What Is Prostate Cancer?
The prostate (pros-tate) is a gland found only in men. The prostate is about the size of a walnut. It is just below the bladder and in front of the rectum. The tube that carries urine (the urethra) runs through the prostate. The prostate contains cells that make some of the seminal fluid. This fluid protects and nourishes the sperm.

Male hormones cause the prostate gland to develop in the fetus. The prostate keeps on growing as a boy grows to manhood. If male hormone levels are low, the prostate gland will not grow to full size. In older men, though, the part of the prostate around the urethra often keeps on growing. This causes BPH (benign prostatic hyperplasia) which can result in problems with urinating.

Although there are several cell types in the prostate, nearly all prostate cancers start in the gland cells. This kind of cancer is known as adenocarcinoma. The rest of this information refers only to prostate adenocarcinoma.

Most of the time, prostate cancer grows slowly. Autopsy studies show that many older men who died of other diseases also had prostate cancer that neither they nor their doctor were aware of. But sometimes prostate cancer can grow and spread quickly. Even with the latest methods, it is hard to tell which prostate cancers will grow slowly and which will grow quickly.

Some doctors believe that prostate cancer begins with very small changes in the size and shape of the prostate gland cells. These changes are known as PIN (prostatic intraepithelial neoplasia). These changes can be either low-grade (almost normal) or high-grade (abnormal).

If you have had a prostate biopsy that showed high-grade PIN, there is a greater chance that there are cancer cells in your prostate. For this reason, you will be watched carefully and may need another biopsy.

How Many Men Get Prostate Cancer?
Prostate cancer is the most common type of cancer found in American men, other than skin cancer. The American Cancer Society estimates that there will be about 234,460 new cases of prostate cancer in the United States in 2006. About 27,350 men will die of this disease. Prostate cancer is the third leading cause of cancer death in men, after lung cancer and colorectal cancer. While 1 man in 6 will get prostate cancer during his lifetime, only 1 man in 34 will die of this disease. The death rate for prostate cancer is going down. And the disease is being found earlier as well.


What Causes Prostate Cancer?
We do not yet know exactly what causes prostate cancer, but we do know that certain risk factors are linked to the disease. A risk factor is anything that increases a person's chance of getting a disease. Different cancers have different risk factors. Some risk factors, such as smoking, can be controlled. Others, like a person's age or family history, can't be changed. But having a risk factor, or even several, doesn't mean that you will get the disease. Several factors, listed below, can increase the risk of a man developing prostate cancer.

Age: The chance of getting prostate cancer goes up as a man gets older. About 2 out of every 3 prostate cancers are found in men over the age of 65.

Race: For unknown reasons, prostate cancer is more common among African-American men than among white men. And African-American men are twice as likely to die of the disease. Prostate cancer occurs less often in Asian men than in whites.

Nationality: Prostate cancer is most common in North America and northwestern Europe. It is less common in Asia, Africa, Central and South America.

Family history: Men with close family members (father or brother) who have had prostate cancer are more likely to get it themselves, especially if their relatives were young when they got the disease.

Diet: Men who eat a lot of red meat or high-fat dairy products seem to have a greater chance of getting prostate cancer. These men also tend to eat fewer fruits and vegetables. Doctors are not sure which of these factors causes the risk to go up. The best advice is to eat 5 or more servings of vegetables and fruits each day and to eat less red meat and high-fat dairy products.

Exercise: Although most studies have not shown a link to exercise, one recent study found that men over the age of 65 who exercised vigorously had a lower rate of prostate cancer.

Some people get cancer because of changes to their DNA. DNA makes up our genes, which control how cells behave. DNA is inherited from our parents. A small percentage (about 5% to 10%) of prostate cancers are linked to such changes. It may also be the case that prostate cancer is linked to higher levels of certain hormones. High levels of male hormones (androgens) may play a part in prostate cancer risk in some men. Also, some researchers have noted that men with high levels of the hormone called IGF-1 are more likely to get prostate cancer. But others have not found such a link. More research is needed in this area.

Can Prostate Cancer Be Prevented?
Because we don't know the exact cause of prostate cancer, it is not possible to prevent most cases of the disease. But some cases might be prevented. One risk factor that can be changed is diet. You may be able to lower your risk of prostate cancer by eating less red meat and fat and eating more vegetables, fruits, and grains. Eat 5 or more servings of fruits and vegetables each day. These guidelines provide an overall healthful approach to eating that may help lower your risk for some other types of cancer, as well as other diseases. Tomatoes, pink grapefruit, and watermelon are rich in substances (lycopenes) that help prevent damage to DNA and may help lower prostate cancer risk.

Some studies suggest that taking vitamin E daily may lower the risk of prostate cancer. But others have found that vitamin E has no impact on cancer risk and might raise the risk for some kinds of heart disease. Selenium, a mineral, may also lower risk. A large study is going on now to see if vitamin E or selenium lowers prostate cancer risk.

