Prostate cancer. Disability uk

PROSTATE CANCER

General Information About Prostate Cancer

Stages Of Prostate Cancer
Recurrent Prostate Cancer
Treatment Option Overview
Treatment Options For Stage I Prostate Cancer
Treatment Options For Stage II Prostate Cancer
Treatment Options For Stage III Prostate Cancer
Treatment Options For Stage IV Prostate Cancer
Treatment Options For Recurrent Prostate Cancer
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Overview Of PDQ

CancerMail from the National Cancer Institute

Information from PDQ for Patients

GENERAL INFORMATION ABOUT PROSTATE CANCER

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 located 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 produces fluid that makes up part of the semen.

Prostate cancer is found mainly in older men. As men age, the prostate may get bigger and block the urethra or bladder. This may cause difficulty in urination or can interfere with sexual function. The condition is called benign prostatic hyperplasia (BPH), and although it is not cancer, surgery may be needed to correct it. The symptoms of benign prostatic hyperplasia or of other problems in the prostate may be similar to symptoms for prostate cancer.

Possible signs of prostate cancer include a weak flow of urine or frequent urination. These and other symptoms may be caused by prostate cancer or by other conditions. A doctor should be consulted if any of the following problems occur:

Weak or interrupted flow of urine.
Frequent urination (especially at night).
Difficulty urinating.
Pain or burning during urination.
Blood in the urine or semen.
Nagging pain in the back, hips, or pelvis.
Painful ejaculation.

Tests that examine the prostate and blood are used to help detect (find) and diagnose prostate cancer. The following tests and procedures can help detect prostate cancer:

Digital rectal examination: The doctor or nurse inserts a lubricated gloved finger into the rectum and feels the prostate through the rectal wall for lumps or abnormal areas.

Prostate-specific antigen (PSA) test: A laboratory test that measures the levels of PSA in a blood sample. PSA is a substance produced by the prostate that may be found in an increased amount in the blood of men who have prostate cancer. PSA levels may also be high in men who have an infection or inflammation of the prostate, or benign prostatic hyperplasia (an enlarged, but non-cancerous, prostate).

Transrectal ultrasound: A procedure used to examine the prostate. An instrument is inserted into the rectum, and sound waves bounce off the prostate. These sound waves create echoes, which a computer uses to create a picture called a sonogram. Transrectal ultrasound may also be used during a biopsy procedure.

Biopsy: The removal of cells, tissues, or fluid to view under a microscope and check for signs of disease. There are 2 types of biopsy procedures used to diagnose prostate cancer:
Transrectal biopsy: A needle is inserted through the rectum into the prostate and a sample of prostate tissue is removed. This procedure is usually done using transrectal ultrasound to help guide the needle.

Transperineal biopsy: A needle is inserted through the skin between the scrotum and rectum into the prostate and a sample of prostate tissue is removed.
A pathologist will examine the sample to check for cancer cells and determine the Gleason score. The Gleason score ranges from 2 to 10 and describes how likely it is that a tumor will spread. The lower the number, the less likely the tumor is to spread.

Certain factors affect prognosis (chance of recovery) and choice of treatment. The prognosis (chance of recovery) and choice of treatment depend on the stage of the cancer (whether it affects part of the prostate, involves the whole prostate, or has spread to other places in the body), the Gleason score, the level of PSA, and the patient's age and general health.

STAGES OF PROSTATE CANCER

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 whether cancer has spread within the prostate or to other parts of the body is called staging. It is important to know the stage of the disease in order to plan the best treatment. The following procedures are used to determine the stage of prostate cancer: Radionuclide bone scan: A procedure used to create images of bones on a computer screen or on film. A small amount of radioactive material is injected into a blood vessel and travels through the bloodstream; it collects in the bones and is detected by a scanner.

Magnetic resonance imaging: A magnet linked to a computer is used to create detailed pictures of areas inside the body. This test is also called MRI or nuclear magnetic resonance imaging (NMRI).

Pelvic lymphadenectomy: Lymph nodes in the pelvis may be removed to see if cancer has spread to them.

