Prostate Cancer

Prostate Cancer

Definition of prostate cancer: Cancer that forms in tissues of the prostate (a gland in the male reproductive system found below the bladder and in front of the rectum). Prostate cancer usually occurs in older men.

 

See also:
Questions to ask your Dr.
Steps to Recovery
Other Treatment Options
Treatment Side Effects
Life-saving Tests
Risk of Recurrence

General Information About Prostate Cancer

Key Points

  • Prostate cancer is a disease in which malignant (cancer) cells form in the tissues of the prostate.
  • Signs of prostate cancer include a weak flow of urine or frequent urination.
  • Tests that examine the prostate and blood are used to detect (find) and diagnose prostate cancer.
  • Certain factors affect prognosis (chance of recovery) and treatment options.

Prostate cancer is a disease in which malignant (cancer) cells form in the tissues of the prostate.

The prostate is a gland in the male reproductive system. It lies just below the bladder (the organ that collects and empties urine) and in front of the rectum (the lower part of the intestine). It is about the size of a walnut and surrounds part of the urethra (the tube that empties urine from the bladder). The prostate gland makes fluid that is part of the semen.

Prostate cancer is most common in older men. In the U.S., about 1 out of 5 men will be diagnosed with prostate cancer.

Signs of prostate cancer include a weak flow of urine or frequent urination.

These and other signs and symptoms may be caused by prostate cancer or by other conditions. Check with your doctor if you have any of the following:

  • Weak or interrupted (“stop-and-go”) flow of urine.
  • Sudden urge to urinate.
  • Frequent urination (especially at night).
  • Trouble starting the flow of urine.
  • Trouble emptying the bladder completely.
  • Pain or burning while urinating.
  • Blood in the urine or semen.
  • A pain in the back, hips, or pelvis that doesn’t go away.
  • Shortness of breath, feeling very tired, fast heartbeat, dizziness, or pale skin caused by anemia.

Other conditions may cause the same symptoms. As men age, the prostate may get bigger and block the urethra or bladder. This may cause trouble urinating or sexual problems. The condition is called benign prostatic hyperplasia (BPH), and although it is not cancer, surgery may be needed. The symptoms of benign prostatic hyperplasia or of other problems in the prostate may be like symptoms of prostate cancer.

Normal prostate and benign prostatic hyperplasia (BPH). A normal prostate does not block the flow of urine from the bladder. An enlarged prostate presses on the bladder and urethra and blocks the flow of urine.

Tests that examine the prostate and blood are used to detect (find) and diagnose prostate cancer.

The following tests and procedures may be used:

  • Physical exam and history : An exam of the body to check general signs of health, including checking for signs of disease, such as lumps or anything else that seems unusual. A history of the patient’s health habits and past illnesses and treatments will also be taken.
  • Digital rectal exam (DRE): An exam of the rectum. 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. EnlargeDigital rectal exam (DRE). The doctor inserts a gloved, lubricated finger into the rectum and feels the rectum, anus, and prostate (in males) to check for anything abnormal.
  • Prostate-specific antigen (PSA) test : A test that measures the level of PSA in the blood. PSA is a substance made by the prostate that may be found in higher than normal amounts 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 BPH (an enlarged, but noncancerous, prostate).
  • Transrectal ultrasound : A procedure in which a probe that is about the size of a finger is inserted into the rectum to check the prostate. The probe is used to bounce high-energy sound waves (ultrasound) off internal tissues or organs and make echoes. The echoes form a picture of body tissues called a sonogram. Transrectal ultrasound may be used during a biopsy procedure. This is called transrectal ultrasound guided biopsy.
  • Transrectal magnetic resonance imaging (MRI): A procedure that uses a strong magnet, radio waves, and a computer to make a series of detailed pictures of areas inside the body. A probe that gives off radio waves is inserted into the rectum near the prostate. This helps the MRI machine make clearer pictures of the prostate and nearby tissue. A transrectal MRI is done to find out if the cancer has spread outside the prostate into nearby tissues. This procedure is also called nuclear magnetic resonance imaging (NMRI). Transrectal MRI may be used during a biopsy procedure. This is called transrectal MRI guided biopsy.
  • Biopsy: The removal of cells or tissues so they can be viewed under a microscope by a pathologist. The pathologist will check the tissue sample to see if there are cancer cells and find out the Gleason score. The Gleason score ranges from 2-10 and describes how likely it is that a tumor will spread. The lower the number, the less likely the tumor is to spread.

Sometimes a biopsy is done using a sample of tissue that was removed during a transurethral resection of the prostate (TURP) to treat BPH.

Certain factors affect prognosis (chance of recovery) and treatment options.

The prognosis (chance of recovery) and treatment options depend on the following:

  • The stage of the cancer (level of PSA, Gleason score, Grade Group, how much of the prostate is affected by the cancer, and whether the cancer has spread to other places in the body).
  • The patient’s age.
  • Whether the cancer has just been diagnosed or has recurred (come back).

Treatment options also may depend on the following:

  • Whether the patient has other health problems.
  • The expected side effects of treatment.
  • Past treatment for prostate cancer.
  • The wishes of the patient.

Most men diagnosed with prostate cancer do not die of it.