On the other hand, vitamin A supplements may actually increase prostate cancer risk. It's always a good idea to check with your doctor about taking vitamins or supplements.

A study of the drug finasteride found that men taking the drug were 25% less likely to get prostate cancer than men taking a placebo ("sugar pill"). But the men taking the drug who did get prostate cancer were more likely to have cancers that looked like they might grow and spread. Also, the men taking the drug were more likely to have side effects such as lower sex drive and trouble getting an erection. On the other hand, they had fewer urinary problems. At this time it's not clear whether taking finasteride to lower the risk of prostate cancer is a good idea or not. The results of the study will become clearer over the next few years.

How Is Prostate Cancer Found?
Prostate cancer can often be found early by testing the amount of PSA (prostate-specific antigen) in your blood. Another way prostate cancer is found early is when the doctor does a digital rectal exam (DRE). Because the prostate gland lies just in front of the rectum, during the exam the doctor can feel if there are any bumps or hard places in the prostate. These might be cancer. If you have had routine yearly exams and either one of these test results becomes abnormal, any cancer you might have has probably been found at an early, more treatable stage.

Since about 1990 it has become more common for men to have tests to find prostate cancer early. The prostate cancer death rate has dropped, too. But we do not yet know if this drop is the direct result of the tests.

These tests are not perfect, though. Wrong test results could lead to excess worry, or even an unneeded biopsy or other tests.

Until more is known, you should talk to your doctor about whether or not you want to be tested. Things to take into account are your age and your health. If you are young and you get prostate cancer, it will probably shorten your life if it is not caught early. But if you are older or in poor health, then prostate cancer may never become a major problem because it often grows so slowly.

What the American Cancer Society Recommends
The American Cancer Society believes that doctors should offer the PSA blood test and DRE (digital rectal exam) yearly, beginning at age 50 to men who do not have any major medical problems and can be expected to live at least 10 more years. Men at high risk should begin testing at age 45. Men at high risk include African Americans and men who have a close relative (father, brother, or son) who had prostate cancer before age 65.

Men at even higher risk (because they have several close relatives with prostate cancer at an early age) could begin testing at age 40. Depending on the results of the first tests, they might not need more testing until age 45.

Doctors should talk to men about the benefits and risks of testing, and men should take an active part in the choice about whether or not to have tests.

No major scientific or medical groups (including the American Cancer Society) recommend routine testing for prostate cancer at this time. Rather, they recommend that men talk to their doctors about the benefits, risks, side effects, and questions about early prostate cancer tests and treatment. Each man needs to have the best information to make the decision that is right for him.

The PSA Blood Test
PSA (prostate-specific antigen) is a substance made by the normal prostate gland. Although PSA is mostly found in semen, a small amount is also found in the blood. Most men have levels under 4 ng/mL (nanograms per milliliter) of blood. Prostate cancer can cause the level to go up. If your level is between 4 and 10, you have about a 1 in 4 chance of having prostate cancer. If it is above 10, your chance is over 50% and goes up as the PSA level goes up. But some men with a PSA below 4 can also have prostate cancer.

Factors other than cancer can also cause the PSA level to go up, including having BPH or an infection in the prostate, taking certain drugs, and getting older. Men with a high PSA will need further tests to find out if they actually have cancer.

There are a number of new types of PSA tests that might help to show whether a man needs more testing or not. Not all doctors agree on how to use these new PSA tests. You should talk to your doctor about your cancer risk and any tests that you are having.

There is no question that the PSA test can help spot prostate cancer. But it can't tell how dangerous the cancer is. The problem is that some prostate cancers are slow growing and may never cause problems. But because of a high PSA level, many men will be found to have prostate cancer that would never lead to their death. Yet they are being treated with either surgery or radiation because they are uncomfortable not having treatment. Doctors and patients are still struggling to decide who should receive treatment and who can be followed without treatment.

The PSA test is also useful after prostate cancer has been found. It can be used along with other results to help decide which types of treatment might be helpful. A very high PSA level might mean that the cancer has spread beyond the prostate. Some forms of treatment are not as useful for cancer that has spread to the lymph nodes or other organs. The PSA test can also be used to help show if treatment is working or if cancer has come back after treatment.

If prostate cancer has spread outside of the prostate or if it has come back after treatment, the way PSA is used changes. The PSA value does not tell whether a person will have symptoms or not or how long he will live. Many men with a high PSA feel just fine. Other people have low values but they have symptoms. With advanced disease, the way the PSA value is changing may be more important than the number alone.

