Prostate Cancer FAQs

Here are some answers to frequently asked questions about prostate cancer.

Q: What is the prostate?

A: The prostate is a male sex gland that produces a thick fluid that forms part of the semen. The prostate is about the size of a walnut. It’s located below the bladder and in front of the rectum. It surrounds the upper part of the urethra, the tube that empties urine from the bladder. The prostate needs male hormones, including testosterone, to function.

Q: What causes prostate cancer?

A: The exact cause of prostate cancer is not known. Men whose close relatives have had prostate cancer are more likely to get it, suggesting that there are genetic factors. Studies are being done to see if exposure to certain materials, such as the metal cadmium, increases the risk of developing prostate cancer. The effect of a high-fat diet is also being studied for its impact on prostate cancer.

Q: What are the symptoms of prostate cancer?

A: Many men have no symptoms. The cancer is found during an examination or a blood test. These are the most common symptoms of prostate cancer:

• A need to urinate often, especially at night

• Weak or interrupted urine flow

• Difficulty starting urination or holding back urine

• Inability to urinate

• Painful or burning urination

• Painful ejaculation

• Blood in urine or semen

• Pain or stiffness in the lower back, hips, or upper thighs

Prostate cancer that has spread to the bones may show up as bone pain, usually in the hips or back.

Q: How is a digital rectal examination done?

A: For a digital rectal exam (DRE), you bend over and the doctor or nurse practitioner inserts a lubricated, gloved finger into your rectum. The examiner can feel your prostate through the rectal wall. He or she will check for hard or lumpy areas.

Q: What does PSAmean?

A: PSA stands for “prostate-specific antigen.” The PSA test measures the levels of PSA in the blood.  PSA is produced by prostate tissue, whether it’s normal or cancerous. The level of PSA in the blood may rise in men who have prostate cancer, BPH (an enlargement of the prostate), or an infection in the prostate. The function of PSA is not yet fully understood, but it doesn’t seem to cause harm even when the blood level is very high. PSA does not cause the cancer to grow or spread. A doctor cannot diagnose prostate cancer with the PSA test alone, since elevated PSA level may also indicate other, noncancerous problems. However, the doctor will take the results of the PSA test into account when deciding whether to check for further for signs of cancer.

Q: What are considered normal PSA levels?

A: A normal test range is from 0 to 4 ng/mL. This range changes with age and race. When a man gets older, the normal range increases. A result of 4 is generally considered normal. Test results between 4 to 10 ng/mL are of concern, and suggest that further tests, such as a biopsy of the prostate, may be needed. Since PSA is a screening tool, it cannot tell the difference between cancer and other diseases of the prostate.   However, a prostate biopsy can help tell the difference between cancer and other diseases of the prostate.

Q: What is a prostate biopsy?

A: A biopsy is a sample of tissue that is looked at under a microscope for cancer cells. Your urologist can take tissue samples from your prostate right in his or her office. Most of the time, the doctor performs the biopsy by inserting a needle through the perineum into the prostate. The perineum is the area between the rectum and the testicles. The doctor usually uses a rectal ultrasound to help guide the needle into the prostate. To get a good tissue sampling, the doctor takes 6 to 12 needle biopsies at the same time.

Q: What is staging?

A: Staging is the process of finding out how far a cancer has spread in the body. Staging involves several types of tests to see if the cancer can be detected beyond the prostate gland. It can spread to tissue nearby or to other organs further away. A doctor may use blood tests, X-rays, CT scans, and nuclear medicine scans to help determine the cancer’s stage.

Q: What is the Gleason score?

A: The Gleason score is the most common system for grading prostate cancer. The pathologist looks at the biopsy specimen under a microscope. That allows him or her to determine the grade. Cancerous tissue that looks similar to the normal prostate is given a low grade. Abnormal, fast-growing tissue is given a high grade. The pathologist reports a final Gleason score between 2 and 10. Prostate cancers with low scores are less likely to spread to other organs than those with high scores.

Q: What parts of the body can prostate cancer spread to?

A: Prostate cancer can spread and form tumors in other parts of the body. When prostate cancer spreads, it often shows up in nearby lymph nodes. It can also spread to the bones, liver, bladder, and other organs.

Q: How is prostate cancer treated?

A: Not all men with prostate cancer need treatment. For those who do, there are a number of available treatments, including surgery, external radiation therapy, brachytherapy, and hormone therapy. The doctor suggests a treatment plan to fit each man’s needs based on the cancer’s stage, the man’s age, general health, and his feelings about the treatments and their possible side effects. A doctor will also be able to discuss the option of the patient taking part in a research study or clinical trial.

Q: What is watchful waiting?

A: There are times when it is in the man’s best interest not to treat the prostate cancer. In those cases, the doctor may suggest watchful waiting. That means following the patient closely and treating him for symptoms that may arise. For older men whose prostate cancer is slow growing and found at an early stage, the possible side effects and risks of treatment may outweigh its possible benefits. Watchful waiting is a method of treatment and should not be considered “doing nothing.”