Stages of Prostate Cancer

Key Points

  • After prostate cancer has been diagnosed, tests are done to find out if cancer cells have spread within the prostate or to other parts of the body.
  • There are three ways that cancer spreads in the body.
  • Cancer may spread from where it began to other parts of the body.
  • The Grade Group and PSA level are used to stage prostate cancer.
  • The following stages are used for prostate cancer:
    • Stage I
    • Stage II
    • Stage III
    • Stage IV

After prostate cancer has been diagnosed, tests are done to find out if cancer cells have spread within the prostate or to other parts of the body.

The process used to find out if cancer has spread within the prostate or to other parts of the body is called staging. The information gathered from the staging process determines the stage of the disease. It is important to know the stage in order to plan treatment. The results of the tests used to diagnose prostate cancer are often also used to stage the disease. (See the General Information section.) In prostate cancer, staging tests may not be done unless the patient has symptoms or signs that the cancer has spread, such as bone pain, a high PSA level, or a high Gleason score.

The following tests and procedures also may be used in the staging process:

  • Bone scan : A procedure to check if there are rapidly dividing cells, such as cancer cells, in the bone. A very small amount of radioactive material is injected into a vein and travels through the bloodstream. The radioactive material collects in the bones with cancer and is detected by a scanner. Bone scan. A small amount of radioactive material is injected into the patient’s bloodstream and collects in abnormal cells in the bones. As the patient lies on a table that slides under the scanner, the radioactive material is detected and images are made on a computer screen or film.
  • MRI (magnetic resonance imaging): A procedure that uses a magnet, radio waves, and a computer to make a series of detailed pictures of areas inside the body. This procedure is also called nuclear magnetic resonance imaging (NMRI).
  • CT scan (CAT scan): A procedure that makes a series of detailed pictures of areas inside the body, taken from different angles. The pictures are made by a computer linked to an x-ray machine. A dye may be injected into a vein or swallowed to help the organs or tissues show up more clearly. This procedure is also called computed tomography, computerized tomography, or computerized axial tomography.
  • Pelvic lymphadenectomy : A surgical procedure to remove the lymph nodes in the pelvis. A pathologist views the tissue under a microscope to look for cancer cells.
  • Seminal vesicle biopsy : The removal of fluid from the seminal vesicles (glands that make semen) using a needle. A pathologist views the fluid under a microscope to look for cancer cells.
  • ProstaScint scan : A procedure to check for cancer that has spread from the prostate to other parts of the body, such as the lymph nodes. A very small amount of radioactive material is injected into a vein and travels through the bloodstream. The radioactive material attaches to prostate cancer cells and is detected by a scanner. The radioactive material shows up as a bright spot on the picture in areas where there are a lot of prostate cancer cells.

There are three ways that cancer spreads in the body.

Cancer can spread through tissue, the lymph system, and the blood:

  • Tissue. The cancer spreads from where it began by growing into nearby areas.
  • Lymph system. The cancer spreads from where it began by getting into the lymph system. The cancer travels through the lymph vessels to other parts of the body.
  • Blood. The cancer spreads from where it began by getting into the blood. The cancer travels through the blood vessels to other parts of the body.

Cancer may spread from where it began to other parts of the body.

When cancer spreads to another part of the body, it is called metastasis. Cancer cells break away from where they began (the primary tumor) and travel through the lymph system or blood.

  • Lymph system. The cancer gets into the lymph system, travels through the lymph vessels, and forms a tumor (metastatic tumor) in another part of the body.
  • Blood. The cancer gets into the blood, travels through the blood vessels, and forms a tumor (metastatic tumor) in another part of the body.

The metastatic tumor is the same type of cancer as the primary tumor. For example, if prostate cancer spreads to the bone, the cancer cells in the bone are actually prostate cancer cells. The disease is metastatic prostate cancer, not bone cancer.

Denosumab, a monoclonal antibody, may be used to prevent bone metastases.

 

metastasis: how cancer spreads

Many cancer deaths are caused when cancer moves from the original tumor and spreads to other tissues and organs. This is called metastatic cancer. This animation shows how cancer cells travel from the place in the body where they first formed to other parts of the body.

The Grade Group and PSA level are used to stage prostate cancer.

The stage of the cancer is based on the results of the staging and diagnostic tests, including the prostate-specific antigen (PSA) test and the Grade Group. The tissue samples removed during the biopsy are used to find out the Gleason score. The Gleason score ranges from 2 to 10 and describes how different the cancer cells look from normal cells under a microscope and how likely it is that the tumor will spread. The lower the number, the more cancer cells look like normal cells and are likely to grow and spread slowly.

The Grade Group depends on the Gleason score.

  • Grade Group 1 is a Gleason score of 6 or less.
  • Grade Group 2 or 3 is a Gleason score of 7.
  • Grade Group 4 is a Gleason score 8.
  • Grade Group 5 is a Gleason score of 9 or 10.

The PSA test measures the level of PSA in the blood. PSA is a substance made by the prostate that may be found in an increased amount in the blood of men who have prostate cancer.

The following stages are used for prostate cancer:

Stage I

In stage I, cancer is found in the prostate only. The cancer:

  • is not felt during a digital rectal exam and is found by needle biopsy (done for a high PSA level) or in a sample of tissue removed during surgery for other reasons (such as benign prostatic hyperplasia). The PSA level is lower than 10 and the Grade Group is 1; or
  • is felt during a digital rectal exam and is found in one-half or less of one side of the prostate. The PSA level is lower than 10 and the Grade Group is 1.