DRE (Digital Rectal Exam)
To do the DRE the doctor inserts a gloved, lubricated finger into the rectum to feel for any irregular or firm areas that might be cancer. The prostate gland is next to the rectum, and most cancers begin in the part of the gland that can be reached by a rectal exam. While it is uncomfortable, the exam isn't painful and takes only a short time.

The DRE is less effective than the PSA blood test in finding prostate cancer, but it can sometimes find cancers in men with normal PSA levels. For this reason, ACS guidelines recommend that when prostate cancer screening is done, both the DRE and the PSA should be used. The DRE is also used once a man is known to have prostate cancer. It can help tell whether the cancer has spread beyond his prostate gland. It can also be used to find cancer that has come back after treatment.

If Cancer Is Suspected
Early prostate cancer often causes no symptoms. It may be found by a PSA test or DRE. Problems with urinating could be a sign of advanced prostate cancer. But more often this problem is caused by a less serious disease known as BPH (benign prostatic hyperplasia).

Symptoms of advanced prostate cancer could include the following:

• trouble having or keeping an erection (impotence)
• blood in the urine
• pain in the spine, hips, ribs, or other bones
• weakness or numbness in the legs or feet
• loss of bladder or bowel control

Once again, other diseases also can cause these symptoms.

If certain symptoms or the results of early tests suggest you might have prostate cancer, your doctor will use further tests to find out whether the disease is present.

The prostate biopsy: A biopsy (by-op-see) is the only way to know for sure if you have prostate cancer. During a biopsy, tissue from your prostate is removed so it can be sent to the lab to see if there are cancer cells. A core needle biopsy is the main method used. Here is how it's done:

A small probe is placed in the rectum. The probe gives off sound waves that create a picture of the prostate on a video screen. This technique is called TRUS (transrectal ultrasound). Guided by TRUS, the doctor inserts a narrow needle through the wall of the rectum into the prostate gland. The needle then removes a piece of tissue, usually about ½ inch long and 1/16 inch across. Some doctors do the biopsy through the skin between the rectum and the scrotum.

Although the test sounds painful, it usually causes little discomfort because it is done very quickly. The doctor can numb the area ahead of time. You might want to ask your doctor about numbing the area. Several samples are often taken from different parts of the prostate. Ask your doctor how many samples will be taken.

The biopsy takes about 15 minutes and is usually done in the doctor's office. You will likely be given antibiotics ahead of time to reduce the chance of infection. For a few days afterwards you may notice some soreness and blood in your urine or light bleeding from the rectum. Some men also have blood in their semen for a month or two after the biopsy.

Cancer may only be present in a small area of the prostate. Because of this, sometimes the biopsy will miss the cancer even when it is there. This is known as a "false negative." If your doctor still strongly suspects cancer, a repeat biopsy may be needed.

Grading the prostate cancer: The biopsy sample will be sent to a lab. A doctor there will look for cancer cells in the sample. If cancer is present, the sample will be graded. Grading the cancer helps to predict how fast the cancer is likely to grow and spread. Prostate cancers are graded on the basis of how closely the cells in the sample look like normal prostate cells. Those that look very different from normal cells are likely to mean a cancer that grows faster. The system used most often for grading prostate cancer is called the Gleason system.

Samples from 2 areas of the prostate are each graded from 1 to 5, and the number grades are added to give a Gleason score or sum of between 2 and 10. The lower the number, the more the cells in the sample look like normal prostate cells. A higher score means the samples look less normal and the cancer is likely to grow more quickly. Ask your doctor to explain the grade of your tumor because it is an important factor in making treatment decisions.

Sometimes the cells don't look like cancer but they don't look really normal either. In these cases, more biopsies may be done later.

How Is Prostate Cancer Treated?
There is a lot for you to think about when choosing the best way to treat or manage your cancer. There may be more than one treatment to choose from. You may feel that you need to make a decision quickly. But give yourself time to absorb the information you have learned. Talk to your doctor. Look at the list of questions at the end of this article to get some ideas. Then add your own.

You may want to get a second opinion, especially if you have several treatments to choose from. You will want to weigh the benefits of each treatment against its possible drawbacks, side effects, and risks.

The best treatment for you depends on a number of factors. These include your age, your overall health, the stage and grade of your cancer, your feelings about the side effects of different treatments, and the chance that each type of treatment might cure the cancer.

Surgery, radiation, and hormone therapy are the most common treatments for prostate cancer. Chemotherapy may be used in some cases, and watchful waiting, though not an active form of treatment, may be an option for some men.

Watchful Waiting (Expectant Management)
Because prostate cancer often grows very slowly, some men (especially those who are older or who have other major health problems) may never need treatment for their cancer. Instead, their doctor may suggest an approach called "watchful waiting" (also called "expectant management").

This approach involves closely watching the cancer (with PSA testing) without using treatment such as surgery or radiation therapy. It may be an option if the cancer is not causing any symptoms, will probably grow slowly, and is small and contained in one place in the prostate. It is less often a choice if you are younger, healthy, and have a fast-growing cancer.