Q: Should everyone get a second opinion?

A: Many people with cancer get a second opinion from another doctor. There are many reasons to get a second opinion. Here are some of those reasons:

• Not feeling comfortable with the treatment decision

• Being diagnosed with a rare type of cancer

• Having several options for how to treat the cancer

• Not being able to see a cancer expert

Q: How can someone get a second opinion?

A: There are many ways to get a second opinion:

• Ask a primary care doctor. A person’s doctor may be able to suggest a specialist. This may be as a surgeon, medical oncologist, or radiation oncologist. Sometimes, these doctors work together at cancer centers or hospitals. Do not be afraid to ask your doctor about a second opinion.

• Call the National Cancer Institute’s Cancer Information Service. The number is 1-800-4-CANCER (1-800-422-6237). They have information about treatment facilities. These include cancer centers and other programs supported by the National Cancer Institute.

• Consult The Official ABMS Directory of Board Certified Medical Specialists. This reference book lists doctors by state. It gives their specialty, background, and training. It is available at most public libraries. You can also view it online at www.abms.org.

• Seek other options. Check with a local medical society, a nearby hospital or medical school, or cancer advocacy group to get names of doctors who can give you a second opinion. Or ask other people who have had cancer to refer you to someone. 

Q: What is a prostatectomy?

A: A prostatectomy is surgery that removes all or part of the prostate. Surgery to remove the entire prostate is called radical prostatectomy. It’s done in one of three ways:

• In retropubic prostatectomy, the surgeon removes the prostate and nearby lymph nodes through an incision in the abdomen.

• In perineal prostatectomy, the surgeon removes the prostate through an incision between the scrotum and the anus. The doctor may also remove nearby lymph nodes through a separate incision in the abdomen.

• A surgeon does a laparoscopic prostatectomy through a small incision in the abdomen and with a small scope. Only the prostate can be removed with this procedure.

Q: Is incontinence or dribbling of urine a long-term side effect of prostate surgery?

A: Unfortunately, it may take time for some men to regain control of their bladder after surgery for prostate cancer. As healing continues, incidences of incontinence or dribbling usually decrease. Exercises to build muscle strength should help lessen the problem and may make it go away completely.

Q: How will prostate cancer surgery affect me sexually?

A: Impotence is not being able to have an erection. It’s the most common side effect of prostate cancer surgery. A technique called nerve-sparing surgery can prevent permanent injury to the nerves that control erection. After this surgery, it may take up to two years for a man to regain the ability to have an erection. If the nerves connected to the tissue that controls erection have to be removed, permanent impotence will result.

Q: What options are available for men who suffer from impotence as a result of prostate cancer surgery?

A: Alternatives exist for those who have impotence due to surgery for prostate cancer. Different prostheses have been developed that can be implanted to aid in the return to normal sexual function. Doctors usually recommend waiting at least six months after the surgery to see if sexual function will return on its own before getting an implant.

Q: Does a prostatectomy cause sterility?

A: Yes. Sterility is the inability to father a child. It results from the removal of the prostate. The prostate gland helps create most of the fluid released during sexual intercourse and climax. Therefore, men who have a prostatectomy no longer produce semen, so they have dry orgasms. This means that they cannot impregnate a woman.

Q: How can prostate cancer spread if my doctor “got it all” with surgery or radiation therapy?

A: Even the best treatment for prostate cancer may not remove or kill every last cancer cell in the body. Staging studies are done as part of the initial treatment planning to see if the cancer has spread or not. But it’s important to remember that the best scans and X-rays can’t look into the body like a microscope. Sometimes a few cells have escaped to other parts of the body, even if they can’t be detected. These cells may grow over months or years to cause problems later. The doctor uses the tumor grade and staging tests to estimate how likely this is to happen for each patient.

Q: What is brachytherapy for prostate cancer?

A: Brachytherapy is a form of internal radiation therapy. For it, a doctor implants radioactive pellets or seeds in the prostate. The seeds kill cancer cells. Patients selected for brachytherapy usually have a lower Gleason score, lower PSA levels, and tumors that have not spread to other parts of the body.

Q: What is hormone therapy for prostate cancer?

A: Hormone therapy blocks the prostate cancer cells from getting the male hormones, including testosterone, they need to grow. When a man has hormone therapy, the level of testosterone is decreased. This drop in testosterone can affect all prostate cancer cells, even if they have spread to other parts of the body. There are several forms of hormone therapy. One is surgery to remove the testicles. Another is taking hormones to prevent the testicles from producing testosterone. In another form, patients take the female hormone estrogen to stop the testicles from producing testosterone. This is used less often than other hormones because of side effects.

Q: Are there support groups for men with prostate cancer?

A: Yes. Support groups specifically for men dealing with prostate cancer are held all over the United States . Having someone to talk with who is going through similar experiences is often helpful. Support groups also offer patients information on treatment options, prognosis, and follow-up care. Your doctor can recommend one in your area.