Stage II

In stage II, cancer is more advanced than in stage I, but has not spread outside the prostate. Stage II is divided into stages IIA, IIB, and IIC.

  • In stage IIA, cancer:
    • is found in one-half or less of one side of the prostate. The PSA level is at least 10 but lower than 20 and the Grade Group is 1; or
    • is found in more than one-half of one side of the prostate or in both sides of the prostate. The PSA level is lower than 20 and the Grade Group is 1.
  • In stage IIB, cancer:
    • is found in one or both sides of the prostate. The PSA level is lower than 20 and the Grade Group is 2.
  • In stage IIC, cancer:
    • is found in one or both sides of the prostate. The PSA level is lower than 20 and the Grade Group is 3 or 4.

Stage III

Stage III is divided into stages IIIA, IIIB, and IIIC.

  • In stage IIIA, cancer:
    • is found in one or both sides of the prostate. The PSA level is at least 20 and the Grade Group is 1, 2, 3, or 4.
  • In stage IIIB, cancer:
    • has spread from the prostate to the seminal vesicles or to nearby tissue or organs, such as the rectum, bladder, or pelvic wall. The PSA can be any level and the Grade Group is 1, 2, 3, or 4.
  • In stage IIIC, cancer:
    • is found in one or both sides of the prostate and may have spread to the seminal vesicles or to nearby tissue or organs, such as the rectum, bladder, or pelvic wall. The PSA can be any level and the Grade Group is 5.

Stage IV

Stage IV is divided into stages IVA and IVB.

  • In stage IVA, cancer:
    • is found in one or both sides of the prostate and may have spread to the seminal vesicles or to nearby tissue or organs, such as the rectum, bladder, or pelvic wall. Cancer has spread to nearby lymph nodes. The PSA can be any level and the Grade Group is 1, 2, 3, 4, or 5.
  • In stage IVB, cancer:
    • has spread to other parts of the body, such as the bones or distant lymph nodes. Prostate cancer often spreads to the bones.

Recurrent Prostate Cancer

Recurrent prostate cancer is cancer that has recurred (come back) after it has been treated. The cancer may come back in the prostate or in other parts of the body.

Treatment Option Overview

Key Points

  • There are different types of treatment for patients with prostate cancer.
  • Seven types of standard treatment are used:
    • Watchful waiting or active surveillance
    • Surgery
    • Radiation therapy and radiopharmaceutical therapy
    • Hormone therapy
    • Chemotherapy
    • Biologic therapy
    • Bisphosphonate therapy
  • There are treatments for bone pain caused by bone metastases or hormone therapy.
  • New types of treatment are being tested in clinical trials.
    • Cryosurgery
    • High-intensity–focused ultrasound therapy
    • Proton beam radiation therapy
  • Treatment for prostate cancer may cause side effects.
  • Patients may want to think about taking part in a clinical trial.
  • Patients can enter clinical trials before, during, or after starting their cancer treatment.
  • Follow-up tests may be needed.

There are different types of treatment for patients with prostate cancer.

Different types of treatment are available for patients with prostate cancer. Some treatments are standard (the currently used treatment), and some are being tested in clinical trials. A treatment clinical trial is a research study meant to help improve current treatments or obtain information on new treatments for patients with cancer. When clinical trials show that a new treatment is better than the standard treatment, the new treatment may become the standard treatment. Patients may want to think about taking part in a clinical trial. Some clinical trials are open only to patients who have not started treatment.

Seven types of standard treatment are used:

Watchful waiting or active surveillance

Watchful waiting and active surveillance are treatments used for older men who do not have signs or symptoms or have other medical conditions and for men whose prostate cancer is found during a screening test.

Watchful waiting is closely monitoring a patient’s condition without giving any treatment until signs or symptoms appear or change. Treatment is given to relieve symptoms and improve quality of life.

Active surveillance is closely following a patient’s condition without giving any treatment unless there are changes in test results. It is used to find early signs that the condition is getting worse. In active surveillance, patients are given certain exams and tests, including digital rectal exam, PSA test, transrectal ultrasound, and transrectal needle biopsy, to check if the cancer is growing. When the cancer begins to grow, treatment is given to cure the cancer.

Other terms that are used to describe not giving treatment to cure prostate cancer right after diagnosis are observation, watch and wait, and expectant management.

Surgery

Patients in good health whose tumor is in the prostate gland only may be treated with surgery to remove the tumor. The following types of surgery are used:

  • Radical prostatectomy: A surgical procedure to remove the prostate, surrounding tissue, and seminal vesicles. There are two types of radical prostatectomy:
    • Retropubic prostatectomy: A surgical procedure to remove the prostate through an incision (cut) in the abdominal wall. Removal of nearby lymph nodes may be done at the same time.
    • Perineal prostatectomy: A surgical procedure to remove the prostate through an incision (cut) made in the perineum (area between the scrotum and anus). Nearby lymph nodes may also be removed through a separate incision in the abdomen.
  • Pelvic lymphadenectomy: A surgical procedure to remove the lymph nodes in the pelvis. A pathologist views the tissue under a microscope to look for cancer cells. If the lymph nodes contain cancer, the doctor will not remove the prostate and may recommend other treatment.
  • Transurethral resection of the prostate (TURP): A surgical procedure to remove tissue from the prostate using a resectoscope (a thin, lighted tube with a cutting tool) inserted through the urethra. This procedure is done to treat benign prostatic hypertrophy and it is sometimes done to relieve symptoms caused by a tumor before other cancer treatment is given. TURP may also be done in men whose tumor is in the prostate only and who cannot have a radical prostatectomy. In some cases, nerve-sparing surgery can be done. 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.