CT scan: Computed tomography scan. A series of detailed pictures of areas inside the body; the pictures are created by a computer linked to an x-ray machine. This test is also called computerized axial tomography (CAT) scan.

Seminal vesicle biopsy: A needle is inserted into the seminal vesicles (glands that help produce semen) and fluid is removed and checked for cancer cells.

The results of these tests are viewed together with the results of the original tumor biopsy to determine the prostate cancer stage.

The following stages are used for prostate cancer

Stage I

In stage I, cancer is found in the prostate only. It is usually found accidentally during surgery for other reasons, such as benign prostatic hyperplasia. Stage I prostate cancer may also be called stage A1 prostate cancer.

Stage II

In stage II, cancer is more advanced, but has not spread outside the prostate. Stage II prostate cancer may also be called stage A2, stage B1, or stage B2 prostate cancer.

Stage III

In stage III, cancer has spread beyond the outer layer of the prostate to nearby tissues. Cancer may be found in the seminal vesicles (glands that help produce semen). Stage III prostate cancer may also be called stage C prostate cancer.

Stage IV

In stage IV, cancer has metastasized (spread) to other parts of the body, such as the bladder, rectum, bone, liver, lungs, or to lymph nodes near or far from the prostate. (Lymph nodes are small, bean-shaped structures that are found throughout the body. They filter substances in a fluid called lymph and help fight infection and disease.) Metastatic prostate cancer often spreads to the bones. Stage IV prostate cancer may also be called stage D1 or stage D2 prostate cancer.

Recurrent Prostate Cancer

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

TREATMENT OPTION OVERVIEW

There are treatments for all patients with prostate cancer. Some treatments are standard (the currently used treatment), and some are being tested in clinical trials. Before starting treatment, patients may want to think about taking part in a clinical trial. 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.

Clinical trials are taking place in many parts of the country. Information about ongoing clinical trials is available from the NCI cancer.gov Web site. Choosing the most appropriate cancer treatment is a decision that ideally involves the patient, family, and health care team.

Four types of standard treatment are used:

Watchful waiting

Watchful waiting is closely monitoring a patient's condition but withholding treatment until symptoms appear or change. This is usually used in older men with other medical problems and early stage disease.

Surgery

Patients in good health who are younger than 70 years old are usually offered surgery as treatment for prostate cancer. The following types of surgery are used: Pelvic lymphadenectomy: A surgical procedure to take out lymph nodes in the pelvis to see if they contain cancer. If the lymph nodes contain cancer, the doctor will not remove the prostate and may recommend other treatment.

Radical prostatectomy: Surgery to remove the entire prostate. Radical prostatectomy is done only if tests show the cancer has not spread outside the prostate. The two types of radical prostatectomy are:
Retropubic prostatectomy: Surgery to remove the prostate through an incision made in the abdominal wall. Removal of surrounding lymph nodes (lymphadenectomy) can be done at the same time.

Perineal prostatectomy: Surgery to remove the prostate through an incision made between the scrotum and the anus. If surrounding lymph nodes are to be removed, this is usually done through a separate incision.

Transurethral resection of the prostate: A surgical procedure to remove tissue from the prostate using an instrument inserted through the urethra. This operation is sometimes done to relieve symptoms caused by the tumor before other treatment is given. Transurethral resection of the prostate may also be done in men who cannot have a radical prostatectomy because of age or illness.

Impotence and leakage of urine from the bladder or stool from the rectum may occur in men treated with surgery. In some cases, doctors can use a technique known as nerve-sparing surgery. This type of surgery may save the nerves that control erection. However, men with large tumors or tumors that are very close to the nerves may not be able to have this surgery.

Radiation therapy

Radiation therapy is the use of x-rays or other types of radiation to kill cancer cells and shrink tumors. Radiation therapy may use external radiation (using a machine outside the body) or internal radiation. Internal radiation involves putting radioisotopes (materials that produce radiation) through thin plastic tubes into the area where cancer cells are found. Prostate cancer is treated with external and internal (implant) radiation. Radiation therapy may be used alone or in addition to surgery.

Impotence and urinary problems may occur in men treated with radiation therapy.

