How is Prostate Cancer treated?

This information represents the views of the doctors and nurses serving on the American Cancer Society's Cancer Information Database Editorial Board. These views are based on their interpretation of studies published in medical journals, as well as their own professional experience.

The treatment information in this document is not official policy of the Society and is not intended as medical advice to replace the expertise and judgment of your cancer care team. It is intended to help you and your family make informed decisions, together with your doctor.

Your doctor may have reasons for suggesting a treatment plan different from these general treatment options. Don't hesitate to ask him or her questions about your treatment options.

Some general comments about prostate cancer treatment

Once your prostate cancer has been diagnosed and staged, you have a lot to think about before you and your doctor choose a treatment plan. You may feel that you must make a decision quickly, but it is important to give yourself time to absorb the information you have just learned. Ask questions of your cancer care team. Read the section "What should you ask your doctor about prostate cancer?"

Depending on the situation, the treatment options for men with prostate cancer may include:

• Expectant management (watchful waiting) or active surveillance
• Surgery
• Radiation therapy
• Cryosurgery (cryotherapy)
• Hormone therapy
• Chemotherapy
• Vaccine treatment
• Bone directed treatment

These treatments are generally used one at a time, although in some cases they may be combined.

The treatment you choose for prostate cancer should take into account:

• Your age and expected life span
• Any other serious health conditions you may have
• The stage and grade of your cancer
• Your feelings (and your doctor's opinion) about the need to treat the cancer
• The likelihood that each type of treatment will cure your cancer (or provide some other measure of benefit)
• Your feelings about the possible side effects from each treatment

Many men find it helpful to get a second opinion about the best treatment options based on their situation, especially if there are several choices available. Prostate cancer is a complex disease, and doctors may differ in their opinions regarding the best treatment options. Speaking with doctors who specialize in different kinds of treatment may help you sort through your options. You will want to weigh the benefits of each treatment against its possible outcomes, side effects, and risks.

The main types of doctors who treat prostate cancer include:

• Urologists: surgeons who specialize in treating diseases of the urinary system and male reproductive system (including the prostate)
• Radiation oncologists: doctors who treat cancer with radiation therapy
• Medical oncologists: doctors who treat cancer with medicines such as chemotherapy or hormone therapy

It is important to discuss all of your treatment options, including goals and possible side effects, with your doctors to help make the decision that best fits your needs.

Once you decide on a treatment plan, many other specialists may be involved in your care as well, including nurse practitioners, nurses, nutrition specialists, social workers, and other health professionals. If you’d like to know more about who may be on your cancer care team, see our document Health Professionals Associated With Cancer Care.

The next few sections describe the types of treatments used for prostate cancer. This is followed by discussion of other treatment-related topics, including things to think about when considering treatment options, typical treatment options based on the stage of the cancer, following PSA levels during and after treatment, and dealing with prostate cancer that remains or recurs after treatment.

Last Medical Review: 08/26/2013

What are the causes of Prostate Cancer?

Nobody is really sure of what the specific causes are. There are so many possible factors, including age, race, lifestyle, medications, and genetics, to name a few.

• Age
  
  Age is considered as the primary risk factor. The older a man is, the higher is his risk. Prostate cancer is rare among men under the age of 45, but much more common after the age of 50.


• Genetics
  
  Statistics indicate that genetics is definitely a factor in prostate cancer risk. It is more common among certain racial groups - in the USA prostate cancer is significantly more common and also more deadly among Afro-Americans than White-Americans. A man has a much higher risk of developing cancer if his identical twin has it. A man whose brother or father had/had prostate cancer runs twice the risk of developing it, compared to other men.
  
  Studies indicate that the two faulty genes - BRCA 1 and BRCA 2 - which are important risk factors for breast cancer and ovarian cancer, have also been implicated in prostate cancer risk. 

Genetic background may contribute to prostate cancer risk, as suggested by associations with race, family, and specific gene variants. Men who have a first-degree relative (father or brother) with prostate cancer have twice the risk of developing prostate cancer, and those with two first-degree relatives affected have a fivefold greater risk compared with men with no family history. In the United States, prostate cancer more commonly affects black men than white or Hispanic men, and is also more deadly in black men. In contrast, the incidence and mortality rates for Hispanic men are one third lower than for non-Hispanic whites. Studies of twins in Scandinavia suggest that 40% of prostate cancer risk can be explained by inherited factors.

No single gene is responsible for prostate cancer; many different genes have been implicated. Mutations in BRCA1 and BRCA2, important risk factors for ovarian cancer and breast cancer in women, have also been implicated in prostate cancer. Other linked genes include the Hereditary Prostate cancer gene 1 (HPC1), the androgen receptor, and the vitamin D receptor. TMPRSS2-ETS gene family fusion, specifically TMPRSS2-ERG or TMPRSS2-ETV1/4 promotes cancer cell growth.

Two large genome-wide association studies linking single nucleotide polymorphisms (SNPs) to prostate cancer were published in 2008. These studies identified several SNPs which substantially affect the risk of prostate cancer. For example, individuals with TT allele pair at SNP rs10993994 were reported to be at 1.6 times higher risk of prostate cancer than those with the CC allele pair. This SNP explains part of the increased prostate cancer risk of African American men as compared to American men of European descent, since the C allele is much more prevalent in the latter; this SNP is located in the promoter region of the MSMB gene, thus affects the amount of MSMB protein synthesized and secreted by epithelial cells of the prostate.