Possible problems after prostate cancer surgery include the following:

  • Impotence.
  • Leakage of urine from the bladder or stool from the rectum.
  • Shortening of the penis (1 to 2 centimeters). The exact reason for this is not known.
  • Inguinal hernia (bulging of fat or part of the small intestine through weak muscles into the groin). Inguinal hernia may occur more often in men treated with radical prostatectomy than in men who have some other types of prostate surgery, radiation therapy, or prostate biopsy alone. It is most likely to occur within the first 2 years after radical prostatectomy.

Radiation therapy and radiopharmaceutical therapy

Radiation therapy is a cancer treatment that uses high-energy x-rays or other types of radiation to kill cancer cells or keep them from growing. There are different types of radiation therapy:

  • External radiation therapy uses a machine outside the body to send radiation toward the cancer. Conformal radiation is a type of external radiation therapy that uses a computer to make a 3-dimensional (3-D) picture of the tumor and shapes the radiation beams to fit the tumor. This allows a high dose of radiation to reach the tumor and causes less damage to nearby healthy tissue.

Hypofractionated radiation therapy may be given because it has a more convenient treatment schedule. Hypofractionated radiation therapy is radiation treatment in which a larger than usual total dose of radiation is given once a day over a shorter period of time (fewer days) compared to standard radiation therapy. Hypofractionated radiation therapy may have worse side effects than standard radiation therapy, depending on the schedules used.

  • Internal radiation therapy uses a radioactive substance sealed in needles, seeds, wires, or catheters that are placed directly into or near the cancer. In early-stage prostate cancer, the radioactive seeds are placed in the prostate using needles that are inserted through the skin between the scrotum and rectum. The placement of the radioactive seeds in the prostate is guided by images from transrectal ultrasound or computed tomography (CT). The needles are removed after the radioactive seeds are placed in the prostate.
  • Radiopharmaceutical therapy uses a radioactive substance to treat cancer. Radiopharmaceutical therapy includes the following:
    • Alpha emitter radiation therapy uses a radioactive substance to treat prostate cancer that has spread to the bone. A radioactive substance called radium-223 is injected into a vein and travels through the bloodstream. The radium-223 collects in areas of bone with cancer and kills the cancer cells.

The way the radiation therapy is given depends on the type and stage of the cancer being treated. External radiation therapy, internal radiation therapy, and radiopharmaceutical therapy are used to treat prostate cancer.

Men treated with radiation therapy for prostate cancer have an increased risk of having bladder and/or gastrointestinal cancer.

Radiation therapy can cause impotence and urinary problems that may get worse with age.

Hormone therapy

Hormone therapy is a cancer treatment that removes hormones or blocks their action and stops cancer cells from growing. Hormones are substances made by glands in the body and circulated in the bloodstream. In prostate cancer, male sex hormones can cause prostate cancer to grow. Drugs, surgery, or other hormones are used to reduce the amount of male hormones or block them from working.

Hormone therapy for prostate cancer may include the following:

  • Abiraterone acetate can prevent prostate cancer cells from making androgens. It is used in men with advanced prostate cancer that has not gotten better with other hormone therapy.
  • Orchiectomy is a surgical procedure to remove one or both testicles, the main source of male hormones, such as testosterone, to decrease the amount of hormone being made.
  • Estrogens (hormones that promote female sex characteristics) can prevent the testicles from making testosterone. However, estrogens are seldom used today in the treatment of prostate cancer because of the risk of serious side effects.
  • Luteinizing hormone-releasing hormone agonists can stop the testicles from making testosterone. Examples are leuprolide, goserelin, and buserelin.
  • Antiandrogens can block the action of androgens (hormones that promote male sex characteristics), such as testosterone. Examples are flutamide, bicalutamide, enzalutamide, and nilutamide.
  • Drugs that can prevent the adrenal glands from making androgens include ketoconazole and aminoglutethimide.

Hot flashes, impaired sexual function, loss of desire for sex, and weakened bones may occur in men treated with hormone therapy. Other side effects include diarrhea, nausea, and itching.

Chemotherapy

Chemotherapy is a cancer treatment that uses drugs to stop the growth of cancer cells, either by killing the cells or by stopping them from dividing. When chemotherapy is taken by mouth or injected into a vein or muscle, the drugs enter the bloodstream and can reach cancer cells throughout the body (systemic chemotherapy). When chemotherapy is placed directly into the cerebrospinal fluid, an organ, or a body cavity such as the abdomen, the drugs mainly affect cancer cells in those areas (regional chemotherapy). The way the chemotherapy is given depends on the type and stage of the cancer being treated.

Biologic therapy

Biologic therapy is a treatment that uses the patient’s immune system to fight cancer. Substances made by the body or made in a laboratory are used to boost, direct, or restore the body’s natural defenses against cancer. Sipuleucel-T is a type of biologic therapy used to treat prostate cancer that has metastasized (spread to other parts of the body).

