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Stages
Of Prostate Cancer
Recurrent Prostate
Cancer
Treatment Option Overview
Treatment
Options For Stage I Prostate Cancer
Treatment Options For Stage II
Prostate Cancer
Treatment Options For Stage III
Prostate Cancer
Treatment Options For Stage IV
Prostate Cancer
Treatment Options For Recurrent
Prostate Cancer
To Learn More
Overview
Of PDQ
Prostate cancer is found mainly in older men. As men age, the prostate may get bigger and block the urethra or bladder. This may cause difficulty in urination or can interfere with sexual function. The condition is called benign prostatic hyperplasia (BPH), and although it is not cancer, surgery may be needed to correct it. The symptoms of benign prostatic hyperplasia or of other problems in the prostate may be similar to symptoms for prostate cancer.
Possible signs of prostate cancer include a weak flow of urine or frequent urination. These and other symptoms may be caused by prostate cancer or by other conditions. A doctor should be consulted if any of the following problems occur:
Tests that examine the prostate and blood are used to help detect (find) and diagnose prostate cancer. The following tests and procedures can help detect prostate cancer:Weak or interrupted flow of urine.
Frequent urination (especially at night).
Difficulty urinating.
Pain or burning during urination.
Blood in the urine or semen.
Nagging pain in the back, hips, or pelvis.
Painful ejaculation.
Digital rectal examination: The doctor or nurse inserts a lubricated gloved finger into the rectum and feels the prostate through the rectal wall for lumps or abnormal areas.
Prostate-specific antigen (PSA) test: A laboratory test that measures the levels of PSA in a blood sample. PSA is a substance produced by the prostate that may be found in an increased amount in the blood of men who have prostate cancer. PSA levels may also be high in men who have an infection or inflammation of the prostate, or benign prostatic hyperplasia (an enlarged, but non-cancerous, prostate).
Transrectal ultrasound: A procedure used to examine the prostate. An instrument is inserted into the rectum, and sound waves bounce off the prostate. These sound waves create echoes, which a computer uses to create a picture called a sonogram. Transrectal ultrasound may also be used during a biopsy procedure.
Biopsy: The removal of cells, tissues, or fluid to view under a microscope and check for signs of disease. There are 2 types of biopsy procedures used to diagnose prostate cancer:
Transrectal biopsy: A needle is inserted through the rectum into the prostate and a sample of prostate tissue is removed. This procedure is usually done using transrectal ultrasound to help guide the needle.
Transperineal biopsy: A needle is inserted through the skin between the scrotum and rectum into the prostate and a sample of prostate tissue is removed.
A pathologist will examine the sample to check for cancer cells and determine the Gleason score. The Gleason score ranges from 2 to 10 and describes how likely it is that a tumor will spread. The lower the number, the less likely the tumor is to spread.
Certain factors affect prognosis (chance of recovery) and choice of treatment. The prognosis (chance of recovery) and choice of treatment depend on the stage of the cancer (whether it affects part of the prostate, involves the whole prostate, or has spread to other places in the body), the Gleason score, the level of PSA, and the patient's age and general health.
The results of these tests are viewed together with the results of the original tumor biopsy to determine the prostate cancer stage.
The following stages are used for prostate cancer
In stage IV, cancer has metastasized (spread) to other parts of the body, such as the bladder, rectum, bone, liver, lungs, or to lymph nodes near or far from the prostate. (Lymph nodes are small, bean-shaped structures that are found throughout the body. They filter substances in a fluid called lymph and help fight infection and disease.) Metastatic prostate cancer often spreads to the bones. Stage IV prostate cancer may also be called stage D1 or stage D2 prostate cancer.
Recurrent prostate cancer is cancer that has recurred (come back) after it has been treated. Recurrent prostate cancer may come back in the prostate or in another part of the body.
Clinical trials are taking place in many parts of the country. Information about ongoing clinical trials is available from the NCI cancer.gov Web site. Choosing the most appropriate cancer treatment is a decision that ideally involves the patient, family, and health care team.
