Prostate Cancer: Who's at Risk?
No one knows the exact causes of prostate cancer. Doctors can seldom explain why
one man develops the disease and another does not. However, it is clear that
prostate cancer is not contagious. No one can "catch" this disease from another
person.
Research has shown that men with certain risk factors are more likely than
others to develop prostate cancer. A risk factor is something that may increase
the chance of developing a disease.
Studies have found the following risk factors for prostate cancer:
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Age: Age is the strongest risk factor for prostate cancer. This disease
is rare in men younger than 45, but the chance of getting it goes up sharply as
a man gets older. In the United States, most men with prostate cancer are older
than 65.
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Family history: A man's risk of prostate cancer is higher than average
if his father or brother had the disease.
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Race: Prostate cancer is more common in African American men than in
white men, including Hispanic white men. It is less common in Asian and
American Indian men.
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Certain prostate changes: Having abnormal cells called high-grade prostatic intraepithelial neoplasia (PIN)
may increase the risk of prostate cancer. These prostate cells look abnormal
under a microscope.
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Diet: Some studies suggest that men who eat a diet high in animal fat or
meat may be at increased risk of prostate cancer. Also, men who eat a diet rich
in fruits and vegetables may have a lower risk.
Scientists have studied whether BPH, obesity, smoking, a sexually transmitted virus, or lack of exercise might
increase the risk of prostate cancer. At this time, these do not appear to be
important risk factors. Also, most studies have not found an increased risk of
prostate cancer for men who have had a vasectomy (surgery to cut or tie off the tubes that carry sperm out of the testicles). Other
possible risk factors are under study.
Many men who have known risk factors do not get prostate cancer. On the other
hand, many who do get the disease have none of these risk factors (other than
being over 65). Men may want to talk with their doctor about factors that
generally increase the chance of getting prostate cancer and about their own
risk.
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Screening
Men can be checked for prostate cancer before any symptoms develop.
Although studies so far have not shown that
screening
tests reduce the number of deaths from prostate cancer, men may want to talk with the doctor about the possible benefits and harms of being checked for this disease. The decision to be screened, like many other medical decisions, is a personal one. Each man should decide after learning about the pros and cons of screening.
The doctor can explain more about these screening tests:
- 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 checks the level of PSA in the man's blood sample. A high level of
PSA most commonly is caused by BPH or prostatitis
(inflammation of the prostate). It also may result from prostate cancer.
The digital rectal exam and PSA test can be used to detect a prostate problem, but they cannot show whether a problem is cancer or another, less serious condition. The doctor will use the results of these tests to help decide whether to check further for signs of cancer. (Information about additional tests is in the "Diagnosis" section.)
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Symptoms
Symptoms of prostate cancer commonly include:
- Urinary problems
- Inability to urinate, or difficulty starting or stopping the urine flow
- The need to urinate frequently, especially at night
- Weak or interrupted flow of urine
- Pain or burning during urination
- Difficulty having an erection
- Blood in the urine or semen
- Frequent pain in the lower back, hips, or upper thighs
In most cases, these symptoms are not due to prostate cancer. They may be caused by BPH, an infection, or another problem. However, a man with these symptoms should see a doctor so that any problem can be diagnosed and treated as early as possible. He may go to see his primary care doctor or a urologist, a doctor who specializes in diseases of the urinary system.
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Diagnosis
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 level.
The doctor also may order other exams:
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Transrectal ultrasound: The
doctor inserts a probe into the man's rectum to check for abnormal areas. The
probe sends out sound waves that cannot be heard by humans (ultrasound).
The sound waves bounce off the prostate, and a computer uses the echoes to
create a picture called a sonogram.
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Cystoscopy: The doctor looks into the urethra and bladder through a
thin, lighted tube.
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Biopsy: A biopsy is the removal of tissue to look for cancer cells. The
doctor inserts a needle through the rectum into the prostate and removes a
small amount of tissue. The doctor takes tissue samples from
several areas of the prostate. Ultrasound may be used to guide the needle. A pathologist uses a microscope to
check for cancer cells in the tissue. A biopsy is the only sure way to diagnose
prostate cancer.