Bisphosphonate therapy

Bisphosphonate drugs, such as clodronate or zoledronate, reduce bone disease when cancer has spread to the bone. Men who are treated with antiandrogen therapy or orchiectomy are at an increased risk of bone loss. In these men, bisphosphonate drugs lessen the risk of bone fracture (breaks). The use of bisphosphonate drugs to prevent or slow the growth of bone metastases is being studied in clinical trials.

There are treatments for bone pain caused by bone metastases or hormone therapy.

Prostate cancer that has spread to the bone and certain types of hormone therapy can weaken bones and lead to bone pain. Treatments for bone pain include the following:

  • Pain medicine.
  • External radiation therapy.
  • Strontium-89 (a radioisotope).
  • Targeted therapy with a monoclonal antibody, such as denosumab.
  • Bisphosphonate therapy.
  • Corticosteroids.

New types of treatment are being tested in clinical trials.

Cryosurgery

Cryosurgery is a treatment that uses an instrument to freeze and destroy prostate cancer cells. Ultrasound is used to find the area that will be treated. This type of treatment is also called cryotherapy.

Cryosurgery can cause impotence and leakage of urine from the bladder or stool from the rectum.

High-intensity–focused ultrasound therapy

High-intensity–focused ultrasound therapy is a treatment that uses ultrasound (high-energy sound waves) to destroy cancer cells. To treat prostate cancer, an endorectal probe is used to make the sound waves.

Proton beam radiation therapy

Proton beam radiation therapy is a type of high-energy, external radiation therapy that targets tumors with streams of protons (small, positively charged particles). This type of radiation therapy is being studied in the treatment of prostate cancer.

Treatment for prostate cancer may cause side effects.

Patients may want to think about taking part in a clinical trial.

For some patients, taking part in a clinical trial may be the best treatment choice. Clinical trials are part of the cancer research process. Clinical trials are done to find out if new cancer treatments are safe and effective or better than the standard treatment.

Many of today’s standard treatments for cancer are based on earlier clinical trials. Patients who take part in a clinical trial may receive the standard treatment or be among the first to receive a new treatment.

Patients who take part in clinical trials also help improve the way cancer will be treated in the future. Even when clinical trials do not lead to effective new treatments, they often answer important questions and help move research forward.

Patients can enter clinical trials before, during, or after starting their cancer treatment.

Some clinical trials only include patients who have not yet received treatment. Other trials test treatments for patients whose cancer has not gotten better. There are also clinical trials that test new ways to stop cancer from recurring (coming back) or reduce the side effects of cancer treatment.

Follow-up tests may be needed.

Some of the tests that were done to diagnose the cancer or to find out the stage of the cancer may be repeated. Some tests will be repeated in order to see how well the treatment is working. Decisions about whether to continue, change, or stop treatment may be based on the results of these tests.

Some of the tests will continue to be done from time to time after treatment has ended. The results of these tests can show if your condition has changed or if the cancer has recurred (come back). These tests are sometimes called follow-up tests or check-ups.

Stage I Prostate Cancer

Standard treatment of stage I prostate cancer may include the following:

  • Watchful waiting.
  • Active surveillance. If the cancer begins to grow, hormone therapy may be given.
  • Radical prostatectomy, usually with pelvic lymphadenectomy. Radiation therapy may be given after surgery.
  • External radiation therapy. Hormone therapy may be given after radiation therapy.
  • Internal radiation therapy with radioactive seeds.
  • A clinical trial of high-intensity–focused ultrasound therapy.
  • A clinical trial of cryosurgery.

Use our clinical trial search to find NCI-supported cancer clinical trials that are accepting patients. You can search for trials based on the type of cancer, the age of the patient, and where the trials are being done. General information about clinical trials is also available.

Stage II Prostate Cancer

Standard treatment of stage II prostate cancer may include the following:

  • Watchful waiting.
  • Active surveillance. If the cancer begins to grow, hormone therapy may be given.
  • Radical prostatectomy, usually with pelvic lymphadenectomy. Radiation therapy may be given after surgery.
  • External radiation therapy. Hormone therapy may be given after radiation therapy.
  • Internal radiation therapy with radioactive seeds.
  • A clinical trial of cryosurgery.
  • A clinical trial of high-intensity–focused ultrasound therapy.
  • A clinical trial of proton beam radiation therapy.
  • Clinical trials of new types of treatment, such as hormone therapy followed by radical prostatectomy.

Stage III Prostate Cancer

Standard treatment of stage III prostate cancer may include the following:

  • External radiation therapy. Hormone therapy may be given after radiation therapy.
  • Hormone therapy. Radiation therapy may be given after hormone therapy.
  • Radical prostatectomy. Radiation therapy may be given after surgery.
  • Watchful waiting.
  • Active surveillance. If the cancer begins to grow, hormone therapy may be given.

Treatment to control cancer that is in the prostate and lessen urinary symptoms may include the following:

  • External radiation therapy.
  • Internal radiation therapy with radioactive seeds.
  • Hormone therapy.
  • Transurethral resection of the prostate (TURP).
  • A clinical trial of new types of radiation therapy.
  • A clinical trial of cryosurgery.

Stage IV Prostate Cancer

Standard treatment of stage IV prostate cancer may include the following:

  • Hormone therapy.
  • Hormone therapy combined with chemotherapy.
  • Bisphosphonate therapy.
  • External radiation therapy. Hormone therapy may be given after radiation therapy.
  • Alpha emitter radiation therapy.
  • Watchful waiting.
  • Active surveillance. If the cancer begins to grow, hormone therapy may be given.
  • A clinical trial of radical prostatectomy with orchiectomy.

