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Prostate Cancer Treatment (PDQ)

General Information About Prostate Cancer
KEY POINTS
Prostatecancerisadiseaseinwhichmalignant(cancer)cellsforminthetissuesoftheprostate.
Signsofprostatecancerincludeaweakflowofurineorfrequenturination.
Teststhatexaminetheprostateandbloodareusedtodetect(find)anddiagnoseprostatecancer.
Certainfactorsaffectprognosis(chanceofrecovery)andtreatmentoptions.

Prostate cancer is a disease in which malignant (cancer) cells form in the

tissues of the prostate.
Theprostateisaglandinthemalereproductivesystem.Itliesjustbelowthebladder(theorganthatcollectsand
emptiesurine)andinfrontoftherectum(thelowerpartoftheintestine).Itisaboutthesizeofawalnutandsurrounds
partoftheurethra(thetubethatemptiesurinefromthebladder).Theprostateglandmakesfluidthatispartofthe
semen.

Anatomyofthemalereproductiveandurinarysystems,showingtheprostate,testicles,bladder,
andotherorgans.

Prostatecancerisfoundmainlyinoldermen.IntheU.S.,about1outof5menwillbediagnosedwithprostatecancer.

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

urination.
Theseandothersignsandsymptomsmaybecausedbyprostatecancerorbyotherconditions.Checkwithyourdoctor
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ifyouhaveanyofthefollowing:

Weakorinterrupted("stop-and-go")flowofurine.
Suddenurgetourinate.
Frequenturination(especiallyatnight).
Troublestartingtheflowofurine.
Troubleemptyingthebladdercompletely.
Painorburningwhileurinating.
Bloodintheurineorsemen.
Apainintheback,hips,orpelvisthatdoesn'tgoaway.
Shortnessofbreath,feelingverytired,fastheartbeat,dizziness,orpaleskincausedbyanemia.
Otherconditionsmaycausethesamesymptoms.Asmenage,theprostatemaygetbiggerandblocktheurethraor
bladder.Thismaycausetroubleurinatingorsexualproblems.Theconditioniscalledbenignprostatichyperplasia
(BPH),andalthoughitisnotcancer,surgerymaybeneeded.Thesymptomsofbenignprostatichyperplasiaorofother
problemsintheprostatemaybelikesymptomsofprostatecancer.

Normalprostateandbenignprostatichyperplasia(BPH).Anormalprostatedoesnotblockthe
flowofurinefromthebladder.Anenlargedprostatepressesonthebladderandurethraand
blockstheflowofurine.

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

Physicalexamandhistory:Anexamofthebodytocheckgeneralsignsofhealth,includingcheckingforsignsof
disease,suchaslumpsoranythingelsethatseemsunusual.Ahistoryofthepatientshealthhabitsandpast
illnessesandtreatmentswillalsobetaken.

Digitalrectalexam(DRE):Anexamoftherectum.Thedoctorornurseinsertsalubricated,glovedfingerintothe
rectumandfeelstheprostatethroughtherectalwallforlumpsorabnormalareas.

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Digitalrectalexam(DRE).Thedoctorinsertsagloved,lubricatedfingerintotherectumand
feelstheprostatetocheckforanythingabnormal.

Prostate-specificantigen(PSA)test:AtestthatmeasuresthelevelofPSAintheblood.PSAisasubstancemade
bytheprostatethatmaybefoundinanincreasedamountinthebloodofmenwhohaveprostatecancer.PSA
levelsmayalsobehighinmenwhohaveaninfectionorinflammationoftheprostateorBPH(anenlarged,but
noncancerous,prostate).

Transrectalultrasound:Aprocedureinwhichaprobethatisaboutthesizeofafingerisinsertedintotherectum
tochecktheprostate.Theprobeisusedtobouncehigh-energysoundwaves(ultrasound)offinternaltissuesor
organsandmakeechoes.Theechoesformapictureofbodytissuescalledasonogram.Transrectalultrasound
maybeusedduringabiopsyprocedure.

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Transrectalultrasound.Anultrasoundprobeisinsertedintotherectumtochecktheprostate.
Theprobebouncessoundwavesoffbodytissuestomakeechoesthatformasonogram
(computerpicture)oftheprostate.

Transrectalmagneticresonanceimaging(MRI):Aprocedurethatusesastrongmagnet,radiowaves,anda
computertomakeaseriesofdetailedpicturesofareasinsidethebody.Aprobethatgivesoffradiowavesis
insertedintotherectumneartheprostate.ThishelpstheMRImachinemakeclearerpicturesoftheprostateand
nearbytissue.AtransrectalMRIisdonetofindoutifthecancerhasspreadoutsidetheprostateintonearby
tissues.Thisprocedureisalsocallednuclearmagneticresonanceimaging(NMRI).

Biopsy:Theremovalofcellsortissuessotheycanbeviewedunderamicroscopebyapathologist.Thepathologist
willcheckthetissuesampletoseeiftherearecancercellsandfindouttheGleasonscore.TheGleasonscore
rangesfrom2-10anddescribeshowlikelyitisthatatumorwillspread.Thelowerthenumber,thelesslikelythe
tumoristospread.
Atransrectalbiopsyisusedtodiagnoseprostatecancer.Atransrectalbiopsyistheremovaloftissuefromthe
prostatebyinsertingathinneedlethroughtherectumandintotheprostate.Thisprocedureisusuallydoneusing
transrectalultrasoundtohelpguidewheresamplesoftissuearetakenfrom.Apathologistviewsthetissueundera
microscopetolookforcancercells.