Some men choose watchful waiting because, in their view, the side effects of strong treatments outweigh the benefits. Others are willing to accept the possible side effects of active treatments in order to try to destroy the cancer.

Watchful waiting does not mean your cancer will be ignored. Rather, your doctor will observe what is going on. You will most likely have a PSA blood test and DRE every 6 months, maybe with a yearly biopsy of the prostate. If you start to have symptoms or if your cancer begins to grow more quickly, you can think about active treatment.

Surgery
The most common operations for prostate cancer are radical prostatectomy (pros-tuh-tek-tuh-me) and transurethral (trans-yuh-ree-thral) resection of the prostate (TURP). Each is explained in more detail below.

Radical prostatectomy
This surgery is done to try to cure the cancer. It is done most often if it looks like the cancer has not spread outside the prostate. The entire prostate gland and some tissue around it are removed.

There are 2 main types of radical prostatectomy. In a radical retropubic (ret-ro-pew-bic) prostatectomy, the incision is made in the lower abdomen. In a radical perineal (pair-uh-nee-ul) prostatectomy, the incision is made in the skin between the scrotum and the anus

The radical retropubic approach is the one used by most surgeons. You will either be asleep (under general anesthesia) or be given medication to numb the lower half of the body along with sedation. The surgeon makes an incision in the lower abdomen.

Your doctor may first remove lymph nodes near the prostate and have them looked at under a microscope. If any of the nodes contain cancer, it means the cancer has spread. Since the cancer probably can't be cured, the doctor may stop the operation.

If you have a low PSA and Gleason score, your doctor may remove only the prostate gland and not remove lymph nodes. This is because the chance that the cancer has spread to the lymph nodes is very low.

During this operation, it is sometimes possible to avoid harming the nerves that control erections, which are close to the prostate. This lowers, but does not do away with, the risk of impotence after surgery. If you were able to have erections before, the doctor will try not to injure these nerves. Of course, if the cancer is growing into them, the doctor will have to remove them.

In the perineal approach, the surgeon makes the incision in the skin between the anus and the scrotum. Nerve-sparing operations are harder to do with the perineal approach, and lymph nodes cannot be removed. However, the surgeon can remove some lymph nodes using a separate technique, if needed. Because this operation is often shorter, it might be used for men who don't need the nerve-sparing procedure or who have other medical problems that make the first approach harder.

These operations last from 1 1/2 to 4 hours, with the perineal approach often taking less time than the retropubic approach. They are followed by an average hospital stay of 3 days and average time away from work of 3 to 5 weeks.

In most cases, you will be able to donate your own blood before surgery. The blood can be given back to you during the operation, if needed. Usually a tube for draining urine (catheter) is placed into the bladder through the penis after surgery while you are still asleep. The catheter stays in place for 1 to 3 weeks and allows you to urinate easily while you are healing. You will be able to urinate on your own after the catheter is removed.

Both of the operations described above use an "open" approach in which the surgeon makes a long cut (incision) to remove the prostate. A newer method involves making several smaller cuts and using special long instruments to remove the prostate. It is called laparoscopic surgery (laparoscopic radical prostatectomy or LRP) and is being used more and more in this country.

LRP has advantages over the open approach: less blood loss and pain, and shorter hospital stays and recovery time. Nerve-sparing is possible with LRP, and the side effects seem to be about the same as for open prostatectomy. Some surgeons even do LRP remotely by use of a robotic device. The difference is really just one of a choice of tools. What is more important is the surgeon's experience and ability.

LRP has been used in the United States since 1999. It is done in community and university centers. Because it is still somewhat new, results of long-term studies are not in yet. If you are thinking about treatment with LRP, find out as much as you can about this approach. And be sure to find a surgeon with a lot of experience doing LRP.

Transurethral resection of the prostate (TURP)
This procedure is done to relieve symptoms such as trouble urinating in men who can't have other types of surgery. It is not done to cure the disease or to remove all the cancer. The same operation is used even more often to relieve symptoms of non-cancerous prostate swelling called BPH.

During the operation, a tool with a small loop of wire on the end is placed through the end of the penis into the urethra. The wire is heated and cuts out the cancerous tissue in the prostate. No incision is needed with this method. You will have either spinal anesthesia or general anesthesia.

The operation takes about 1 hour. You can usually leave the hospital after 1 to 2 days and return to work in 1 to 2 weeks. You will need a catheter to drain urine afterwards for about 2 or 3 days. There may be some bleeding into the urine after surgery.

Risks and side effects of radical prostatectomy
The risks with this surgery are like those of any major surgery and can include problems from the anesthesia, a small risk of heart attack, stroke, blood clots in the legs, infection, and bleeding. Your risk depends, in part, on your overall health, your age, and the skill of your doctors.