Treatment to control cancer that is in the prostate and lessen urinary symptoms may include the following:

  • Transurethral resection of the prostate (TURP).
  • Radiation therapy.

Treatment Options for Recurrent or Hormone-Resistant Prostate Cancer

For information about the treatments listed below, see the Treatment Option Overview section.

Standard treatment of recurrent or hormone-resistant prostate cancer may include the following:

  • Hormone therapy.
  • Chemotherapy for patients already treated with hormone therapy.
  • Biologic therapy with sipuleucel-T for patients already treated with hormone therapy.
  • External radiation therapy.
  • Prostatectomy for patients already treated with radiation therapy.
  • Alpha emitter radiation therapy.

Updated: October 12, 2018


Did you know?
In 2005, Dr. Dean Ornish MD conducted an interventional study with 93 patients PROVING that you can reverse the progression of early stage prostate cancer with a plant-based diet, exercise, and stress reduction.

 

Exercise and Improved Survival

Limited evidence from a few epidemiologic studies has suggested a possible link between physical activity and better outcomes among men diagnosed with prostate cancer. In one study, men with nonmetastatic prostate cancer who engaged in vigorous activity for at least 3 hours per week had a 61% lower risk of death from prostate cancer compared with men who engaged in vigorous activity for less than 1 hour per week. Another study of men with localized prostate cancer found that higher levels of physical activity were associated with reduced overall and prostate cancer–specific mortality.


IMPORTANT: Can you take your own steps to treat your prostate cancer and live longer?

The idea of simply ‘waiting’ can fill men with some horror. But then so too can the thought of prostate surgery, drugs to cut testosterone, radiotherapy and debilitating side-effects.

So can you take matters in hand? The answer is an emphatic ‘Yes’.

  1. Prostate cancer risk and aggression increases the more saturated fat, such as cows’ dairy, and alcohol you consume. Higher triglyceride levels in the blood stream are known to progress the disease.
  2. Conversely, diets high in polyphenols (such as pomegranate, curcumin, resveratrol and EGCG in green tea) slow growth. One supplement, POMI-T, developed by Professor Robert Thomas has been shown to reduce PSA levels in clinical trials. Thomas originally had all newly diagnosed men around his hospital on broccoli, tomatoes and light daily exercise, pushing back the need for surgery by at least three years. Oestrogen regulators like Indole 3 Carbinol and melatonin also help slow the process.
  3. A good diet and lifestyle can limit prostate cancer growth rate. And there is research concluding that both curcumin and grape seed extract can reduce metastases in prostate cancer.
  4. German Clinics (such as Klinik St Georg) have evidence that prostate biopsies, apart from risking infection and impotence, can spread the disease. There are UK clinical studies concluding the same. Do you really need a biopsy?
  5. Rather than invasive surgery, men should look into localised hyperthermia (also called Ablation). This can melt away the tumour and hospitalisation is short with side-effects minimal. The prostate tumour can be heated using High Intensity Focused Ultrasound (HIFU) or a tube with a metal element placed in the middle of the tumour.
  6. The Nanoknife IRE, which uses needles either side of the tumour and passes a current through the tumour to punch holes in the cancer cells causing them to lyse, is another potential option.
  7. Instead of radiotherapy and brachytherapy, less damaging and more contained proton therapy is now increasing in popularity in America.
  8. Research in 2008 linked 13 chemicals to prostate cancer. All these chemicals were ‘oestrogen mimics’. Research has shown that where selenium levels are low, supplementation of up to 200 micrograms can have positive effects. Selenium can displace chemicals and heavy metals from the body.
  9. Vitamin D, the sunshine vitamin, has been shown in research to reduce both risk and aggression. Public Health, England advise everybody to go in the sun and, if you can’t, to supplement. Harvard Medical School advise supplementation at 5,000IUs per day for people with cancer.
  10. Men who incorporate a higher overall ratio of plant-based foods and herbs into their diets reduce aggressive prostate cancer risk by 25 per cent according to a University of South Carolina study. Researchers claimed the benefit came from bioactive compounds called flavonoids found in colourful foods (for example, strawberries, grapes, greens, onions, citrus fruits).
  11. Another study showed the higher your consumption of naturally fibrous foods the stronger your immune system; while yet another showed the same high-fibre diet slowed prostate cancer growth.
  12. Maintaining a healthy gut (taking probiotics and probiotic foods like Kefir, Sauerkraut and unpasteurized milk products) can boost the immune system and lower bad triglyceride levels. Extra virgin olive oil, fish oils and consuming nuts and seeds can also help significantly.

Other Treatments

Vitamin C and Doxycycline
This study found that antibiotics, such as Doxycycline, could eradicate Cancer Stem Cells in multiple cancer types. These include: DCIS, breast (ER(+) and ER(-)), ovarian, prostate, lung, and pancreatic carcinomas, as well as melanoma and glioblastoma.The study authors propose the combined use of Doxycycline and Vitamin C as a new strategy for eradicating CSCs.

Vitamin D
This study says Vitamin D and its analogs have inhibitory effects on cancer stem cell signaling in various types of human cancer cells and may be promising therapeutic/preventive agents against Cancer Stem Cells.

