National Cancer Institute

What You Need 

To Know About TM 

Prostate 

Cancer 

U.S. DEPARTMENT OF 

HEALTH AND HUMAN SERVICES 

National Institutes of Health 
For more publications 

This is only one of many free booklets for 

people with cancer. 

Here’s how to get other National Cancer 

Institute (NCI) booklets: 

• Call the NCI’s Cancer Information Service 

at 1–800–4–CANCER (1–800–422–6237) 

• Go to the NCI’s Web site at 

http://www.cancer.gov/publications 

For materials in Spanish 

Here’s how to get NCI materials in Spanish: 

• Call the NCI’s Cancer Information Service 

at 1–800–422–6237 

• Go to the NCI’s Web site at 

http://www.cancer.gov/espanol 
Contents 

About This Booklet 1
 

The Prostate 2
 

Prostate Cancer Cells 2
 

Risk Factors 5
 

Symptoms 7
 

Detection and Diagnosis 8
 

Staging 12
 

Treatment 14
 

Second Opinion 28
 

Nutrition and Physical Activity 29
 

Follow-up Care 30
 

Sources of Support 31
 

Taking Part in Cancer Research 32
 

Dictionary 35
 

National Cancer Institute Information Resources 50
 

National Cancer Institute Publications 51
 

U.S. DEPARTMENT OF 

HEALTH AND HUMAN SERVICES 

National Institutes of Health 

National Cancer Institute 
About This Booklet 

This National Cancer Institute (NCI) booklet is 

about cancer* of the prostate. Each year, more than 

186,000 American men learn they have this disease. 

Prostate cancer is the second most common type of 

cancer among men in this country. Only skin cancer is 

more common. 

Learning about medical care for prostate cancer can 

help you take an active part in making choices about 

your care. This booklet tells about: 

•	 Diagnosis and staging 

•	 Treatment options 

•	 Tests you may have after treatment 

•	 Taking part in research studies 

This booklet has lists of questions that you may 

want to ask your doctor. Many people find it helpful to 

take a list of questions to a doctor visit. To help 

remember what your doctor says, you can take notes or 

ask whether you may use a tape recorder. You may also 

want to have a family member or friend go with you 

when you talk with the doctor—to take notes, ask 

questions, or just listen. 

For the latest information about prostate cancer, 

please visit our Web site at http://www.cancer.gov/ 

cancertopics/types/prostate. Or, contact our Cancer 

Information Service. We can answer your questions 

about cancer. We can also send you NCI booklets 

and fact sheets. Call 1–800–4–CANCER 

(1–800–422–6237) or instant message us through the 

LiveHelp service at http://www.cancer.gov/help. 

*Words in italics are in the Dictionary on page 35. The Dictionary 

explains these terms. It also shows how to pronounce them. 

1
 
The Prostate 

The prostate is part of a man’s reproductive system. 

It’s an organ located in front of the rectum and under 

the bladder. The prostate surrounds the urethra, the 

tube through which urine flows. 

A healthy prostate is about the size of a walnut. If 

the prostate grows too large, it squeezes the urethra. 

This may slow or stop the flow of urine from the 

bladder to the penis. 

The prostate is a gland. It makes part of the seminal 

fluid. During ejaculation, the seminal fluid helps carry 

sperm out of the man’s body as part of semen. 

Male hormones (androgens) make the prostate grow. 

The testicles are the main source of male hormones, 

including testosterone. The adrenal gland also makes 

testosterone, but in small amounts. 

Prostate Cancer Cells 

Cancer begins in cells, the building blocks that make 

up tissues. Tissues make up the organs of the body. 

Normal cells grow and divide to form new cells as 

the body needs them. When normal cells grow old or 

get damaged, they die, and new cells take their place. 

Sometimes, this process goes wrong. New cells 

form when the body doesn’t need them, and old or 

damaged cells don’t die as they should. The buildup of 

extra cells often forms a mass of tissue called a growth 

or tumor. 

2
 
This shows the prostate and nearby organs. 

This shows the inside of the prostate, 

urethra, rectum, and bladder. 