• Diet
  
  
  
  A review of diets indicated that the Mediterranean diet mayreduce a person's chances of developing prostate cancer.Another study indicates that soy, selenium and green tea, offer additional possibilities for disease prevention - however,a more recent study indicated that combination therapy ofvitamin E, selenium and soy does not prevent the progression from high-grade prostatic intraepithelial neoplasia (HGPIN) to prostate cancer. A diet high in vegetable consumption was found in a study to be beneficial.
  
  A US pilot study on men with low risk prostate cancer found that following an intensive healthy diet and lifestyle regime focusing on low meat and high vegetable and fruit intake, regular exercise, yoga stretching, meditation and support group participation, can alter the way that genes behave and change the progress of cancer, for instance by switching on tumor killers and turning down tumor promoters.
  
  Other studies have indicated that lack of vitamin D, a diet high in red meat may raise a person's chances of developing prostate cancer.


• Medication
  
  Some studies say there might be a link between the daily use of anti-inflammatory medicines and prostate cancer risk. A study found that statins, which are used to lower cholesterol levels, may lower a person's risk of developing prostate cancer.


• Obesity
  
  A study found a clear link between obesity and raised prostate cancer risk, as well as a higher risk of metastasis and death among obese people who develop prostate cancer.


• Sexually transmitted diseases (STDs) 
  
  Men who have had gonorrhea have a higher chance of developing prostate cancer, according to research from the University of Michigan Health System.


• Agent Orange
  
  Veterans exposed to Agent Orange have a 48% higher risk of prostate cancer recurrence following surgery than their unexposed peers, and when the disease comes back, it seems more aggressive, researchers say. Another study found that Vietnam War veterans who had been exposed to Agent Orange have significantly increased risks of prostate cancer and even greater risks of getting the most aggressive form of the disease as compared to those who were not exposed.


• Enzyme PRSS3 linked to aggressive prostate cancer
  
  Scientists from the Mayo Clinic, Florida, reported in Molecular Cancer Research that PRSS3, an enzyme, changes the environment of prostate cancer cells, making the cancer much more likely to metastasize.
  
  Senior researcher, Evette Radisky, Ph.D., said "This molecule is a protease, which means it digests other molecules. Our data suggests PRSS3 activity changes the environment around prostate cancer cells - perhaps by freeing them from surrounding tissue - to promote malignancy and invasiveness. I don't think PRSS3 is the only factor involved in driving aggressive prostate cancer, but it may be significant for a certain subset of this cancer - the kind that is potentially lethal."

What are the symptoms of Prostate Cancer?

During the early stages of prostate cancer there are usually no symptoms. Most men at this stage find out they have prostate cancer after a routine check up or blood test. When symptoms do exist, they are usually one or more of the following:

• The patient urinates more often
• The patient gets up at night more often to urinate
• He may find it hard to start urinating
• He may find it hard to keep urinating once he has started
• There may be blood in the urine
• Urination might be painful
• Ejaculation may be painful (less common)
• Achieving or maintaining an erection may be difficult (less common)

If the prostate cancer is advanced the following symptoms are also possible:

• Bone pain, often in the spine (vertebrae), pelvis, or ribs
• The proximal part of the femur can be painful
• Leg weakness (if cancer has spread to the spine and compressed the spinal cord)
• Urinary incontinence (if cancer has spread to the spine and compressed the spinal cord)
• Fecal incontinence (if cancer has spread to the spine and compressed the spinal cord)

What is Prostate Cancer?

Prostate cancer is a form of cancer that develops in the prostate, a gland in the male reproductive system. Most prostate cancers are slow growing; however, there are cases of aggressive prostate cancers. The cancer cells may metastasize (spread) from the prostate to other parts of the body, particularly the bones and lymph nodes. Prostate cancer may cause pain, difficulty in urinating, problems during sexual intercourse, erectile dysfunction, or death. Other symptoms can potentially develop during later stages of the disease.

Rates of detection of prostate cancers vary widely across the world, with South and East Asia detecting less frequently than in Europe, and especially the United States. Prostate cancer tends to develop in men over the age of fifty. Globally it is the sixth leading cause of cancer-related death in men (it is now the first in the UK and second in the United States). Prostate cancer is most common in the developed world with increasing rates in the developing world. However, many men with prostate cancer never have symptoms, undergo no therapy, and eventually die of other unrelated causes. Many factors, including genetics and diet, have been implicated in the development of prostate cancer. Recently the prevalence of light pollution has been implicated in the development of prostate cancer.

The presence of prostate cancer may be indicated by symptoms, physical examination, prostate-specific antigen (PSA), or biopsy. Prostate-specific antigen testing increases cancer detection but does not decrease mortality. The United States Preventive Services Task Force in 2012 recommended against screening for prostate cancer using the PSA testing, due to the risk of over-diagnosis and over-treatment with most prostate cancer remaining asymptomatic. The USPSTF concludes that the potential benefit of testing does not outweigh the expected harms.

Management strategies for prostate cancer should be guided by the severity of the disease. Many low-risk tumors can be safely followed with active surveillance. Curative treatment generally involves surgery, various forms of radiation therapy, proton therapy or, less commonly, cryosurgery; hormonal therapy and chemotherapy are generally reserved for cases of advanced disease (although hormonal therapy may be given with radiation in some cases). Several studies suggest that masturbation reduces the risk of prostate cancer, but the results are controversial.

The age and underlying health of the man, the extent of metastasis, appearance under the microscope and response of the cancer to initial treatment are important in determining the outcome of the disease. The decision whether or not to treat localized prostate cancer (a tumor that is contained within the prostate) with curative intent is a patient trade-off between the expected beneficial and harmful effects in terms of patient survival and quality of life.