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Transrectalbiopsy.Anultrasoundprobeisinsertedintotherectumtoshowwherethetumor
is.Thenaneedleisinsertedthroughtherectumintotheprostatetoremovetissuefromthe
prostate.

Certain factors affect prognosis (chance of recovery) and treatment

options.
Theprognosis(chanceofrecovery)andtreatmentoptionsdependonthefollowing:

Thestageofthecancer(levelofPSA,Gleasonscore,gradeofthetumor,howmuchoftheprostateisaffectedby
thecancer,andwhetherthecancerhasspreadtootherplacesinthebody).

Thepatientsage.
Whetherthecancerhasjustbeendiagnosedorhasrecurred(comeback).
Treatmentoptionsalsomaydependonthefollowing:

Whetherthepatienthasotherhealthproblems.
Theexpectedsideeffectsoftreatment.
Pasttreatmentforprostatecancer.
Thewishesofthepatient.
Mostmendiagnosedwithprostatecancerdonotdieofit.

Stages of Prostate Cancer

KEY POINTS
Afterprostatecancerhasbeendiagnosed,testsaredonetofindoutifcancercellshavespreadwithintheprostate
ortootherpartsofthebody.

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Therearethreewaysthatcancerspreadsinthebody.
Cancermayspreadfromwhereitbegantootherpartsofthebody.
Thefollowingstagesareusedforprostatecancer:
StageI
StageII
StageIII
StageIV

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.
Theprocessusedtofindoutifcancerhasspreadwithintheprostateortootherpartsofthebodyiscalledstaging.The
informationgatheredfromthestagingprocessdeterminesthestageofthedisease.Itisimportanttoknowthestage
inordertoplantreatment.Theresultsofthetestsusedtodiagnoseprostatecancerareoftenalsousedtostagethe
disease.(SeetheGeneralInformationsection.)Inprostatecancer,stagingtestsmaynotbedoneunlessthepatient
hassymptomsorsignsthatthecancerhasspread,suchasbonepain,ahighPSAlevel,orahighGleasonscore.
Thefollowingtestsandproceduresalsomaybeusedinthestagingprocess:

Bonescan:Aproceduretocheckiftherearerapidlydividingcells,suchascancercells,inthebone.Averysmall
amountofradioactivematerialisinjectedintoaveinandtravelsthroughthebloodstream.Theradioactive
materialcollectsinthebonesandisdetectedbyascanner.

Bonescan.Asmallamountofradioactivematerialisinjectedintothepatient'sbloodstream
andcollectsinabnormalcellsinthebones.Asthepatientliesonatablethatslidesunderthe
scanner,theradioactivematerialisdetectedandimagesaremadeonacomputerscreenor
film.

MRI(magneticresonanceimaging):Aprocedurethatusesamagnet,radiowaves,andacomputertomakea
seriesofdetailedpicturesofareasinsidethebody.Thisprocedureisalsocallednuclearmagneticresonance
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imaging(NMRI).

CTscan(CATscan):Aprocedurethatmakesaseriesofdetailedpicturesofareasinsidethebody,takenfrom
differentangles.Thepicturesaremadebyacomputerlinkedtoanx-raymachine.Adyemaybeinjectedintoa
veinorswallowedtohelptheorgansortissuesshowupmoreclearly.Thisprocedureisalsocalledcomputed
tomography,computerizedtomography,orcomputerizedaxialtomography.

Pelviclymphadenectomy:Asurgicalproceduretoremovethelymphnodesinthepelvis.Apathologistviewsthe
tissueunderamicroscopetolookforcancercells.

Seminalvesiclebiopsy:Theremovaloffluidfromtheseminalvesicles(glandsthatmakesemen)usinganeedle.
Apathologistviewsthefluidunderamicroscopetolookforcancercells.

ProstaScintscan:Aproceduretocheckforcancerthathasspreadfromtheprostatetootherpartsofthebody,
suchasthelymphnodes.Averysmallamountofradioactivematerialisinjectedintoaveinandtravelsthroughthe
bloodstream.Theradioactivematerialattachestoprostatecancercellsandisdetectedbyascanner.The
radioactivematerialshowsupasabrightspotonthepictureinareaswheretherearealotofprostatecancercells.
Thestageofthecancerisbasedontheresultsofthestaginganddiagnostictests,includingtheprostate-specific
antigen(PSA)testandtheGleasonscore.Thetissuesamplesremovedduringthebiopsyareusedtofindoutthe
Gleasonscore.TheGleasonscorerangesfrom2-10anddescribeshowdifferentthecancercellslookfromnormalcells
andhowlikelyitisthatthetumorwillspread.Thelowerthenumber,thelesslikelythetumoristospread.

There are three ways that cancer spreads in the body.