Hormone therapy

Hormones are chemicals produced by glands in the body and circulated in the bloodstream. Hormone therapy is the use of hormones to stop cancer cells from growing. Male hormones (especially testosterone) can help prostate cancer grow. To stop the cancer from growing, female hormones or drugs that decrease production of male hormones may be given.

Hormone therapy used in the treatment of prostate cancer may include the following:

Estrogens (hormones that promote female sex characteristics) can prevent the testicles from producing testosterone. However, estrogens are seldom used today in the treatment of prostate cancer because of the risk of serious side effects.
Luteinizing hormone-releasing hormone agonists also can prevent the testicles from producing testosterone. Examples are leuprolide, goserelin, and buserelin.
Antiandrogens can block the action of androgens (hormones that promote male sex characteristics). Two examples are flutamide and bicalutamide.
Drugs that can prevent the adrenal glands from making androgens include ketoconazole and aminoglutethimide.
Orchiectomy is surgery to remove the testicles, the main source of male hormones, to decrease hormone production.Hot flashes, impaired sexual function, and loss of desire for sex may occur in men treated with hormone therapy.

Other types of treatment are being tested in clinical trials.

Cryosurgery

Cryosurgery is performed with an instrument that freezes and destroys prostate cancer cells. This treatment is being studied as an alternative to conventional surgery and radiation therapy.

Chemotherapy

Chemotherapy is the use of drugs to kill cancer cells. Chemotherapy may be taken by mouth, or it may be put into the body by inserting a needle into a vein or muscle. Either type of chemotherapy is called systemic treatment because the drugs enter the bloodstream, travel through the body, and can kill cancer cells throughout the body.

Biological therapy

Biological therapy is treatment to stimulate the ability of the 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 disease. Biological therapy is sometimes called biological response modifier (BRM) therapy or immunotherapy.

This summary section refers to specific treatments under study in clinical trials, but it may not mention every new treatment being studied. Information about ongoing clinical trials is available from the NCI cancer.gov Web site.

TREATMENT OPTIONS FOR STAGE I PROSTATE CANCER

Treatment of stage I prostate cancer may include the following: Watchful waiting.
External-beam radiation therapy.
Radical prostatectomy, usually with pelvic lymphadenectomy, with or without radiation therapy after surgery. It may be possible to remove the prostate without damaging nerves that are necessary for an erection.

Implant radiation therapy.
A clinical trial of radiation therapy.
A clinical trial evaluating new treatment options.

TREATMENT OPTIONS FOR STAGE II PROSTATE CANCER

Treatment of stage II prostate cancer may include the following:
Watchful waiting.
External-beam radiation therapy.
Radical prostatectomy, usually with pelvic lymphadenectomy, with or without radiation therapy after surgery. It may be possible to remove the prostate without damaging nerves that are necessary for an erection.

Implant radiation therapy.
A clinical trial of radiation therapy.
A clinical trial of ultrasound-guided cryosurgery.
A clinical trial of hormone therapy followed by radical prostatectomy.
A clinical trial evaluating new treatment options.

TREATMENT OPTIONS FOR STAGE III PROSTATE CANCER

Treatment of stage III prostate cancer may include the following:

External-beam radiation therapy with or without hormone therapy.
Hormone therapy.
Radical prostatectomy, usually with pelvic lymphadenectomy, with or without radiation therapy after surgery.

Watchful waiting.
Transurethral resection of the prostate as palliative therapy to relieve symptoms caused by the cancer.
A clinical trial of radiation therapy.
A clinical trial of ultrasound-guided cryosurgery.
A clinical trial evaluating new treatment options.

TREATMENT OPTIONS FOR STAGE IV PROSTATE CANCER

Treatment of stage IV prostate cancer may include the following:

Hormone therapy.
External-beam radiation therapy with or without hormone therapy.
Radiation therapy or transurethral resection of the prostate as palliative therapy to relieve symptoms caused by the cancer.
Watchful waiting.
A clinical trial of radical prostatectomy with orchiectomy.
A clinical trial of chemotherapy.