This study says: Several lines of evidence have demonstrated that vitamin D plays an important role in the regulation of stem cells of the prostate and the skin.
Sunlight spurs the body to make vitamin D.
Food sources:
Fish such as salmon, tuna, and mackerel. Small amounts of vitamin D are found in beef liver, cheese, and egg yolks.

Indole-3-Carbinol (I3C)
The authors of this research paper say previous studies have shown that I3C inhibits prostate cancer cell growth and prevent or delay the progression of cancer, through its ability to attack cancer stem cells
I3C has a widespread effect on multiple cancer cells, such as breast cancer, melanoma, and prostate cancers, according to this study. This demonstrates the I3C plays a significant role in either the cell cycle arrest or apoptosis of various cancers.
Food sources: vegetables such as cabbage, brussels sprouts, cauliflower, radishes, and broccoli
Also available as a Supplement

Vitamin E, Selenium, and Lycopene
A combination of vitamin E, selenium, and lycopene has been shown to dramatically inhibit prostate cancer development and to increase disease-free survival, according to this study

Artemisinin (Anti-Malaria drug)
This study says: Taken together, our results suggest that artemisinin is a very potent anti-cancer compound that exhibits unique effects on the cell cycle regulation of human prostate cancer cells. As such, artemisinin has the potential to be developed as a potent anti-prostate cancer therapeutic.

Phellinus linteus
Phellinus linteus is a well-known Oriental medicinal fungus with a variety of biological activities, including immunomodulatory or direct antitumor activities, according to this study. 
Its extracts demonstrated tumor regression in three independent case reports…

We encountered a case of advanced prostate cancer that became resistant to all kinds of hormonal and radiation therapy, but improved dramatically with oral intake of an extract from the mushroom, Phellinus linteus, say the authors of this study.
Saw Palmetto
Enlarged prostate and prostate cancer is caused, not by testosterone, but by excessive DHT. This is where saw palmetto works and can make a big difference. A high quality saw palmetto can help you prevent prostate problems from developing in the first place.

Anti-parasite drug, nitazoxanide (NTZ)
Source: Labiotech.eu

A group from the University of Bergen have been testing hundreds of drugs to see how they affect cancer cells. They have now found a drug taken to treat intestinal parasites, Giardia and tapeworms, which acts as a tailored medicine against prostate and colon cancer. A widely used anti-parasite drug, nitazoxanide (NTZ), is able to break down a protein called beta-catenin, which is found at high levels in prostate and colon cancer cells and supports their growth and survival. This opens up the possibility of repurposing the drug for the treatment of these cancers.

Hormone Refractory Prostate cancer

Pfeifer Protocol

The Protocol uses a tailored programme of herbs, glyconutrients, minerals and vitamins, via 4 commercially developed products. This protocol is not applicable where the prostate cancer is not hormone (oestrogen) driven. Pfeifer also states that his therapy does not work where radiotherapy has caused cellular damage.


Medical treatment a waste of time in men over 55 diagnosed with prostate cancer (2016)

Source: CancerActive

WARNING: PROSTATE CANCER DIAGNOSED?

MEN – Do not do a thing until you read this!

A growing number of research studies shows that there is little or no survival benefit in having orthodox medical prostate cancer treatment if you are diagnosed over the age of 50. With the known and common side-effects, you are probably better off doing absolutely nothing or looking at non-invasive alternative treatments, and later in the article, we will cover some of those.

Other studies have exposed more medical mythology. Experts now view the PSA test as virtually useless, while others are clear that testosterone levels have no causal effect on prostate cancer.

And, let´s be clear, after the age of 50-55, at least 4 out of every 10 men will develop prostate cancer!

“No survival advantage in prostate cancer treatment”

In August 2016, a major research study by Professor Freddy Hamdy and his Oxford University team found that there is absolutely no survival advantage in having orthodox medical treatment for a newly diagnosed prostate cancer patient after 50 years of age.

The 2016 NHS study followed more than 82,000 men aged between 50 and 69 for a decade. And the bottom line? Only 1 per cent of the men died in that time from their cancer, whether or not they had treatment! The fact is that in the great majority of men diagnosed with prostate cancer later in life, the cancer is slow growing. You are more likely to die with it, than of it.

Importantly, this study was not the first of its kind, as you will see below, but it was the biggest, and in all such studies the results have been remarkably consistent bringing in to question the worth of orthodox medical treatment for prostate cancer in men over 55 years of age, especially in the light of its known high levels of side-effects.

PSA tests, false positives and completely unnecessary prostate cancer treatment

In 2012 there was a full report from the American Preventive Services Task Force (PSTF) on prostate cancer. This Government body concluded that PSA tests for prostate cancer were unreliable, do not offer men any tangible benefit in lifespan or quality of life, and conclude that many more men are injured than helped by PSA tests.

The PSTF research concluded that “only one man in a thousand tested would derive any real benefit, whereas a staggering 100 will receive false positives. Many of these people will then have biopsies, which can cause complications including infection”.

Prostate Specific Antigen (PSA) is a biological marker that oncologists and doctors use to detect the presence of a potential prostate tumour. However there are many other reasons why the PSA can be high; for example, you cycled in the previous 24 hours, consumed dairy, you have prostatitis (inflammation or infection in the prostate gland), or benign prostatic hyperplasia (BPH), or you went to the gym on the way to the hospital. Equally consuming lycopene (tomatoes) or eating a cooked tomato-rich meal will temporarily lower the score.