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A man who needs a biopsy may want to ask the doctor some of the following
questions:
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Where will the biopsy take place? Will I have to go to the hospital?
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How long will it take? Will I be awake? Will it hurt?
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What are the risks? What are the chances of infection or bleeding after the
biopsy?
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How long will it take me to recover?
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How soon will I know the results?
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If I do have cancer, who will talk to me about the next steps? When?
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If the physical exam and test results do not suggest cancer, the doctor may
recommend medicine to reduce 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. Men should talk to their doctor about the best treatment
option.
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. It suggests how
fast the tumor is likely to grow. Tumors with higher grades tend to grow more
quickly and are more likely to spread than those with lower grades.
One system of grading prostate cancer uses G1 through G4. Another way of grading
is with the Gleason score. The pathologist
studies tissue samples from the prostate under a microscope. Each area of
cancer gets a grade of 1 through 5. The pathologist adds the two most common
grades together to make a Gleason score, or the pathologist may add the most
common grade and the highest (most abnormal) grade. Gleason scores can range
from 2 to 10.
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Staging
To plan the best treatment for prostate cancer, the doctor needs to know the stage (extent) of the disease. The
stage is based on the size of the tumor, whether the cancer has spread outside
the prostate and, if so, to what parts of the body.
The man may have blood tests to check for signs that the cancer has spread and
is affecting other organs. Also, in some cases, the following imaging tests may be used to stage
prostate cancer:
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Bone scan: The doctor injects a small amount of radioactive material into a blood
vessel. It flows through the bloodstream and collects in the bones. A machine
called a scanner detects and measures the radioactivity. The scanner creates
pictures or images of the bones on a computer screen or on film. The image can
show cancer that has spread to the bones or other problems.
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CT scan: A CT scan creates
a series of detailed pictures of areas inside the body, such as the pelvis or
abdomen. An x-ray machine takes the pictures
from different angles, and a computer creates the images.
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MRI: A magnet linked to a
computer creates detailed pictures of areas inside the body.
The doctor may describe the stage using a Roman number (I-IV):
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Stage I is cancer that cannot be felt during a rectal exam. It is found
by chance when surgery is done for another reason, usually for BPH. Cancer is
found only in the prostate.
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Stage II is more advanced cancer, but it has not spread outside the
prostate.
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Stage III is cancer that has spread beyond the outer layer of the
prostate. It may be found in the seminal vesicles, but it has not
spread to the lymph nodes.
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Stage IV is one or more of the following:
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Cancer that has invaded the bladder, rectum, or other nearby structures (other
than the seminal vesicles);
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Cancer that has spread to lymph nodes;
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Cancer that has spread to other parts of the body, such as the bones.
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Recurrent cancer is cancer
that has come back after treatment.
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Treatment
Many men with prostate cancer want to take an active part in making decisions
about their medical care. They want to learn all they can about their disease
and their treatment choices. However, shock and stress after the diagnosis can
make it hard to think of everything they want to ask the doctor. It often helps
to make a list of questions before an appointment. To help remember what the
doctor says, men may take notes or ask whether they may use a tape recorder.
Some men also want to have a family member or friend with them when they talk
to the doctor--to take part in the discussion, to take notes, or just to
listen.
The doctor may refer the man with prostate cancer to a specialist, or the
patient may ask for a referral. Specialists who treat prostate cancer include urologists, urologic oncologists, medical oncologists, and radiation oncologists.
Before deciding on a treatment plan, a man might want a second opinion about his
diagnosis and treatment options. Some insurance companies require a second
opinion; others may cover a second opinion if the man or his doctor requests
it. It may take time and effort to gather medical records and arrange to see
another doctor. In general, taking several weeks to get a second opinion does
not make treatment less effective or worsen the man's outlook.
There are a number of ways to find a doctor for a second opinion:
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The man's doctor may refer him to one or more specialists. At cancer centers,
several specialists often work together as a team.
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The Cancer Information Service, at 1-800-4-CANCER, can tell callers about
nearby treatment centers.
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A local or state medical society, a nearby hospital, or a medical school can
usually provide the names of specialists.
