruits, vegetables, and other food products might prevent a
recurrence. The Cancer Information Service can provide information about
these studies.

In July, 2003, an Austrailian research team lead Graham Giles of The Cancer
Council released a report of a medical study that concluded that frequent
masturbation by males may be an effective preventative measure. It was
speculated by the researchers that the resulting ejaculations helps remove
carcinogens from the gland area.

Screening/Early Detection

Researchers are studying ways to screen men for prostate cancer (check for
the disease in men who have no symptoms). At this time, it is not known
whether screening for prostate cancer actually saves lives, even if the
disease is found at an earlier stage. The NCI-supported Prostate, Lung,
Colorectal, and Ovarian Cancer Screening Trial is designed to show whether
certain detection tests can reduce the number of deaths from these cancers.
This trial is looking at the usefulness of prostate cancer screening by
performing a digital rectal exam and checking the PSA level in the blood in
men ages 55 to 74. The results of this trial may change the way men are
screened for prostate cancer. The Cancer Information Service can provide
information about this trial.

Treatment

Through research, doctors try to find new, more effective ways to treat
prostate cancer. Many studies of new approaches for men with prostate cancer
are under way. When laboratory research shows that a new treatment method
has promise, cancer patients receive the new approach in treatment clinical
trials. These studies are designed to answer important questions and to find
out whether the new approach is safe and effective. Often, clinical trials
compare a new treatment with a standard approach.

Cryosurgery is under study as an alternative to surgery and radiation
therapy. The doctor tries to avoid damaging healthy tissue by placing an
instrument known as a cryoprobe in direct contact with the tumor to freeze
it. The extreme cold destroys the cancer cells.

Doctors are studying new ways of using radiation therapy and hormonal
therapy. They also are testing the effectiveness of chemotherapy and
biological therapy for men whose cancer does not respond or stops responding
to hormonal therapy. In addition, scientists are exploring new treatment
schedules and new ways of combining various types of treatment. For example,
they are studying the usefulness of hormonal therapy before primary therapy
(surgery or radiation) to shrink the tumor.

For men with early stage prostate cancer, researchers also are comparing
treatment with watchful waiting. The results of this work will help doctors
know whether to treat early stage prostate cancer immediately or only later
on, if symptoms occur or worsen.

Surviving Prostate Cancer Without Surgery
Surviving prostate cancer without surgery promotes less harmful ways to treat prostate cancer than radical surgery, because radical surgery for prostate cancer has horrible adverse side effects and a very low benefit in terms of overall survival.

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