Also many prostate tumours are benign, would never cause serious health problems yet give high PSA readings.

The same study found that 90 per cent of men may then be treated with surgery or radiation for cancers that are not and will never be life-threatening, but five out of every thousand having these treatments will die within a month of initiating them. In other words, more than ten percent of all men screened for prostate cancer will generate false positives that could result in death from treatment, while a mere 0.001 percent or less will derive any sort of benefit.

“There is a small potential benefit and a significant known harm,” said Dr. Virginia A. Moyer, a professor of paediatrics at Baylor College of Medicine in Houston, Texas, and chair of the task force. She and her team are recommending that the PSA test for prostate cancer be abandoned altogether, and that patients avoid the test as part of their normal check-ups.

No link between testosterone levels and prostate cancer

Many doctors state that PSA tests might be imperfect but they are all that is available, so they might as well use them. This is actually not true. In America some experts measure the DHT levels.

DiHydroTestosterone (DHT) is the active compound, produced by the action of oestrogen on nice safe testosterone. DHT is what causes prostate cancer and the test is also a measure of cancer aggression.

Be clear: There is absolutely no link between prostate cancer and testosterone levels according to Peter Boyle, MD, of the International Prevention Research Institute, who reviewed two meta-studies and found no evidence that testosterone levels were linked in either.

No real benefit in prostate cancer surgery and hormone treatment but there are many problems

In research published in the Journal of the National Cancer Institute, Swedish researchers have concluded that if none of the men diagnosed with early prostate cancer had any treatment at all, over 97 per cent would still survive ten years or more!

After comparing a group of low to mid-risk prostate patients having no treatment with a group having the usual surgery and hormone treatments, some eight years later the death rate amongst men in the no-treatment (active surveillance) group was exactly the same as the figure for the general population!! The researchers stated that after ten years only a little over two per cent of men in the untreated group would have died from prostate cancer.

The researchers even suggested having surgery was pretty much a waste of time and made no difference to the outcome; worse, patients had to put up with often debilitating side-effects.

In a second study (New England Journal of Medicine – PIVOT study) led by Dr.Timothy Wilt of the University of Minnesota School of Medicine, 731 men were followed for ten years, after being diagnosed with prostate cancer. Some had surgery, some did nothing.

At the end of the ten years 47 per cent of the surgery men died during the study compared with 50 per cent of those having nothing. This difference is not deemed statistically significant. However, importantly, men who choose to do nothing are only half as likely to suffer from urinary incontinence or erectile dysfunction.

“We think our results apply to the vast majority of men diagnosed with prostate cancer today,” said Dr. Wilt to the Chicago Tribune.

Importantly, in this study only 3 per cent of men diagnosed with prostate cancer actually died from it, whether they had had surgery or not! The rest died of other causes!

So this study also shows orthodox prostate treatment in men over 60 does not extend life. However, men who have surgery are much more likely to suffer side-effects – overall more than 50 per cent suffer impotence, and more than 10 per cent suffer incontinence.

Over 55 and diagnosed with prostate cancer? Watch and wait

Both the US National Health Institutes and the American Society of Clinical Oncology recommend ‘Active surveillance’, or ‘Active Monitoring’. The ‘cut off’ is a Gleeson score of 6 or lower. Starting once every three months then every 6 months this may become once per year and then once every two years. 50 per cent of men diagnosed in America in 2016 with early stage prostate cancer now ‘watch and wait’. CANCERactive first recommended this strategy in 2005, 11 years ago and four years ahead of other UK charities. Five years ago in America only 10 per cent of men followed Active surveillance programmes.

One expert US oncologist Dr. Matthew R. Cooperberg, a urologist and epidemiologist at the University of California, San Francisco, is actually arguing for new terminology that says there is abnormality but doesn’t use the ‘C’ word. Cooperberg observes that life expectancy in the over 60s is 10-15 years when diagnosed, even without treatment.


Prostate Cancer – Risk of Recurrence?

Oncotype DX® Prostate Cancer Assay
Article source: Oncotypedx
Test available from: Oncotypedx

The Oncotype DX Prostate Cancer Assay harnesses the power of genomics to provide a more precise and accurate assessment of risk based on individual tumor biology. Using a minimal tissue sample from a needle biopsy, the test builds on traditional clinical pathologic factors to provide additional, clinically relevant insight into the underlying prostate tumor biology, enabling physicians and their patients to make treatment decisions with greater confidence.

Patients with newly diagnosed low-risk prostate cancer—and their urologists—need to know the aggressiveness of their tumor. The Oncotype DX Prostate Cancer Assay can help. This genomic test performed on a patient’s needle biopsy provides essential insight into the underlying biology of that patient’s prostate cancer. The result is reported as the Genomic Prostate Score or GPS, and provides a more precise, accurate, and individualized risk assessment that can help a patient and his urologist make a confident choice between active surveillance and immediate treatment.


Hormone therapy can make prostate cancer worse, study find.

Scientists have discovered how prostate cancer can sometimes withstand and outwit a standard hormone therapy, causing the cancer to spread. Their findings also point to a simple blood test that may help doctors predict when this type of hormone therapy resistance will occur.
Continue reading
Source: Science Daily / University of Toronto
( link to original study)

See also

All Your Treatment Options

Tests you need to know about

Vital questions to ask your doctor / oncologist

Steps to Recovery

Source References:
National Cancer Institute
CancerActive

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