3
 
Prostate growths can be benign (not cancer) or 

malignant (cancer). 

Benign prostatic hyperplasia (BPH) is a 

benign growth of prostate cells. It is not cancer. 

The prostate grows larger and squeezes the 

urethra. This prevents the normal flow of urine. 

BPH is a very common problem. In the United 

States, most men over the age of 50 have 

symptoms of BPH. For some men, the symptoms 

may be severe enough to need treatment. 

To learn about BPH and other prostate changes 

that are not cancer, read NCI’s booklet 

Understanding Prostate Changes: A Health 

Guide for Men. 

Benign growths are not as harmful as malignant 

growths: 

•	 Benign growths (such as BPH): 

—are rarely a threat to life 

—can be removed and probably won’t grow back 

—don’t invade the tissues around them 

—don’t spread to other parts of the body 

•	 Malignant tumors: 

—may be a threat to life 

—often can be removed, but sometimes grow back 

—can invade and damage nearby tissues and organs 

—can spread to other parts of the body 

4
 
Cancer cells can spread by breaking away from the 

prostate tumor. They enter blood vessels or lymph 

vessels, which branch into all the tissues of the body. 

The cancer cells can attach to other tissues and grow to 

form new tumors that may damage those tissues. The 

spread of cancer is called metastasis. See the Staging 

section on page 12 for information about prostate 

cancer that has spread. 

Risk Factors 

When you’re told you have prostate cancer, it’s 

natural to wonder what may have caused the disease. 

But no one knows the exact causes of prostate cancer. 

Doctors seldom know why one man develops prostate 

cancer and another doesn’t. 

However, research has shown that men with certain 

risk factors are more likely than others to develop 

prostate cancer. A risk factor is something that may 

increase the chance of getting a disease. 

Studies have found the following risk factors for 

prostate cancer: 

•	 Age over 65: Age is the main risk factor for prostate 

cancer. The chance of getting prostate cancer 

increases as you get older. In the United States, most 

men with prostate cancer are over 65. This disease is 

rare in men under 45. 

•	 Family history: Your risk is higher if your father, 

brother, or son had prostate cancer. 

•	 Race: Prostate cancer is more common among black 

men than white or Hispanic/Latino men. It’s less 

common among Asian/Pacific Islander and 

American Indian/Alaska Native men. 

5
 
•	 Certain prostate changes: Men with cells called 

high-grade prostatic intraepithelial neoplasia (PIN) 

may be at increased risk of prostate cancer. These 

prostate cells look abnormal under a microscope. 

•	 Certain genome changes: Researchers have found 

specific regions on certain chromosomes that are 

linked to the risk of prostate cancer. According to 

recent studies, if a man has a genetic change in one 

or more of these regions, the risk of prostate cancer 

may be increased. The risk increases with the 

number of genetic changes that are found. Also, 

other studies have shown an elevated risk of prostate 

cancer among men with changes in certain genes, 

such as BRCA1 and BRCA2. 

Having a risk factor doesn’t mean that a man will 

develop prostate cancer. Most men who have risk 

factors never develop the disease. 

Many other possible risk factors are under study. For 

example, researchers have studied whether vasectomy 

(surgery to cut or tie off the tubes that carry sperm out 

of the testicles) may pose a risk, but most studies have 

found no increased risk. Also, most studies have shown 

that the chance of getting prostate cancer is not 

increased by tobacco or alcohol use, BPH, a sexually 

transmitted disease, obesity, a lack of exercise, or a diet 

high in animal fat or meat. Researchers continue to 

study these and other possible risk factors. 

Researchers are also studying how prostate cancer 

may be prevented. For example, they are studying the 

possible benefits of certain drugs, vitamin E, selenium, 

green tea extract, and other substances. These studies 

are with men who have not yet developed prostate 

cancer. 