The main possible side effects of radical prostatectomy are lack of bladder control (incontinence) and not being able to get an erection (impotence). These side effects can also happen with other kinds of treatment but they are described here in more detail.

Incontinence: Incontinence means you can't control your urine or you have trouble with leaking. There are different types of incontinence. Having this problem can affect you not only physically but emotionally, too.

Normal bladder control returns for many men within several weeks or months after the operation. Doctors can't predict how any one man will function after surgery. In one large study, researchers found that 5 years after radical prostatectomy:

• 14% of men had no bladder control or had frequent urine leaks
• 16% leaked more than twice a day
• 29% wore pads to keep dry

Most large cancer centers, where this surgery is done more often and surgeons have more experience, report fewer problems with incontinence. If you have problems with incontinence, let your doctors know. Doctors who treat men with prostate cancer should know about incontinence, and should be able to suggest ways to help you. There are exercises (Kegel exercises) you can learn that might help to strengthen your bladder. There are also medicines or even surgery that might help. There are also products to help keep you dry and comfortable.

Impotence: Impotence means that a man can't get an erection strong enough to have sex. The nerves that allow men to get erections may be damaged during surgery, radiation treatment, or other treatments. During the first 3 to12 months after surgery, you will probably not be able to get an erection without using medicine or some other treatment. Later, some men will be able to get an erection and some will still have trouble. Whether or not you will be able to get an erection depends on your age and the type of surgery that was done. The younger you are, the more likely you will still be able to get an erection. In any case the feeling of pleasure (orgasm) during sex will still be there. The orgasm will be "dry," though, since semen is not being made.

If you are concerned about erection problems, be sure and talk to your doctor. There are ways to help. There are medicines and even devices such as vacuum pumps and penile implants that could prove useful. For more information to help you understand and cope with the sexual side effects of prostate cancer treatment, please see "Sexuality and Cancer: For the Man Who Has Cancer and His Partner." You can order it through our toll-free number or find it on our Web site.

Sterility: A radical prostatectomy cuts the tubes between the testicles (where sperm are made) and the urethra. This means that a man can no longer father a child. Often this is not an issue as men with prostate cancer tend to be older. But if this is a concern for you, talk to your doctor about "banking" your sperm before the operation.

Lymphedema: A rare side effect of removing many of the lymph nodes around the prostate is lymphedema, which causes swelling and pain. Lymph nodes provide a way for fluid to return from all around the body to the heart. When the nodes are removed, fluid can collect in the legs or genital region. Lymphedema can often be treated with physical therapy, but it might not go away completely.

Radiation Therapy
Radiation therapy is treatment with high-energy rays (such as x-rays) to kill or shrink cancer cells. The radiation may come from outside the body (external radiation) or from radioactive materials placed directly in the tumor (brachytherapy or internal radiation).

Radiation is sometimes used for low-grade cancer that has not spread outside the prostate gland, or has spread only to nearby tissue. Cure rates seem to be about the same as for men having surgery. If the disease is more advanced, radiation may be used to shrink the tumor and provide pain relief.

External beam radiation
This treatment is much like getting a regular x-ray, but for a longer time. Each treatment lasts only a few minutes. Men usually have 5 treatments per week in an outpatient center over a period of 8 or 9 weeks. The treatment itself is painless.

Side effects can include diarrhea with or without blood in the stool, rectal leakage, and irritated intestines. Sometimes, normal bowel function does not return after treatment is stopped. Other side effects might include frequent urination, feeling like you have to urinate all the time, burning while urinating, and blood in the urine. Although incontinence is less common than after surgery, a recent study found that the number of incontinent men continued to increase every year after radiation. By 6 years after treatment, the rate was almost as high as it was in men who had surgery Also, external radiation therapy can cause tiredness that may not go away until a month or two after treatment stops. Lymphedema is also possible.

After several years, the impotence rate after radiation is the same as that of surgery. More than 7 out of 10 men become impotent within 5 years of having external beam radiation therapy. Impotence usually does not begin right after treatment (as it often does with surgery) but develops slowly over one or more years. Impotence can often be treated, for example with drugs like sildenafil (Viagra). A recent study found that over half of treated men were able to have erections using sildenafil (Viagra).

Newer forms of radiation therapy appear to have a good success rate and may have fewer side effects.

Internal radiation: brachytherapy (brake-ee-ther-uh-pee)

In this approach, small radioactive pellets (each about the size of a grain of rice) are placed directly into the prostate. Sometimes these pellets are referred to as "seeds." They may be left in the prostate permanently. Because they are so small, they cause little discomfort and are simply left in place after their radioactive material is used up. In another form of brachytherapy, a stronger radioactive substance is placed in the prostate for 5 to 15 minutes and then removed. Usually 3 brief treatments are given over a couple of days. Often this treatment is combined with external radiation, given at a lower dose than it would be if used alone.