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The American Board of Medical Specialties (ABMS) offers a list of doctors who
have met specific education and training requirements and have passed a
specialty examination. Their directory--the Official ABMS Directory of Board
Certified Medical Specialists--lists doctors' names along with their
specialty and their educational background. The directory is available in most
public libraries. Also, ABMS offers this information by telephone and on the
Internet. The toll-free telephone number is 1-866-ASK-ABMS (1-866-275-2267).
The Internet address is http://www.abms.org.
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The NCI provides a helpful fact sheet called "How To Find a Doctor or Treatment
Facility If You Have Cancer. and may be ordered by calling the Cancer
Information Service at 1-800-4-CANCER.
There is not a single best way to treat prostate cancer. Each man can work with
his doctor to develop a treatment plan that meets his medical needs and his
personal values. Treatment for prostate cancer depends mainly on the stage of
the disease, the grade of the tumor, a man's symptoms, and his general health.
The man and his doctor will want to consider both the expected benefits and
possibleside effects of each option,
especially the effects on sexual activity and urination, and other concerns
about quality of life.
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Men with prostate cancer may want to ask the doctor these questions before
treatment begins:
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What is the stage of the disease?
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What is the grade of the tumor?
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What are my treatment choices? Which do you recommend for me? Why?
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What are the expected benefits of each kind of treatment?
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What are the risks and possible side effects of each treatment? How can the
side effects be managed?
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How will treatment affect my normal activities? Is it likely to affect my sex
life? Am I likely to have urinary problems? Am I likely to have bowel problems?
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What will the treatment cost? Is this treatment covered by my insurance plan?
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Would a clinical trial (research study) be
appropriate for me?
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Men do not need to ask all of their questions at once. They will have other
chances to ask the doctor to explain things that are not clear and to ask for
more information.
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Methods of Treatment
Treatment for prostate cancer may involve surgery, radiation therapy, hormonal therapy, or watchful waiting. A man may have a combination of treatments. 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.
At any stage of disease, a man with prostate cancer may have treatment to control pain and other symptoms, to relieve the side effects of therapy, and to ease emotional and practical problems. This kind of treatment is called supportive care, symptom management,
or palliative care. Information about supportive care is available on NCI's Web site at
cancer.gov and from NCI's Cancer Information Service at 1-800-4-CANCER.
A man may want to talk to the doctor about taking part in a clinical trial, a research study of new treatment methods.
Surgery is a common treatment for early stage prostate cancer.
It is a type of local therapy. (It affects cells only in the treated area.)
The doctor may remove the whole prostate or only part of it. In some cases, the doctor 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.
The doctor can describe the types of surgery and can discuss and compare their benefits and risks:
- Radical retropubic prostatectomy:
The doctor removes the entire prostate and nearby lymph nodes through an incision in the abdomen.
- 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.
- 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. TURP does not remove the whole prostate and may not remove all of the cancer, but it does remove tissue that blocks urine flow.
- Laparoscopic prostatectomy and cryosurgery: New types of surgery for prostate cancer are under study at some medical centers.
- Pelvic lymphadenectomy: The doctor removes lymph nodes in the pelvis to see if cancer has spread to them. 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. If the pathologist finds cancer cells in the lymph nodes, it is likely that the disease has spread to other parts of the body. In this case, the doctor usually does not remove the prostate, but may suggest other treatment.
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Men with prostate cancer may want to ask the doctor these questions before having surgery:
- What kind of operation will I have?
- Will I have local or general anesthesia?
- How will I feel after the operation?
- If I have pain, how will it be controlled?
- How long will I be in the hospital?
- When can I get back to my normal activities?
- Will I have any lasting side effects?
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Radiation therapy (also called radiotherapy uses high-energy rays to kill cancer cells. It is a type of local therapy. In early stage prostate cancer, radiation therapy may be the primary treatment (instead of surgery). It also may be used after surgery to destroy any cancer cells that may remain in the area. In advanced stages, radiation therapy may help relieve pain.
Doctors use two types of radiation therapy to treat prostate cancer:
- External radiation: The radiation comes from a machine. Patients go to the hospital or clinic for their treatment,
generally 5 days a week for several weeks. Some men with prostate cancer receive 3-dimensional conformal radiation therapy.
This type of radiation therapy more closely targets the cancer and spares normal tissue.