Cancercanspreadthroughtissue,thelymphsystem,andtheblood:

Tissue.Thecancerspreadsfromwhereitbeganbygrowingintonearbyareas.
Lymphsystem.Thecancerspreadsfromwhereitbeganbygettingintothelymphsystem.Thecancertravels
throughthelymphvesselstootherpartsofthebody.

Blood.Thecancerspreadsfromwhereitbeganbygettingintotheblood.Thecancertravelsthroughtheblood
vesselstootherpartsofthebody.

Cancer may spread from where it began to other parts of the body.
Whencancerspreadstoanotherpartofthebody,itiscalledmetastasis.Cancercellsbreakawayfromwherethey
began(theprimarytumor)andtravelthroughthelymphsystemorblood.

Lymphsystem.Thecancergetsintothelymphsystem,travelsthroughthelymphvessels,andformsatumor
(metastatictumor)inanotherpartofthebody.

Blood.Thecancergetsintotheblood,travelsthroughthebloodvessels,andformsatumor(metastatictumor)in
anotherpartofthebody.
Themetastatictumoristhesametypeofcancerastheprimarytumor.Forexample,ifprostatecancerspreadstothe
bone,thecancercellsintheboneareactuallyprostatecancercells.Thediseaseismetastaticprostatecancer,notbone
cancer.
Denosumab,amonoclonalantibody,maybeusedtopreventbonemetastases.

The following stages are used for prostate cancer:

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AsprostatecancerprogressesfromStageItoStageIV,thecancercellsgrowwithintheprostate,
throughtheouterlayeroftheprostateintonearbytissue,andthentolymphnodesorotherparts
ofthebody.

Stage I
InstageI,cancerisfoundintheprostateonly.Thecancer:

isfoundbyneedlebiopsy(doneforahighPSAlevel)orinasmallamountoftissueduringsurgeryforother
reasons(suchasbenignprostatichyperplasia).ThePSAlevelislowerthan10andtheGleasonscoreis6orlower;
or

isfoundinone-halforlessofonelobeoftheprostate.ThePSAlevelislowerthan10andtheGleasonscoreis6or
lower;or

cannotbefeltduringadigitalrectalexamandcannotbeseeninimagingtests.Cancerisfoundinone-halforless
ofonelobeoftheprostate.ThePSAlevelandtheGleasonscorearenotknown.

Stage II
InstageII,cancerismoreadvancedthaninstageI,buthasnotspreadoutsidetheprostate.StageIIisdividedinto
stagesIIAandIIB.
InstageIIA,cancer:

isfoundbyneedlebiopsy(doneforahighPSAlevel)orinasmallamountoftissueduringsurgeryforother
reasons(suchasbenignprostatichyperplasia).ThePSAlevelislowerthan20andtheGleasonscoreis7;or
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isfoundbyneedlebiopsy(doneforahighPSAlevel)orinasmallamountoftissueduringsurgeryforother

reasons(suchasbenignprostatichyperplasia).ThePSAlevelisatleast10butlowerthan20andtheGleasonscore
is6orlower;or

isfoundinone-halforlessofonelobeoftheprostate.ThePSAlevelisatleast10butlowerthan20andthe
Gleasonscoreis6orlower;or

isfoundinone-halforlessofonelobeoftheprostate.ThePSAlevelislowerthan20andtheGleasonscoreis7;or
isfoundinmorethanone-halfofonelobeoftheprostate.
InstageIIB,cancer:

isfoundinoppositesidesoftheprostate.ThePSAcanbeanylevelandtheGleasonscorecanrangefrom2to10;
or

cannotbefeltduringadigitalrectalexamandcannotbeseeninimagingtests.ThePSAlevelis20orhigherand
theGleasonscorecanrangefrom2to10;or

cannotbefeltduringadigitalrectalexamandcannotbeseeninimagingtests.ThePSAcanbeanylevelandthe
Gleasonscoreis8orhigher.

Stage III
InstageIII,cancerhasspreadbeyondtheouterlayeroftheprostateandmayhavespreadtotheseminalvesicles.The
PSAcanbeanylevelandtheGleasonscorecanrangefrom2to10.

Stage IV
InstageIV,thePSAcanbeanylevelandtheGleasonscorecanrangefrom2to10.Also,cancer:

hasspreadbeyondtheseminalvesiclestonearbytissueororgans,suchastherectum,bladder,orpelvicwall;or
mayhavespreadtotheseminalvesiclesortonearbytissueororgans,suchastherectum,bladder,orpelvicwall.
Cancerhasspreadtonearbylymphnodes;or

hasspreadtodistantpartsofthebody,whichmayincludelymphnodesorbones.Prostatecanceroftenspreadsto
thebones.

Recurrent Prostate Cancer

Recurrentprostatecanceriscancerthathasrecurred(comeback)afterithasbeentreated.Thecancermaycomeback
intheprostateorinotherpartsofthebody.

Treatment Option Overview

KEY POINTS
Therearedifferenttypesoftreatmentforpatientswithprostatecancer.
Seventypesofstandardtreatmentareused:
Watchfulwaitingoractivesurveillance
Surgery
Radiationtherapyandradiopharmaceuticaltherapy
Hormonetherapy
Chemotherapy
Biologictherapy
Bisphosphonatetherapy
Therearetreatmentsforbonepaincausedbybonemetastasesorhormonetherapy.