6
 
Symptoms 

A man with prostate cancer may not have any 

symptoms. For men who do have symptoms, the 

common symptoms include: 

•	 Urinary problems 

—Not being able to pass urine 

—Having a hard time starting or stopping the urine 

flow 

—Needing to urinate often, especially at night 

—Weak flow of urine 

—Urine flow that starts and stops 

—Pain or burning during urination 

•	 Difficulty having an erection 

•	 Blood in the urine or semen 

•	 Frequent pain in the lower back, hips, or upper 

thighs 

Most often, these symptoms are not due to cancer. 

BPH, an infection, or another health problem may 

cause them. If you have any of these symptoms, you 

should tell your doctor so that problems can be 

diagnosed and treated. 

7
 
Detection and Diagnosis 

Your doctor can check for prostate cancer before 

you have any symptoms. During an office visit, your 

doctor will ask about your personal and family medical 

history. You’ll have a physical exam. You may also 

have one or both of the following tests: 

•	 Digital rectal exam: Your doctor inserts a 

lubricated, gloved finger into the rectum and feels 

your prostate through the rectal wall. Your prostate 

is checked for hard or lumpy areas. 

•	 Blood test for prostate-specific antigen (PSA): A 

lab checks the level of PSA in your blood sample. 

The prostate makes PSA. A high PSA level is commonly caused by BPH or prostatitis (inflammation 

of the prostate). Prostate cancer may also cause a 

high PSA level. See the NCI fact sheet The 

Prostate-Specific Antigen (PSA) Test: Questions 

and Answers. 

The digital rectal exam and PSA test are being studied 

in clinical trials to learn whether finding prostate 

cancer early can lower the number of deaths from this 

disease. 

The digital rectal exam and PSA test can detect a 

problem in the prostate. However, they can’t show 

whether the problem is cancer or a less serious 

condition. If you have abnormal test results, your 

doctor may suggest other tests to make a diagnosis. For 

example, your visit may include other lab tests, such as 

a urine test to check for blood or infection. Your doctor 

may order other procedures: 

8
 
•	 Transrectal ultrasound: The doctor inserts a probe 

into the rectum to check your prostate for abnormal 

areas. The probe sends out sound waves that people 

cannot hear (ultrasound). The waves bounce off the 

prostate. A computer uses the echoes to create a 

picture called a sonogram. 

•	 Transrectal biopsy: A biopsy is the removal of tissue 

to look for cancer cells. It’s the only sure way to 

diagnose prostate cancer. The doctor inserts needles 

through the rectum into the prostate. The doctor 

removes small tissue samples (called cores) from 

many areas of the prostate. Transrectal ultrasound is 

usually used to guide the insertion of the needles. A 

pathologist checks the tissue samples for cancer 

cells. 

9
 
You may want to ask the doctor these 

questions before having a transrectal ultrasound 

or biopsy: 

•	 Where will the procedure take place? Will I 

have to go to the hospital? 

•	 How long will it take? Will I be awake? 

•	 Will it hurt? Will I need local anesthesia? 

•	 What are the risks? What are the chances of 

infection or bleeding afterward? 

•	 How do I prepare for it? Will I need to avoid 

taking aspirin to reduce the chance of 

bleeding? Will I need an enema before the 

procedure? 

•	 How long will it take me to recover? Will I be 

given an antibiotic or other medicine 

afterward? 

•	 How soon will I know the results? If a biopsy 

is done, will I get a copy of the pathology 

report? 

•	 If I do have cancer, who will talk to me about 

the next steps? When? 

If Cancer Is Not Found 

If cancer cells are not found in the biopsy sample, 

ask your doctor how often you should have checkups. 

Information about BPH and other benign prostate 

problems can be found in the NCI booklet 

Understanding Prostate Changes: A Health Guide for 

Men. 

10
 
If Cancer Is Found 

If cancer cells are found, the pathologist studies 

tissue samples from the prostate under a microscope to 

report the grade of the tumor. The grade tells how 

much the tumor tissue differs from normal prostate 

tissue. It suggests how fast the tumor is likely to grow. 

Tumors with higher grades tend to grow faster than 

those with lower grades. They are also more likely to 

spread. Doctors use tumor grade along with your age 

and other factors to suggest treatment options. 