- Internal radiation(implant radiation or brachytherapy): The radiation comes from radioactive material placed in seeds, needles, or thin plastic tubes put directly in the tissue. The patient stays in the hospital. The implants generally remain in place for several days. Usually they are removed before the patient goes home.
Some men with prostate cancer receive both kinds of radiation therapy.
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Men with prostate cancer may want to ask the doctor these questions before having radiation therapy:
- What kind of radiation therapy will I have?
- How will I feel after the radiation?
- How long will my treatment last?
- If I have to be in the hospital, how long will I need to stay?
- When can I get back to my normal activities?
- Will I have any lasting side effects?
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Hormonal therapy keeps cancer cells from getting the male hormones they need to grow. It is called systemic therapy because it enters the bloodstream and can affect cancer cells throughout the body. Systemic therapy is used mainly to treat cancer that has spread. Sometimes this type of therapy is used to try to prevent cancer from coming back after surgery or radiation treatment.
There are several forms of hormonal therapy:
- Orchiectomy: This is an operation to remove the testicles, which are the main source of the male hormone testosterone.
- Luteinizing hormone-releasing hormone (LH-RH) agonists: These drugs can prevent the testicles from producing testosterone. Examples are leuprolide and goserelin.
- Antiandrogens: These drugs can block the action of androgens. Examples are flutamide,bicalutamide,
and nilutamide.
- Other anticancer drugs: Drugs that can prevent the adrenal glands from making testosterone 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 man also receives an antiandrogen, which blocks the effect of male hormones made by the adrenal glands. This combination of treatments is known as total androgen blockade. Studies have not shown whether total androgen blockade is more effective than orchiectomy or an 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.
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Men with prostate cancer may want to ask the doctor these questions before having hormonal therapy:
- What kind of hormonal therapy will I have?
- How long will my treatment last?
- If I have an orchiectomy, how long will I need to stay in the hospital?
- How will I feel during the therapy?
- When can I get back to my normal activities?
- Will I have any lasting side effects?
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Men sometimes choose watchful waiting when the risks and possible side effects of surgery, radiation therapy, or hormonal therapy may outweigh the possible benefits.
Men who choose watchful waiting are offered treatment when symptoms occur or get worse. Watchful waiting may be advised for older men or for men who have prostate cancer and other serious medical problems. Also, watchful waiting may be suggested for some men who have prostate cancer that is found at an early stage and appears to be growing slowly.
Watchful waiting is under study.
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Men with prostate cancer may want to ask the doctor these questions before choosing watchful waiting:
- If I choose watchful waiting, can I change my mind later on?
- Will the disease be harder to treat later?
- How often will I have checkups?
- Between checkups, what problems should I report to the doctor?
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Side Effects of Cancer Treatment
Because treatment may damage healthy cells and tissues, unwanted side effects are common. These side effects depend on many factors, including the type and extent of the treatment. Side effects may not be the same for each person, and they may even change from one treatment session to the next. Before treatment starts, the health care team will explain possible side effects and suggest ways to help the patient manage them.
The NCI provides helpful booklets about cancer treatments and coping with side effects.
It takes time to heal after surgery, and the time needed to recover is different for each man. It is common to feel tired or weak for a while, and men are often uncomfortable during the first few days. However, medicine can usually control their pain. Before surgery, men should discuss the plan for pain relief with the doctor or nurse. The doctor can adjust the plan if more pain relief is needed.
After surgery, the urethra needs time to heal. The man will have a catheter (a tube inserted through the urethra into the bladder) to drain urine for 10 days to 3 weeks. The nurse or doctor will show the man how to care for the catheter.
Surgery to remove the prostate may cause long-term problems, including incontinence.
After surgery, some men are unable to control the flow of urine from the bladder (urinary incontinence). If the rectum is injured, men may be unable to prevent the escape of stool from the body (fecal incontinence).
Some men may become impotent. 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. In some cases, however, even men who have this procedure become permanently impotent. Men can talk with their doctor about medicine and other ways to help manage the sexual effects of cancer treatment.
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.
Men are likely to become 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.
Some men may have diarrhea or frequent and uncomfortable urination.