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Newtypesoftreatmentarebeingtestedinclinicaltrials.
Cryosurgery
High-intensityfocusedultrasound
Protonbeamradiationtherapy
Patientsmaywanttothinkabouttakingpartinaclinicaltrial.
Patientscanenterclinicaltrialsbefore,during,orafterstartingtheircancertreatment.
Follow-uptestsmaybeneeded.

There are different types of treatment for patients with prostate cancer.
Differenttypesoftreatmentareavailableforpatientswithprostatecancer.Sometreatmentsarestandard(the
currentlyusedtreatment),andsomearebeingtestedinclinicaltrials.Atreatmentclinicaltrialisaresearchstudy
meanttohelpimprovecurrenttreatmentsorobtaininformationonnewtreatmentsforpatientswithcancer.When
clinicaltrialsshowthatanewtreatmentisbetterthanthestandardtreatment,thenewtreatmentmaybecomethe
standardtreatment.Patientsmaywanttothinkabouttakingpartinaclinicaltrial.Someclinicaltrialsareopenonlyto
patientswhohavenotstartedtreatment.

Seven types of standard treatment are used:

Watchful waiting or active surveillance
Watchfulwaitingandactivesurveillancearetreatmentsusedforoldermenwhodonothavesignsorsymptomsor
haveothermedicalconditionsandformenwhoseprostatecancerisfoundduringascreeningtest.
Watchfulwaitingiscloselymonitoringapatientsconditionwithoutgivinganytreatmentuntilsignsorsymptoms
appearorchange.Treatmentisgiventorelievesymptomsandimprovequalityoflife.
Activesurveillanceiscloselyfollowingapatient'sconditionwithoutgivinganytreatmentunlesstherearechangesin
testresults.Itisusedtofindearlysignsthattheconditionisgettingworse.Inactivesurveillance,patientsaregiven
certainexamsandtests,includingdigitalrectalexam,PSAtest,transrectalultrasound,andtransrectalneedlebiopsy,to
checkifthecancerisgrowing.Whenthecancerbeginstogrow,treatmentisgiventocurethecancer.
Othertermsthatareusedtodescribenotgivingtreatmenttocureprostatecancerrightafterdiagnosisare
observation,watchandwait,andexpectantmanagement.

Surgery
Patientsingoodhealthwhosetumorisintheprostateglandonlymaybetreatedwithsurgerytoremovethetumor.
Thefollowingtypesofsurgeryareused:

Radicalprostatectomy:Asurgicalproceduretoremovetheprostate,surroundingtissue,andseminalvesicles.
Therearetwotypesofradicalprostatectomy:

Retropubicprostatectomy:Asurgicalproceduretoremovetheprostatethroughanincision(cut)inthe
abdominalwall.Removalofnearbylymphnodesmaybedoneatthesametime.

Perinealprostatectomy:Asurgicalproceduretoremovetheprostatethroughanincision(cut)madeinthe
perineum(areabetweenthescrotumandanus).Nearbylymphnodesmayalsoberemovedthrougha
separateincisionintheabdomen.

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Twotypesofradicalprostatectomy.Inaretropubicprostatectomy,theprostateisremoved
throughanincisioninthewalloftheabdomen.Inaperinealprostatectomy,theprostateis
removedthroughanincisionintheareabetweenthescrotumandtheanus.

Pelviclymphadenectomy:Asurgicalproceduretoremovethelymphnodesinthepelvis.Apathologistviewsthe
tissueunderamicroscopetolookforcancercells.Ifthelymphnodescontaincancer,thedoctorwillnotremove
theprostateandmayrecommendothertreatment.

Transurethralresectionoftheprostate(TURP):Asurgicalproceduretoremovetissuefromtheprostateusinga
resectoscope(athin,lightedtubewithacuttingtool)insertedthroughtheurethra.Thisprocedureisdonetotreat
benignprostatichypertrophyanditissometimesdonetorelievesymptomscausedbyatumorbeforeother
cancertreatmentisgiven.TURPmayalsobedoneinmenwhosetumorisintheprostateonlyandwhocannot
havearadicalprostatectomy.

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Transurethralresectionoftheprostate(TURP).Tissueisremovedfromtheprostateusinga
resectoscope(athin,lightedtubewithacuttingtoolattheend)insertedthroughtheurethra.
Prostatetissuethatisblockingtheurethraiscutawayandremovedthroughthe
resectoscope.

Insomecases,nerve-sparingsurgerycanbedone.Thistypeofsurgerymaysavethenervesthatcontrolerection.
However,menwithlargetumorsortumorsthatareveryclosetothenervesmaynotbeabletohavethissurgery.
Possibleproblemsafterprostatecancersurgeryincludethefollowing:

Impotence.
Leakageofurinefromthebladderorstoolfromtherectum.
Shorteningofthepenis(1to2centimeters).Theexactreasonforthisisnotknown.
Inguinalhernia(bulgingoffatorpartofthesmallintestinethroughweakmusclesintothegroin).Inguinalhernia
mayoccurmoreofteninmentreatedwithradicalprostatectomythaninmenwhohavesomeothertypesof
prostatesurgery,radiationtherapy,orprostatebiopsyalone.Itismostlikelytooccurwithinthefirst2yearsafter
radicalprostatectomy.