Four types of standard treatment are used:
Watchful waiting is closely monitoring a patient's condition but withholding treatment until symptoms appear or change. This is usually used in older men with other medical problems and early stage disease.
Patients in good health who are younger than 70 years old are usually offered surgery as treatment for prostate cancer. The following types of surgery are used: Pelvic lymphadenectomy: A surgical procedure to take out lymph nodes in the pelvis to see if they contain cancer. If the lymph nodes contain cancer, the doctor will not remove the prostate and may recommend other treatment.Transurethral resection of the prostate: A surgical procedure to remove tissue from the prostate using an instrument inserted through the urethra. This operation is sometimes done to relieve symptoms caused by the tumor before other treatment is given. Transurethral resection of the prostate may also be done in men who cannot have a radical prostatectomy because of age or illness.
Impotence and leakage of urine from the bladder or stool from the rectum may occur in men treated with surgery. In some cases, doctors can use a 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.
Impotence and urinary problems may occur in men treated with radiation therapy.
Hormone therapy used in the treatment of prostate cancer may include the following:
Estrogens (hormones that promote female sex characteristics) can prevent the testicles from producing testosterone. However, estrogens are seldom used today in the treatment of prostate cancer because of the risk of serious side effects.Other types of treatment are being tested in clinical trials.
Chemotherapy is the use of drugs to kill cancer cells. Chemotherapy may be taken by mouth, or it may be put into the body by inserting a needle into a vein or muscle. Either type of chemotherapy is called systemic treatment because the drugs enter the bloodstream, travel through the body, and can kill cancer cells throughout the body.
This summary section refers to specific treatments under study in clinical trials, but it may not mention every new treatment being studied. Information about ongoing clinical trials is available from the NCI cancer.gov Web site.
This summary section refers to specific treatments under study in clinical trials, but it may not mention every new treatment being studied. Information about ongoing clinical trials is available from the NCI cancer.gov Web site.
Treatment of stage II prostate cancer may include the following:
Watchful waiting.
External-beam radiation therapy.
Radical prostatectomy, usually with pelvic lymphadenectomy, with or without radiation therapy after surgery. It may be possible to remove the prostate without damaging nerves that are necessary for an erection.
Implant radiation therapy.
A clinical trial of radiation therapy.
A clinical trial of ultrasound-guided cryosurgery.
A clinical trial of hormone therapy followed by radical prostatectomy.
A clinical trial evaluating new treatment options.
This summary section refers to specific treatments under study in clinical trials, but it may not mention every new treatment being studied. Information about ongoing clinical trials is available from the NCI cancer.gov Web site.
External-beam radiation therapy with or without hormone therapy.
Hormone therapy.
Radical prostatectomy, usually with pelvic lymphadenectomy, with or without radiation therapy after surgery.
Watchful waiting.
Transurethral resection of the prostate as palliative therapy to relieve symptoms caused by the cancer.
A clinical trial of radiation therapy.
A clinical trial of ultrasound-guided cryosurgery.
A clinical trial evaluating new treatment options.
This summary section refers to specific treatments under study in clinical trials, but it may not mention every new treatment being studied. Information about ongoing clinical trials is available from the NCI cancer.gov Web site.
Hormone therapy.
External-beam radiation therapy with or without hormone therapy.
Radiation therapy or transurethral resection of the prostate as palliative therapy to relieve symptoms caused by the cancer.
Watchful waiting.
A clinical trial of radical prostatectomy with orchiectomy.
A clinical trial of chemotherapy.
This summary section refers to specific treatments under study in clinical trials, but it may not mention every new treatment being studied. Information about ongoing clinical trials is available from the NCI cancer.gov Web site.
Treatment of recurrent prostate cancer may include the following: Radiation therapy.
Prostatectomy for patients initially treated with radiation therapy.
Hormone therapy.
Pain medication, external radiation therapy, internal radiation therapy with radioisotopes such as strontium-89, or other treatments as palliative therapy to lessen bone pain.
A clinical trial of ultrasound-guided cryosurgery.