If you have pellets that are left in place, they will give off small amounts of radiation for several weeks. Even though the radiation doesn't travel far, you may be told to stay away from pregnant women and small children during this time. You may be asked to be careful in other ways as well.

For about a week after the pellets are put in place, there may be some pain in the area and a red-brown color to the urine. There is also a small risk that some of the seeds might move (migrate) to other parts of the body. Like external radiation treatment, this approach can have side effects such as problems with the bladder and bowel and impotence. But it may be that these occur at a lower rate. Be sure to talk to your doctor if you have any of these side effects. Often there are medicines or other methods to help.

Cryosurgery
This approach is sometimes used to treat prostate cancer by freezing the cells with cold metal probes. It is used only for prostate cancer that has not spread but may not be a good option for men with large prostate glands. The probes are placed through incisions between the anus and the scrotum. Cold gases are then passed through the probes, which creates ice balls that destroy the prostate gland. Some type of anesthesia is used during this procedure.

A catheter is also put in place (usually through the abdomen) so that when the prostate swells urine does not stay trapped in the bladder. You will probably be in the hospital for a day. The catheter is removed a couple of weeks later. After the procedure, there will be some bruising and soreness of the area where the probe was inserted. You may have some blood in the urine for the first few days. Short-term swelling of the penis and scrotum after cryosurgery is also common

There are benefits and drawbacks to cryosurgery. On the one hand, because it is less invasive than radical surgery, there is less loss of blood, a shorter hospital stay, shorter recovery time, and less pain. But freezing can damage nerves near the prostate and cause impotence and incontinence. These side effects may occur more often than they do after radical prostatectomy. In addition, freezing may damage the bladder and intestines. This can cause pain, a burning sensation, and the need to empty the bladder and bowels often.

Compared to surgery or radiation treatment, doctors know much less about how well the method works in the long run. For this reason, most doctors do not include cryosurgery among the first options they recommend for treating prostate cancer.

Hormone Therapy
The goal of hormone therapy (also called androgen deprivation) is to lower the levels of the male hormones or androgens (an-dro-jens), such as testosterone (tes-toss-ter-own). Androgens, which are made mostly in the testicles, cause prostate cancer cells to grow. Lowering androgen levels often makes prostate cancer shrink or grow more slowly. But hormone therapy will not cure the cancer. It is not a substitute for treatments aimed at a cure.

Hormone therapy is often used in men for whom other treatments such as surgery or radiation may not be good options. It is also used for men whose cancer has spread to other parts of the body or has come back after earlier treatment. It may be used along with radiation in men who are at high risk of having the cancer return after treatment. Sometimes it is used before surgery or radiation to shrink the cancer.

While hormone therapy does not cure the cancer, it can provide relief from symptoms. Some doctors think that hormone therapy works better if it is started as early as possible after the cancer has reached an advanced stage. But not all doctors agree with this.

Because nearly all prostate cancers become resistant to this treatment over time, some doctors use an on-again, off-again approach (intermittent therapy). The drugs are given for a while, then stopped, then started again. One advantage is that some men are able to avoid the side effects (impotence, loss of sex drive, etc.) for a time. Studies are now going on to see whether this new approach is better or worse than giving the drugs constantly.

There are several methods used for hormone therapy. They involve either surgery or the use of drugs to lower the amount of testosterone or to block the body's ability to use androgens. These treatments include:

• orchiectomy (or-key-eck-tuh-me)
• LHRH analogs
• antiandrogens

Orchiectomy
Surgery to remove the testicles (orchiectomy) works by removing the main source of male hormones. While this is a fairly simple procedure and is not as costly as some other options, it is permanent and many men have trouble accepting this operation. Most men who have this surgery lose the desire for sex and cannot have erections.

Side effects of orchiectomy: Hormone treatment can have serious side effects. These vary and depend on the kind of treatment you are given. About 90% of men who get hormone therapy have reduced or no sexual desire and impotence. Other side effects could include:

• hot flashes (these often go away with time)
• breast tenderness • growth of breast tissue
• weakening of the bones (osteoporosis)
• low red blood cell counts (anemia)
• lower mental sharpness
• loss of muscle mass
• weight gain
• tiredness
• lower levels of HDL ("good") cholesterol
• depression

Many of these side effects can be treated. Osteoporosis can be a major problem because men who have it are more likely to develop bone fractures. If osteoporosis develops, it should be treated.

LHRH analogs (luteinizing hormone-releasing analogs)
These drugs lower testosterone levels just as well as orchiectomy. LHRH analogs (or agonists) are given as shots, either monthly or every 3, 4, 6, or 12 months. Even though this treatment costs more and means more doctor visits, most men choose this method over surgery to remove the testicles.