TREATMENT OPTIONS FOR RECURRENT PROSTATE CANCER

Treatment of recurrent prostate cancer may include the following: Radiation therapy.
Prostatectomy for patients initially treated with radiation therapy.
Hormone therapy.
Pain medication, external radiation therapy, internal radiation therapy with radioisotopes such as strontium-89, or other treatments as palliative therapy to lessen bone pain.
A clinical trial of ultrasound-guided cryosurgery.
A clinical trial of chemotherapy or biological therapy.

TO LEARN MORE

Call

For more information, U.S. residents may call the Cancer Information Service toll-free at 1-800-4-CANCER (1-800-422-6237) Monday through Friday from 9:00 a.m. to 4:30 p.m. Deaf and hard-of-hearing callers with TTY equipment may call 1-800-332-8615. The call is free and a trained Cancer Information Specialist is available to answer your questions.

Publications

The National Cancer Institute (NCI) has booklets and other materials for patients, health professionals, and the public. These publications discuss types of cancer, methods of cancer treatment, coping with cancer, and clinical trials. Some publications provide information on tests for cancer, cancer causes and prevention, cancer statistics, and NCI research activities. NCI materials on these and other topics may be ordered online or printed directly from the NCI Publications Locator. These materials can also be ordered by telephone from the Cancer Information Service toll-free at 1-800-4-CANCER (1-800-422-6237), TTY at 1-800-332-8615.

LiveHelp

The NCI's LiveHelp ( Http: //cancer.gov/livehelp/vp/vp_sq.html) service, a program available on several of the Institute's Web sites, provides Internet users with the ability to chat online with an Information Specialist. The service is available from 9:00 a.m. to 5:00 p.m. Eastern time, Monday through Friday. Information Specialists can help Internet users find information on NCI Web sites and answer questions about cancer.

Organizations and Web sites

There are many other places where people can get materials and information about cancer treatment and services. Local hospitals may have information on local and regional agencies that offer information about finances, getting to and from treatment, receiving care at home, and dealing with problems associated with cancer treatment. A list of organizations and Web sites that offer information and services for cancer patients and their families is available on cancer.gov ( Http: //cancer.gov/support_resources.html).

Write

For more information from the NCI, please write to this address:

National Cancer Institute
Office of Communications
31 Center Drive, MSC 2580
Bethesda, MD 20892-2580

OVERVIEW OF PDQ

PDQ is a comprehensive cancer database available on cancer.gov.

PDQ is the National Cancer Institute's (NCI's) comprehensive cancer information database. Most of the information contained in PDQ is available on cancer.gov, the NCI's Web site. PDQ is provided as a service of the NCI. The NCI is part of the National Institutes of Health, the federal government's focal point for biomedical research.

PDQ contains cancer information summaries.

The PDQ database contains summaries of the latest published information on cancer prevention, detection, genetics, treatment, supportive care, and complementary and alternative medicine. Most summaries are available in two versions. The health professional versions provide detailed information written in technical language. The patient versions are written in easy-to-understand, non-technical language. Both versions provide current and accurate cancer information.

The PDQ cancer information summaries are developed by cancer experts and reviewed regularly.

Editorial Boards made up of experts in oncology and related specialties are responsible for writing and maintaining the cancer information summaries. The summaries are reviewed regularly and changes are made as new information becomes available. The date at the top of each summary ("Date Last Modified") indicates the time of the most recent change.

PDQ also contains information on clinical trials.

Before starting treatment, patients may want to think about taking part in a clinical trial. A clinical trial is a study to answer a scientific question, such as whether one treatment is better than another. Trials are based on past studies and what has been learned in the laboratory. Each trial answers certain scientific questions in order to find new and better ways to help cancer patients. During treatment clinical trials, information is collected about new treatments, the risks involved, and how well they do or do not work. If a clinical trial shows that a new treatment is better than one currently being used, the new treatment may become "standard."

Listings of clinical trials are included in PDQ and are available at Http: //cancer.gov/search/clinical_trials. Descriptions of the trials are available in health professional and patient versions. Many cancer doctors who take part in clinical trials are also listed in PDQ. For more information, call the Cancer Information Service 1-800-4-CANCER (1-800-422-6237); TTY at 1-800-332-8615.

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