Radiation therapy and radiopharmaceutical therapy

Radiationtherapyisacancertreatmentthatuseshigh-energyx-raysorothertypesofradiationtokillcancercellsor
keepthemfromgrowing.Therearedifferenttypesofradiationtherapy:

Externalradiationtherapyusesamachineoutsidethebodytosendradiationtowardthecancer.Conformal
radiationisatypeofexternalradiationtherapythatusesacomputertocreatea3-dimensional(3-D)pictureofthe
tumor.Theradiationbeamsareshapedtofitthetumor.

Internalradiationtherapyusesaradioactivesubstancesealedinneedles,seeds,wires,orcathetersthatareplaced
directlyintoornearthecancer.Inearly-stageprostatecancer,theradioactiveseedsareplacedintheprostate
usingneedlesthatareinsertedthroughtheskinbetweenthescrotumandrectum.Theplacementofthe
radioactiveseedsintheprostateisguidedbyimagesfromtransrectalultrasoundorcomputedtomography(CT).
Theneedlesareremovedaftertheradioactiveseedsareplacedintheprostate.

Radiopharmaceuticaltherapyusesaradioactivesubstancetotreatcancer.Radiopharmaceuticaltherapyincludes
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thefollowing:

Alphaemitterradiationtherapyusesaradioactivesubstancetotreatprostatecancerthathasspreadtothe
bone.Aradioactivesubstancecalledradium-223isinjectedintoaveinandtravelsthroughthebloodstream.
Theradium-223collectsinareasofbonewithcancerandkillsthecancercells.
Thewaytheradiationtherapyisgivendependsonthetypeandstageofthecancerbeingtreated.
Mentreatedwithradiationtherapyforprostatecancerhaveanincreasedriskofhavingbladderand/orgastrointestinal
cancer.
Radiationtherapycancauseimpotenceandurinaryproblems.

Hormone therapy
Hormonetherapyisacancertreatmentthatremoveshormonesorblockstheiractionandstopscancercellsfrom
growing.Hormonesaresubstancesmadebyglandsinthebodyandcirculatedinthebloodstream.Inprostatecancer,
malesexhormonescancauseprostatecancertogrow.Drugs,surgery,orotherhormonesareusedtoreducethe
amountofmalehormonesorblockthemfromworking.
Hormonetherapyforprostatecancermayincludethefollowing:

Luteinizinghormone-releasinghormoneagonistscanstopthetesticlesfrommakingtestosterone.Examplesare
leuprolide,goserelin,andbuserelin.

Antiandrogenscanblocktheactionofandrogens(hormonesthatpromotemalesexcharacteristics),suchas
testosterone.Examplesareflutamide,bicalutamide,enzalutamide,andnilutamide.

Drugsthatcanpreventtheadrenalglandsfrommakingandrogensincludeketoconazoleandaminoglutethimide.
Orchiectomyisasurgicalproceduretoremoveoneorbothtesticles,themainsourceofmalehormones,suchas
testosterone,todecreasetheamountofhormonebeingmade.

Estrogens(hormonesthatpromotefemalesexcharacteristics)canpreventthetesticlesfrommakingtestosterone.
However,estrogensareseldomusedtodayinthetreatmentofprostatecancerbecauseoftheriskofseriousside
effects.
Hotflashes,impairedsexualfunction,lossofdesireforsex,andweakenedbonesmayoccurinmentreatedwith
hormonetherapy.Othersideeffectsincludediarrhea,nausea,anditching.
SeeDrugsApprovedforProstateCancerformoreinformation.

Chemotherapy
Chemotherapyisacancertreatmentthatusesdrugstostopthegrowthofcancercells,eitherbykillingthecellsorby
stoppingthemfromdividing.Whenchemotherapyistakenbymouthorinjectedintoaveinormuscle,thedrugsenter
thebloodstreamandcanreachcancercellsthroughoutthebody(systemicchemotherapy).Whenchemotherapyis
placeddirectlyintothecerebrospinalfluid,anorgan,orabodycavitysuchastheabdomen,thedrugsmainlyaffect
cancercellsinthoseareas(regionalchemotherapy).Thewaythechemotherapyisgivendependsonthetypeand
stageofthecancerbeingtreated.
SeeDrugsApprovedforProstateCancerformoreinformation.

Biologic therapy
Biologictherapyisatreatmentthatusesthepatientsimmunesystemtofightcancer.Substancesmadebythebodyor
madeinalaboratoryareusedtoboost,direct,orrestorethebodysnaturaldefensesagainstcancer.Sipuleucel-Tisa
typeofbiologictherapyusedtotreatprostatecancerthathasmetastasized(spreadtootherpartsofthebody).
SeeDrugsApprovedforProstateCancerformoreinformation.

Bisphosphonate therapy
Bisphosphonatedrugs,suchasclodronateorzoledronate,reducebonediseasewhencancerhasspreadtothebone.
Menwhoaretreatedwithantiandrogentherapyororchiectomyareatanincreasedriskofboneloss.Inthesemen,
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bisphosphonatedrugslessentheriskofbonefracture(breaks).Theuseofbisphosphonatedrugstopreventorslow
thegrowthofbonemetastasesisbeingstudiedinclinicaltrials.