When men with prostate cancer receive external radiation therapy, the skin in the treated area may become red, dry, and tender. External radiation therapy also can cause hair loss in the treated area. The loss may be temporary or permanent, depending on the dose of radiation.
Both internal and external radiation therapy can cause nerve damage that results in impotence. However, internal radiation therapy is not as likely to have this effect.
Internal radiation therapy may cause temporary incontinence. Long-term side effects from internal radiation therapy are uncommon.
Orchiectomy and LH-RH agonists are likely to affect a man's quality of life. They often cause side effects such as impotence, hot flashes, loss of sexual desire, and weaker bones. 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 (such as nilutamide) can cause nausea, diarrhea, or breast growth or tenderness. Rarely, they may cause pain in the abdomen, yellow eyes, or dark urine from liver problems. Some men who use nilutamide may have difficulty breathing. Nilutamide also can slow down the time it takes for eyes to adjust to light. It may be harder to go from bright light to darkness, or from darkness to light.
If used for a long time, ketoconazole may cause liver problems, and aminoglutethimide can cause skin rashes. Men who receive total androgen blockade may have more side effects than men who have just one type of hormonal therapy.
Any method of hormonal therapy that lowers hormone levels can contribute to weakening of the bones. The man's doctor can suggest medicines or
dietary supplements that can reduce the risk of bone fractures.
Although men who choose watchful waiting avoid or delay the side effects of surgery and radiation, there can be 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 get older and develop other health problems.
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 approach is nearly always available.
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Nutrition
Patients need to eat well during cancer therapy. They need enough calories to maintain a good weight and enough protein to keep up their strength. Good nutrition often helps people with cancer feel better and have more energy.
But eating well can be difficult. People who are uncomfortable or tired may not feel like eating. Also, the side effects of treatment, such as poor appetite, nausea, or vomiting, can be a problem.
The doctor, dietitian, or other health care provider can suggest ways to maintain a healthy diet.
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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. The doctor monitors recovery and checks for recurrent cancer. Checkups help ensure that any changes in health are noted and treated as needed. Patients may have lab tests, x-rays, biopsies, or other tests.
The NCI has prepared a booklet for people who have completed their treatment to help answer questions about follow-up care and other concerns.
Facing Forward Series: Life After Cancer Treatment provides tips for making the best use of medical visits. It describes how to talk to the doctor about creating a plan of action for recovery and future health.
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Support for Men with Prostate Cancer
A diagnosis of prostate cancer can change a man's life and the lives of those close to him. These changes can be hard to handle. It is common for a man and his family and friends to have many different and sometimes confusing emotions. Many men find that having good information and support services can make it easier to cope with these changes.
Men living with prostate cancer may worry about keeping their jobs, caring for their families, 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 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 financial aid, transportation, home care, or emotional support.
It is also 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 a couple to talk about their concerns and help each other find ways to be intimate during and after treatment. For some couples, it helps to talk with a sex counselor.
Friends and relatives can be supportive and can play an important role. Also, some men find it helps to discuss their concerns with others who have cancer. In support groups, men get together to share what they have learned about coping with the disease and the effects of treatment. Men may want to talk with a member of their health care team about finding a support group. Groups may offer support in person, over the telephone, or on the Internet.
The Cancer Information Service can provide information to help men and their families locate programs, services, and publications.
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The Promise of Cancer Research
Doctors all over the country are conducting many types of clinical trials (research studies in which people take part voluntarily). These are studies of ways to prevent, detect, and treat prostate cancer.
Clinical trials are designed to answer important questions and to find out whether a new approach is safe and effective. Research already has led to advances in these areas, and researchers continue to search for more effective approaches.
People who join clinical trials may be among the first to benefit if a new approach is shown to be effective. And if participants do not benefit directly, they still make an important contribution to medical science by helping doctors learn more about the disease and how to control it. Although clinical trials may pose some risks, researchers do all they can to protect their patients.
Men who are interested in being part of a clinical trial should talk with their doctor.
They may want to read the
NCI booklets
Taking Part in Clinical Trials: What Cancer Patients Need To Know
or
Taking Part in Clinical Trials: Cancer Prevention Studies. The NCI also offers an easy-to-read brochure called
If You Have Cancer…What You Should Know About Clinical Trials. These NCI publications describe how clinical trials are carried out and explain their possible benefits and risks.