Side effects are like those from the surgery (see above). Also, when LHRH analogs are the first given, the testosterone level goes up briefly before going down to low levels. This is called "flare." Men whose cancer has spread to the bones may have bone pain. To reduce flare, drugs called antiandrogens can be given for a few weeks before starting treatment with LHRH analogs.

LHRH antagonists
A newer drug, abarelix (Plenaxis) is an LHRH antagonist. It lowers testosterone more quickly and does not cause a flare. But a small number of men are allergic to the drug. For this reason it is only used for men who cannot take other forms of hormone therapy. The side effects are similar to those of orchiectomy or LHRH agonists (see above).

Abarelix is given only in certain doctors' offices. It is given as a shot every 2 weeks for the first month, then every 4 weeks. You will need to stay in the office for 30 minutes after the shot to make sure you're not allergic.

Antiandrogens
These drugs block the body's ability to use any androgens. Even after the testicles are removed or during LHRH treatment, the adrenal glands still make a small amount of androgens. Antiandrogens may be used along with orchiectomy or the LHRH analogs to provide combined androgen blockade (CAB), or total blocking of all androgens produced by the body. There is still debate about whether CAB is better than using the other treatments alone. Antiandrogens can cause diarrhea, nausea, liver problems, and tiredness. They seem to cause fewer sexual side effects than other hormone treatments.

Other drugs
At one time estrogens (female hormones) were used to treat men with prostate cancer. Because of side effects, LHRH analogs and antiandrogens are now used. But estrogen or some other drugs such as ketoconazole (Nizoral) may be used if other hormone treatments are no longer working.

Many issues about hormone therapy are not yet resolved, such as the best time to start and stop it and the best way to give it. Studies looking at these issues are now going on. If you are thinking about hormone therapy, ask your doctor to explain which treatments will be used and what side effects you might expect to have.

Chemotherapy
Chemotherapy is the use of drugs for treating cancer. The drugs are often injected into a vein. Some can be swallowed in pill form. Once the drugs enter the bloodstream, they spread throughout the body to reach and destroy the cancer cells.

Until recently, chemotherapy had not worked very well in treating prostate cancer. In the past few years, new drugs have been shown to relieve symptoms from prostate cancer in men with advanced disease.

Chemotherapy is sometimes used if the cancer has spread outside of the prostate gland and hormone therapy isn't working. It will not cure the cancer or destroy all the cancer cells, but it may slow tumor growth, reduce pain, and may prolong life. Chemotherapy is not used as a treatment for early prostate cancer.

There are a number of different chemotherapy drugs. Often 2 or more are given at the same time for better effect.

Side effects
While chemotherapy drugs kill cancer cells, they also damage some normal cells and this can lead to side effects. The side effects of chemotherapy depend on the type of drugs, the amount taken, and the length of treatment. They could include:

• nausea and vomiting
• loss of appetite
• hair loss
• mouth sores

Because normal cells are also damaged, you may have low blood cell counts. This can cause:

• increased risk of infection (from a shortage of white blood cells)
• bleeding or bruising after minor cuts or injuries (from a shortage of blood platelets)
• tiredness (from low red blood cell counts)

Also, each drug may have its own unique side effects.

Most side effects go away once treatment is over. If you have problems with side effects, talk with your doctor or nurse about what can be done. There is help for many of the side effects of chemotherapy. For example, there are drugs to prevent or reduce nausea and vomiting. Other drugs can be given to boost blood cell counts.

Treatment of Pain and Other Symptoms
Most of this article talks about ways to remove or destroy cancer cells or to slow their growth. But it is important to realize that having a good quality of life is also a valid goal. Don't hesitate to talk to your doctor or nurse about pain or any symptoms that are bothering you. There are ways to treat these. And getting good treatment can help you feel better and allow you to focus on things that are important in your life.

While radiation therapy can be used as the main treatment for prostate cancer, it can also be used to treat bone pain for cancer that has spread to the bone.

Substances called radiopharmaceuticals are also used for this purpose. These are a group of drugs that have radioactive elements. They can be given into a vein. Then they settle in areas of bones that contain cancer. Often patients with pain from cancer that has spread to the bone are helped with this approach. About 8 out of 10 prostate cancer patients with bone pain are helped by this treatment. The main side effect is a lowering of blood cell counts. This could increase your risk of getting an infection or bleeding easily.

Bisphosphonates are another group of drugs that can relieve bone pain. They may also slow the growth of the cancer cells and strengthen bones in men who are having hormone treatment. But some men have had a very distressing side effect from these drugs. They have pain in the jaw and their doctors find that part of the bone of the upper or lower jaw has died. This can lead to loss of teeth or infections of the jaw bone. Doctors don't know why this happens or how to prevent it. So far, the only treatment has been to stop the bisphosphonate treatment. Some cancer doctors recommend that patients have a dental checkup and have any tooth or jaw problems treated before they start taking bisphosphonates.