There are treatments for bone pain caused by bone metastases or

hormone therapy.
Prostatecancerthathasspreadtotheboneandcertaintypesofhormonetherapycanweakenbonesandleadtobone
pain.Treatmentsforbonepainincludethefollowing:

Painmedicine.
Externalradiationtherapy.
Strontium-89(aradioisotope).
Targetedtherapywithamonoclonalantibody,suchasdenosumab.
Bisphosphonatetherapy.
Corticosteroids.
SeethePDQsummaryonPainformoreinformation.

New types of treatment are being tested in clinical trials.

Thissummarysectiondescribestreatmentsthatarebeingstudiedinclinicaltrials.Itmaynotmentioneverynew
treatmentbeingstudied.InformationaboutclinicaltrialsisavailablefromtheNCIwebsite.

Cryosurgery
Cryosurgeryisatreatmentthatusesaninstrumenttofreezeanddestroyprostatecancercells.Ultrasoundisusedto
findtheareathatwillbetreated.Thistypeoftreatmentisalsocalledcryotherapy.
Cryosurgerycancauseimpotenceandleakageofurinefromthebladderorstoolfromtherectum.

High-intensity focused ultrasound

High-intensityfocusedultrasoundisatreatmentthatusesultrasound(high-energysoundwaves)todestroycancer
cells.Totreatprostatecancer,anendorectalprobeisusedtomakethesoundwaves.

Proton beam radiation therapy

Protonbeamradiationtherapyisatypeofhigh-energy,externalradiationtherapythattargetstumorswithstreamsof
protons(small,positivelychargedparticles).Thistypeofradiationtherapyisbeingstudiedinthetreatmentofprostate
cancer.

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

Forsomepatients,takingpartinaclinicaltrialmaybethebesttreatmentchoice.Clinicaltrialsarepartofthecancer
researchprocess.Clinicaltrialsaredonetofindoutifnewcancertreatmentsaresafeandeffectiveorbetterthanthe
standardtreatment.
Manyoftoday'sstandardtreatmentsforcancerarebasedonearlierclinicaltrials.Patientswhotakepartinaclinical
trialmayreceivethestandardtreatmentorbeamongthefirsttoreceiveanewtreatment.
Patientswhotakepartinclinicaltrialsalsohelpimprovethewaycancerwillbetreatedinthefuture.Evenwhenclinical
trialsdonotleadtoeffectivenewtreatments,theyoftenanswerimportantquestionsandhelpmoveresearchforward.

Patients can enter clinical trials before, during, or after starting their
cancer treatment.
Someclinicaltrialsonlyincludepatientswhohavenotyetreceivedtreatment.Othertrialstesttreatmentsforpatients
whosecancerhasnotgottenbetter.Therearealsoclinicaltrialsthattestnewwaystostopcancerfromrecurring
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(comingback)orreducethesideeffectsofcancertreatment.
Clinicaltrialsaretakingplaceinmanypartsofthecountry.SeetheTreatmentOptionssectionthatfollowsforlinksto
currenttreatmentclinicaltrials.ThesehavebeenretrievedfromNCI'slistingofclinicaltrials.

Follow-up tests may be needed.

Someoftheteststhatweredonetodiagnosethecancerortofindoutthestageofthecancermayberepeated.Some
testswillberepeatedinordertoseehowwellthetreatmentisworking.Decisionsaboutwhethertocontinue,change,
orstoptreatmentmaybebasedontheresultsofthesetests.
Someofthetestswillcontinuetobedonefromtimetotimeaftertreatmenthasended.Theresultsofthesetestscan
showifyourconditionhaschangedorifthecancerhasrecurred(comeback).Thesetestsaresometimescalledfollowuptestsorcheck-ups.

Treatment Options by Stage

Stage I Prostate Cancer
StandardtreatmentofstageIprostatecancermayincludethefollowing:

Watchfulwaiting.
Activesurveillance.Ifthecancerbeginstogrow,hormonetherapymaybegiven.
Radicalprostatectomy,usuallywithpelviclymphadenectomy.Radiationtherapymaybegivenaftersurgery.
External-beamradiationtherapy.Hormonetherapymaybegivenafterradiationtherapy.
Internalradiationtherapywithradioactiveseeds.
Aclinicaltrialofhigh-intensityfocusedultrasound.
Aclinicaltrialofcryosurgery.
CheckthelistofNCI-supportedcancerclinicaltrialsthatarenowacceptingpatientswithstageIprostatecancer.For
morespecificresults,refinethesearchbyusingothersearchfeatures,suchasthelocationofthetrial,thetypeof
treatment,orthenameofthedrug.Talkwithyourdoctoraboutclinicaltrialsthatmayberightforyou.General
informationaboutclinicaltrialsisavailablefromtheNCIwebsite.