One system of grading is with the Gleason score. 

Gleason scores range from 2 to 10. To come up with 

the Gleason score, the pathologist uses a microscope to 

look at the patterns of cells in the prostate tissue. The 

most common pattern is given a grade of 1 (most like 

normal cells) to 5 (most abnormal). If there is a second 

most common pattern, the pathologist gives it a grade 

of 1 to 5, and adds the two most common grades 

together to make the Gleason score. If only one pattern 

is seen, the pathologist counts it twice. For example, 

5 + 5 = 10. A high Gleason score (such as 10) means a 

high-grade prostate tumor. High-grade tumors are more 

likely than low-grade tumors to grow quickly and 

spread. 

Another system of grading prostate cancer uses 

grades 1 through 4 (G1 to G4). G4 is more likely than 

G1, G2, or G3 to grow quickly and spread. 

For more about tumor grade, see the NCI fact sheet 

Tumor Grade: Questions and Answers. 

11
 
Staging 

If the biopsy shows that you have cancer, your 

doctor needs to learn the extent (stage) of the disease to 

help you choose the best treatment. Staging is a careful 

attempt to find out whether the tumor has invaded 

nearby tissues, whether the cancer has spread and, if 

so, to what parts of the body. 

Some men may need tests that make pictures of the 

body: 

•	 Bone scan: The doctor injects a small amount of a 

radioactive substance into a blood vessel. It travels 

through the bloodstream and collects in the bones. A 

machine called a scanner detects and measures the 

radiation. The scanner makes pictures of the bones 

on a computer screen or on film. The pictures may 

show cancer that has spread to the bones. 

•	 CT scan: An x-ray machine linked to a computer 

takes a series of detailed pictures of your pelvis or 

other parts of the body. Doctors use CT scans to 

look for prostate cancer that has spread to lymph 

nodes and other areas. You may receive contrast 

material by injection into a blood vessel in your arm 

or hand, or by enema. The contrast material makes 

abnormal areas easier to see. 

•	 MRI: A strong magnet linked to a computer is used 

to make detailed pictures of areas inside your body. 

The doctor can view these pictures on a monitor and 

can print them on film. An MRI can show whether 

cancer has spread to lymph nodes or other areas. 

Sometimes contrast material makes abnormal areas 

show up more clearly on the picture. 

12
 
When prostate cancer spreads, it’s often found in 

nearby lymph nodes. If cancer has reached these nodes, 

it also may have spread to other lymph nodes, the 

bones, or other organs. 

When cancer spreads from its original place to 

another part of the body, the new tumor has the same 

kind of abnormal cells and the same name as the 

primary tumor. For example, if prostate cancer spreads 

to bones, the cancer cells in the bones are actually 

prostate cancer cells. The disease is metastatic prostate 

cancer, not bone cancer. For that reason, it’s treated as 

prostate cancer, not bone cancer. Doctors call the new 

tumor “distant” or metastatic disease. 

These are the stages of prostate cancer: 

•	 Stage I: The cancer can’t be felt during a digital 

rectal exam, and it can’t be seen on a sonogram. It’s 

found by chance when surgery is done for another 

reason, usually for BPH. The cancer is only in the 

prostate. The grade is G1, or the Gleason score is no 

higher than 4. 

•	 Stage II: The tumor is more advanced or a higher 

grade than Stage I, but the tumor doesn’t extend 

beyond the prostate. It may be felt during a digital 

rectal exam, or it may be seen on a sonogram. 

•	 Stage III: The tumor extends beyond the prostate. 

The tumor may have invaded the seminal vesicles, 

but cancer cells haven’t spread to the lymph nodes. 

•	 Stage IV: The tumor may have invaded the bladder, 

rectum, or nearby structures (beyond the seminal 

vesicles). It may have spread to the lymph nodes, 

bones, or to other parts of the body. 

13
 
Treatment 

Men with prostate cancer have many treatment 

options. The treatment that’s best for one man may 

not be best for another. The options include active 

surveillance (also called watchful waiting), surgery, 

radiation therapy, hormone therapy, and chemotherapy. You may have a combination of treatments. 