Sometimes corticosteroids can relieve bone pain for some men.

Pain medicines work very well. When they are used right, you need not worry about addiction or dependence. Symptoms such as drowsiness and constipation may occur, but can usually be handled by changing the dosage or by adding other medicines.

What Is the Best Treatment for Me?
If you have prostate cancer, you will want to take several factors into account before you choose a course of treatment. These factors include your age, your overall health, your goals for treatment, and your feelings about side effects. Some men, for example, can't imagine living with side effects such as incontinence or impotence. Others are less concerned about these and more concerned about getting rid of the cancer.

If you are over 70 or have serious health problems, you might want to think of prostate cancer as a chronic disease. It will most likely not lead to your death. But it could cause symptoms you want to avoid. In this view, the goal is to relieve symptoms and avoid side effects of treatment. So you might decide to choose watchful waiting or hormone therapy.

On the other hand, many younger men (in their 50s and 60s, for example) might be more interested in treatments that offer the best chance for a cure. Most doctors now feel that external radiation, radical prostatectomy, and radioactive implants have the same cure rates for the earliest stage prostate cancers. But each man's situation is unique and is influenced by factors such as his blood PSA level, the stage of the cancer, and its Gleason score. And age alone is not the only factor to take into account. Many men are quite youthful at age 70 while a few, at 60, are frail and debilitated.

These decisions are even harder for you if you try to make them alone. It is often helpful to discuss treatment options with more than one doctor. It's natural for surgical specialists such as urologists to recommend surgery and for radiation oncologists to recommend radiation. Your primary care doctor can often help you to choose the treatment plan that is best for you.

Many men find that talking to others who have faced the same issues is helpful. The American Cancer Society's Man to Man program (or similar programs offered by other organizations) provides a way for men to meet and discuss issues related to prostate cancer. To learn more about Man to Man, please call us at 1-800-ACS-2345, or visit our Web site at www.cancer.org.

Prostate Cancer Survival Rates
The 5-year relative survival rate is the percentage of patients who do not die from prostate cancer within 5 years after the cancer is found. (Men with prostate cancer who die of other causes are not counted.) Of course, patients might live more than 5 years after diagnosis. These 5-year survival rates are based on men with prostate cancer first treated more than 5 years ago.

Overall, 99% of men diagnosed with prostate cancer survive at least 5 years. Ninety one percent of all prostate cancers are found while they are still within the prostate or only in nearby areas. The 5-year relative survival rate for these men is nearly 100%. For the men whose cancer has already spread to distant parts of the body when it is found, 34% will survive at least 5 years.

Modern methods of finding and treating prostate cancer have led to a yearly drop in death rate of about 3.5% in recent years. So men treated today may have an even better outlook than the numbers above.

While these numbers provide an overall picture, keep in mind that every man's situation is unique and the statistics can't predict exactly what will happen in your case. Talk with your cancer care team if you have questions about your personal chances of a cure, or how long you might survive your cancer. They know your situation best.

Clinical Trials
Studies of promising new treatments are known as clinical trials. A clinical trial is done only when there is some reason to believe that the new treatment may be of value to the patient. Clinical trials are needed in order to find new and better ways to treat cancer. Treatments used in clinical trials are often found to have real benefits. The main questions the researchers want to answer are:

• Is this treatment helpful?
• Does it work better than the one we're now using?
• What side effects does it cause?
• Do the benefits outweigh the side effects?
• Which patients are most likely to find this treatment helpful?

Clinical trials are carried out in steps called phases. Each phase is designed to answer certain questions

Phase I clinical trials look at the best way to give a new treatment and how much of it can be given safely. The main purpose of a phase I study is to test the safety of the new drug.

Phase II clinical trials are designed to see if the drug works. Patients are given the highest dose that doesn't cause serious side effects and then watched closely to see if there is an effect on the cancer.

Phase III clinical trials compare the new treatment with standard treatment. Large numbers of patients are divided into 2 groups. The control group receives standard treatment and the other group receives the new treatment. Everyone is closely watched to see which treatment is more effective. The study is stopped if the side effects are too severe or if one group has much better results than the other.

If you are in a clinical trial, you will have a team of experts watching your progress very carefully. However, there are some risks. No one knows in advance if the treatment will work or exactly what side effects will occur. That is what the study is designed to discover. Keep in mind, though, that even standard treatments have side effects.

Taking part in a clinical trial is completely up to you. Even after joining a clinical trial, you are free to leave the study at any time, for any reason. Taking part in the study will not prevent you from getting other medical care you may need.

Courtesy: www.cancer.org, Please visit the website for further information