Stage II Prostate Cancer

StandardtreatmentofstageIIprostatecancermayincludethefollowing:

Watchfulwaiting.
Activesurveillance.Ifthecancerbeginstogrow,hormonetherapymaybegiven.
Radicalprostatectomy,usuallywithpelviclymphadenectomy.Radiationtherapymaybegivenaftersurgery.
External-beamradiationtherapy.Hormonetherapymaybegivenafterradiationtherapy.
Internalradiationtherapywithradioactiveseeds.
Aclinicaltrialofcryosurgery.
Aclinicaltrialofhigh-intensityfocusedultrasound.
Aclinicaltrialofprotonbeamradiationtherapy.
Clinicaltrialsofnewtypesoftreatment,suchashormonetherapyfollowedbyradicalprostatectomy.
CheckthelistofNCI-supportedcancerclinicaltrialsthatarenowacceptingpatientswithstageIIprostatecancer.For
morespecificresults,refinethesearchbyusingothersearchfeatures,suchasthelocationofthetrial,thetypeof
treatment,orthenameofthedrug.Talkwithyourdoctoraboutclinicaltrialsthatmayberightforyou.General
informationaboutclinicaltrialsisavailablefromtheNCIwebsite.

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Stage III Prostate Cancer

StandardtreatmentofstageIIIprostatecancermayincludethefollowing:

External-beamradiationtherapy.Hormonetherapymaybegivenafterradiationtherapy.
Hormonetherapy.
Radicalprostatectomy.Radiationtherapymaybegivenaftersurgery.
Watchfulwaiting.
Activesurveillance.Ifthecancerbeginstogrow,hormonetherapymaybegiven.
Treatmenttocontrolcancerthatisintheprostateandlessenurinarysymptomsmayincludethefollowing:

External-beamradiationtherapy.
Internalradiationtherapywithradioactiveseeds.
Hormonetherapy.
Transurethralresectionoftheprostate(TURP).
Aclinicaltrialofnewtypesofradiationtherapy.
Aclinicaltrialofcryosurgery.
CheckthelistofNCI-supportedcancerclinicaltrialsthatarenowacceptingpatientswithstageIIIprostatecancer.For
morespecificresults,refinethesearchbyusingothersearchfeatures,suchasthelocationofthetrial,thetypeof
treatment,orthenameofthedrug.Talkwithyourdoctoraboutclinicaltrialsthatmayberightforyou.General
informationaboutclinicaltrialsisavailablefromtheNCIwebsite.

Stage IV Prostate Cancer

StandardtreatmentofstageIVprostatecancermayincludethefollowing:

Hormonetherapy.
Bisphosphonatetherapy.
External-beamradiationtherapy.Hormonetherapymaybegivenafterradiationtherapy.
Alphaemitterradiationtherapy.
Watchfulwaiting.
Activesurveillance.Ifthecancerbeginstogrow,hormonetherapymaybegiven.
Aclinicaltrialofradicalprostatectomywithorchiectomy.
Aclinicaltrialofhormonetherapycombinedwithchemotherapy.
Treatmenttocontrolcancerthatisintheprostateandlessenurinarysymptomsmayincludethefollowing:

Transurethralresectionoftheprostate(TURP).
Radiationtherapy.
CheckthelistofNCI-supportedcancerclinicaltrialsthatarenowacceptingpatientswithstageIVprostatecancer.For
morespecificresults,refinethesearchbyusingothersearchfeatures,suchasthelocationofthetrial,thetypeof
treatment,orthenameofthedrug.Talkwithyourdoctoraboutclinicaltrialsthatmayberightforyou.General
informationaboutclinicaltrialsisavailablefromtheNCIwebsite.

Treatment Options for Recurrent Prostate Cancer

Standardtreatmentofrecurrentprostatecancermayincludethefollowing:

Hormonetherapy.
Chemotherapyforpatientsalreadytreatedwithhormonetherapy.

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Biologictherapywithsipuleucel-Tforpatientsalreadytreatedwithhormonetherapy.
External-beamradiationtherapy.
Prostatectomyforpatientsalreadytreatedwithradiationtherapy.
Alphaemitterradiationtherapy.
CheckthelistofNCI-supportedcancerclinicaltrialsthatarenowacceptingpatientswithrecurrentprostatecancer.For
morespecificresults,refinethesearchbyusingothersearchfeatures,suchasthelocationofthetrial,thetypeof
treatment,orthenameofthedrug.Talkwithyourdoctoraboutclinicaltrialsthatmayberightforyou.General
informationaboutclinicaltrialsisavailablefromtheNCIwebsite.

To Learn More About Prostate Cancer

FormoreinformationfromtheNationalCancerInstituteaboutprostatecancer,seethefollowing:

ProstateCancerHomePage
WhatYouNeedtoKnowAboutProstateCancer
ProstateCancer,Nutrition,andDietarySupplements
ProstateCancerPrevention
ProstateCancerScreening
DrugsApprovedforProstateCancer
Prostate-SpecificAntigen(PSA)Test
HormoneTherapyforProstateCancer
TreatmentChoicesforMenwithEarly-StageProstateCancer
CryosurgeryinCancerTreatment:QuestionsandAnswers
ForgeneralcancerinformationandotherresourcesfromtheNationalCancerInstitute,seethefollowing:

CancerStaging
ChemotherapyandYou:SupportforPeopleWithCancer
RadiationTherapyandYou:SupportforPeopleWithCancer
CopingwithCancer
QuestionstoAskYourDoctoraboutCancer
ForSurvivorsandCaregivers

About This PDQ Summary

About PDQ
PhysicianDataQuery(PDQ)istheNationalCancerInstitute's(NCI's)comprehensivecancerinformationdatabase.The
PDQdatabasecontainssummariesofthelatestpublishedinformationoncancerprevention,detection,genetics,
treatment,supportivecare,andcomplementaryandalternativemedicine.Mostsummariescomeintwoversions.The
healthprofessionalversionshavedetailedinformationwrittenintechnicallanguage.Thepatientversionsarewritten
ineasy-to-understand,nontechnicallanguage.Bothversionshavecancerinformationthatisaccurateanduptodate
andmostversionsarealsoavailableinSpanish.
PDQisaserviceoftheNCI.TheNCIispartoftheNationalInstitutesofHealth(NIH).NIHisthefederalgovernments
centerofbiomedicalresearch.ThePDQsummariesarebasedonanindependentreviewofthemedicalliterature.They
arenotpolicystatementsoftheNCIortheNIH.

Purpose of This Summary

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ThisPDQcancerinformationsummaryhascurrentinformationaboutthetreatmentofprostatecancer.Itismeantto
informandhelppatients,families,andcaregivers.Itdoesnotgiveformalguidelinesorrecommendationsformaking
decisionsabouthealthcare.

Reviewers and Updates

EditorialBoardswritethePDQcancerinformationsummariesandkeepthemuptodate.TheseBoardsaremadeupof
expertsincancertreatmentandotherspecialtiesrelatedtocancer.Thesummariesarereviewedregularlyandchanges
aremadewhenthereisnewinformation.Thedateoneachsummary("DateLastModified")isthedateofthemost
recentchange.
Theinformationinthispatientsummarywastakenfromthehealthprofessionalversion,whichisreviewedregularly
andupdatedasneeded,bythePDQAdultTreatmentEditorialBoard.

Clinical Trial Information

Aclinicaltrialisastudytoanswerascientificquestion,suchaswhetheronetreatmentisbetterthananother.Trialsare
basedonpaststudiesandwhathasbeenlearnedinthelaboratory.Eachtrialanswerscertainscientificquestionsin
ordertofindnewandbetterwaystohelpcancerpatients.Duringtreatmentclinicaltrials,informationiscollected
abouttheeffectsofanewtreatmentandhowwellitworks.Ifaclinicaltrialshowsthatanewtreatmentisbetterthan
onecurrentlybeingused,thenewtreatmentmaybecome"standard."Patientsmaywanttothinkabouttakingpartin
aclinicaltrial.Someclinicaltrialsareopenonlytopatientswhohavenotstartedtreatment.
ClinicaltrialsarelistedinPDQandcanbefoundonlineatNCI'swebsite.Manycancerdoctorswhotakepartinclinical
trialsarealsolistedinPDQ.Formoreinformation,calltheCancerInformationService1-800-4-CANCER(1-800-4226237).

Permission to Use This Summary

PDQisaregisteredtrademark.ThecontentofPDQdocumentscanbeusedfreelyastext.Itcannotbeidentifiedasan
NCIPDQcancerinformationsummaryunlessthewholesummaryisshownanditisupdatedregularly.However,auser
wouldbeallowedtowriteasentencesuchasNCIsPDQcancerinformationsummaryaboutbreastcancerprevention
statestherisksinthefollowingway:[includeexcerptfromthesummary].
ThebestwaytocitethisPDQsummaryis:
NationalCancerInstitute:PDQProstateCancerTreatment.Bethesda,MD:NationalCancerInstitute.Datelast
modified<MM/DD/YYYY>.Availableat:http://www.cancer.gov/types/prostate/patient/prostate-treatment-pdq.
Accessed<MM/DD/YYYY>.
Imagesinthissummaryareusedwithpermissionoftheauthor(s),artist,and/orpublisherforuseinthePDQ
summariesonly.IfyouwanttouseanimagefromaPDQsummaryandyouarenotusingthewholesummary,you
mustgetpermissionfromtheowner.ItcannotbegivenbytheNationalCancerInstitute.Informationaboutusingthe
imagesinthissummary,alongwithmanyotherimagesrelatedtocancercanbefoundinVisualsOnline.VisualsOnline
isacollectionofmorethan2,000scientificimages.

Disclaimer
Theinformationinthesesummariesshouldnotbeusedtomakedecisionsaboutinsurancereimbursement.More
informationoninsurancecoverageisavailableonCancer.govontheManagingCancerCarepage.

Contact Us
MoreinformationaboutcontactingusorreceivinghelpwiththeCancer.govwebsitecanbefoundonourContactUs
forHelppage.QuestionscanalsobesubmittedtoCancer.govthroughthewebsitesE-mailUs.
Updated:July31,2015
Most text on the National Cancer Institute website may be reproduced or reused freely. The National Cancer Institute should
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be credited as the source. Please note that blog posts that are written by individuals from outside the government may be
owned by the writer, and graphics may be owned by their creator. In such cases, it is necessary to contact the writer, artist, or
publisher to obtain permission for reuse.

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