NCI's Web site includes a section on clinical trials at http://cancer.gov/clinicaltrials with general information about clinical trials as well as detailed information about specific ongoing studies of prostate cancer. The Cancer Information Service at 1-800-4-CANCER or at
LiveHelp can answer questions and provide information about clinical trials.
Scientists are trying to learn more about factors that may increase the risk of prostate cancer, including:
- Diet: As noted above, prostate cancer seems to occur more commonly among men whose diets are high in animal fat or meat and low in fruits and vegetables. Researchers are studying the possible link between diet and prostate cancer.
- Hormones: 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 testosterone levels, but it also could result from diet or other lifestyle factors.
- Family history: Researchers also are looking for changes in genes that may increase the risk of prostate cancer. They are studying the genes of men with prostate cancer and their family members. 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.
Several studies are under way to explore how prostate cancer might be prevented:
- Diet: Some studies suggest that a diet that regularly includes tomato-based foods may help protect men from prostate cancer. Research is in progress to see if lycopene, the antioxidant that gives tomatoes and some other fruits and vegetables their color, can help prevent prostate cancer.
- Dietary supplements: The Selenium and Vitamin E Cancer Prevention Trial (SELECT) is studying whether selenium, vitamin E, or a combination can reduce the chance of developing prostate cancer. The study began in 2001, and it will continue to enroll men across the United States, Puerto Rico, and Canada through 2004.
- Drug: In 2003, a very large clinical trial (the Prostate Cancer Prevention Trial) showed that a drug called finasteride
can reduce the chance of developing prostate cancer. However, men who developed prostate cancer while taking finasteride were more likely to have high-grade cancers, which tend to grow and spread more quickly than low-grade cancers. Whether these tumors were actually high-grade or only looked that way is still under study. Men who are concerned about getting prostate cancer should talk with their health care provider about the potential benefits and possible risks of taking finasteride, or they may consider taking part in another prostate cancer prevention trial.
Researchers are studying ways to check for prostate cancer in men who have no symptoms. Although screening for prostate cancer may lead to diagnosis at an earlier stage, it is not known whether it actually saves lives. The NCI-supported Prostate, Lung, Colorectal, and Ovarian Cancer Screening Trial (PLCO) is designed to show whether certain screening tests can reduce the number of deaths from these cancers. The prostate cancer screening tests under study in the PLCO are the PSA test and digital rectal exam. Although enrollment was complete in 2001, the researchers will continue to screen the men in the study until 2007. The trial will directly 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.
Scientists are exploring new treatment schedules and ways of combining various types of treatment, such as radiation therapy and hormonal therapy. They are studying the effectiveness of chemotherapy, the use of drugs to kill cancer cells.
They also are studying biological therapy, which uses the body's natural ability immune system to fight cancer. Researchers are also studying drugs to lessen the side effects of treatment, such as bone loss.
Surgeons at some medical centers are exploring the use of laparoscopic prostatectomy. The surgeon makes several tiny incisions
rather than a single long incision. The laparoscope (a thin, lighted tube) allows the surgeon to see inside the abdomen and remove the prostate.
Surgeons also are using cryosurgery for early prostate cancer. The surgeon uses a device that freezes and kills prostate tissue.
For men with early stage prostate cancer, researchers are comparing immediate treatment with surgery or radiation against watchful waiting. Men with early prostate cancer usually do not have any symptoms of disease. This study delays giving treatment to men in the watchful waiting group until they have symptoms. The results of the study will help doctors know whether to treat early stage prostate cancer immediately or only later on, if symptoms occur or get worse.
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National Cancer Institute Booklets
National Cancer Institute (NCI) publications can be ordered by writing to the address below:
Publications Ordering Service
National Cancer Institute
Suite 3035A
6116 Executive Boulevard, MSC 8322
Bethesda, MD 20892-8322
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Some NCI publications can be viewed, downloaded, and ordered from cancer.gov/publications/patient-education on the Internet. In addition, people in the United States and its territories may order these and other NCI booklets by calling the Cancer Information Service at 1-800-4-CANCER.
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