A clinical trial of chemotherapy or biological therapy.
This summary section refers to specific treatments under study in clinical trials, but it may not mention every new treatment being studied. Information about ongoing clinical trials is available from the NCI cancer.gov Web site.
For more information, U.S. residents may call the Cancer Information Service toll-free at 1-800-4-CANCER (1-800-422-6237) Monday through Friday from 9:00 a.m. to 4:30 p.m. Deaf and hard-of-hearing callers with TTY equipment may call 1-800-332-8615. The call is free and a trained Cancer Information Specialist is available to answer your questions.
Publications
The National Cancer Institute (NCI) has booklets and other materials for patients, health professionals, and the public. These publications discuss types of cancer, methods of cancer treatment, coping with cancer, and clinical trials. Some publications provide information on tests for cancer, cancer causes and prevention, cancer statistics, and NCI research activities. NCI materials on these and other topics may be ordered online or printed directly from the NCI Publications Locator. These materials can also be ordered by telephone from the Cancer Information Service toll-free at 1-800-4-CANCER (1-800-422-6237), TTY at 1-800-332-8615.
LiveHelp
The NCI's LiveHelp ( Http: //cancer.gov/livehelp/vp/vp_sq.html) service, a program available on several of the Institute's Web sites, provides Internet users with the ability to chat online with an Information Specialist. The service is available from 9:00 a.m. to 5:00 p.m. Eastern time, Monday through Friday. Information Specialists can help Internet users find information on NCI Web sites and answer questions about cancer.
Organizations and Web sites
There are many other places where people can get materials and information about cancer treatment and services. Local hospitals may have information on local and regional agencies that offer information about finances, getting to and from treatment, receiving care at home, and dealing with problems associated with cancer treatment. A list of organizations and Web sites that offer information and services for cancer patients and their families is available on cancer.gov ( Http: //cancer.gov/support_resources.html).
Write
For more information from the NCI, please write to this address:
National Cancer
Institute
Office of Communications
31 Center Drive, MSC 2580
Bethesda,
MD 20892-2580
PDQ is the National Cancer Institute's (NCI's) comprehensive cancer information database. Most of the information contained in PDQ is available on cancer.gov, the NCI's Web site. PDQ is provided as a service of the NCI. The NCI is part of the National Institutes of Health, the federal government's focal point for biomedical research.
PDQ contains cancer information summaries.
The PDQ database contains summaries of the latest published information on cancer prevention, detection, genetics, treatment, supportive care, and complementary and alternative medicine. Most summaries are available in two versions. The health professional versions provide detailed information written in technical language. The patient versions are written in easy-to-understand, non-technical language. Both versions provide current and accurate cancer information.
The PDQ cancer information summaries are developed by cancer experts and reviewed regularly.
Editorial Boards made up of experts in oncology and related specialties are responsible for writing and maintaining the cancer information summaries. The summaries are reviewed regularly and changes are made as new information becomes available. The date at the top of each summary ("Date Last Modified") indicates the time of the most recent change.
PDQ also contains information on clinical trials.
Before starting treatment, patients may want to think about taking part in a clinical trial. A clinical trial is a study to answer a scientific question, such as whether one treatment is better than another. Trials are based on past studies and what has been learned in the laboratory. Each trial answers certain scientific questions in order to find new and better ways to help cancer patients. During treatment clinical trials, information is collected about new treatments, the risks involved, and how well they do or do not work. If a clinical trial shows that a new treatment is better than one currently being used, the new treatment may become "standard."
Listings of clinical trials are included in PDQ and are available at Http: //cancer.gov/search/clinical_trials. Descriptions of the trials are available in health professional and patient versions. Many cancer doctors who take part in clinical trials are also listed in PDQ. For more information, call the Cancer Information Service 1-800-4-CANCER (1-800-422-6237); TTY at 1-800-332-8615.
These web site links are listed as a convenience to our visitors. If you use these links, we take no responsibility and give no guarantees, warranties or representations, implied or otherwise, for the content or accuracy of these third-party sites.
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