The treatment that’s right for you depends mainly on 

your age, the grade of the tumor (the Gleason score), 

the number of biopsy tissue samples that contain 

cancer cells, the stage of the cancer, your symptoms, 

and your general health. Your doctor can describe your 

treatment choices, the expected results of each, and the 

possible side effects. You and your doctor can work 

together to develop a treatment plan that meets your 

medical and personal needs. 

14
 
You may want to talk to your doctor about taking 

part in a clinical trial, a research study of new 

treatment methods. See the section on Taking Part in 

Cancer Research on page 32. 

Your doctor may refer you to a specialist, or you 

may ask for a referral. You may want to see a urologist, 

a surgeon who specializes in treating problems in the 

urinary or male sex organs. Other specialists who treat 

prostate cancer include urologic oncologists, medical 

oncologists, and radiation oncologists. Your health care 

team may also include an oncology nurse and a 

registered dietitian. 

Before treatment starts, ask your health care team 

about possible side effects and how treatment may 

change your normal activities. For example, you may 

want to discuss with your doctor the possible effects on 

sexual activity. The NCI booklet Treatment Choices for 

Men with Early-Stage Prostate Cancer can tell you 

more about treatments and their side effects. 

At any stage of the disease, supportive care is 

available to relieve the side effects of treatment, to 

control pain and other symptoms, and to help you cope 

with the feelings that a diagnosis of cancer can bring. 

You can get information about coping on the NCI Web 

site at http://www.cancer.gov/ 

cancertopics/coping and from NCI’s Cancer 

Information Service at 1–800–4–CANCER or 

LiveHelp (http://www.cancer.gov/help). 

15
 
You may want to ask your doctor these 

questions before choosing your treatment: 

•	 What is the grade of the tumor? 

•	 What is the stage of the disease? Has the 

cancer spread? Do any lymph nodes show 

signs of cancer? 

•	 What is the goal of treatment? What are my 

treatment choices? Which do you recommend 

for me? Why? 

•	 What are the expected benefits of each type of 

treatment? 

•	 What are the risks and possible side effects of 

each treatment? How can side effects be 

managed? 

•	 What can I do to prepare for treatment? 

•	 Will I need to stay in the hospital? If so, for 

how long? 

•	 How will treatment affect my normal 

activities? Will it affect my sex life? Will I 

have urinary problems? Will I have bowel 

problems? 

•	 What will the treatment cost? Will my 

insurance cover it? 

•	 Would a clinical trial (research study) be 

appropriate for me? 

•	 Can you recommend other doctors who could 

give me a second opinion about my treatment 

options? 

16
 
Active Surveillance 

You may choose active surveillance if the risks and 

possible side effects of treatment outweigh the possible 

benefits. Your doctor may suggest active surveillance if 

you’re diagnosed with early stage prostate cancer that 

seems to be slowly growing. Your doctor may also 

offer this option if you are older or have other serious 

health problems. 

Choosing active surveillance doesn’t mean you’re 

giving up. It means you’re putting off the side effects 

of surgery or radiation therapy. Having surgery or 

radiation therapy is no guarantee that a man will live 

longer than a man who chooses to put off treatment. 

If you and your doctor agree that active surveillance 

is a good idea, your doctor will check you regularly 

(such as every 3 to 6 months, at first). After about one 

year, your doctor may order another biopsy to check 

the Gleason score. You may begin treatment if your 

Gleason score rises, your PSA level starts to rise, or 

you develop symptoms. You’ll receive surgery, 

radiation therapy, or another approach. 

Active surveillance avoids or delays the side effects 

of surgery and radiation therapy, but this choice has 

risks. For some men, it may reduce the chance to 

control cancer before it spreads. Also, it may be harder 

to cope with surgery or radiation therapy when you’re 

older. 

If you choose active surveillance but grow 

concerned later, you should discuss your feelings with 

your doctor. Another approach is an option for most 

men. 

17
 
You may want to ask your doctor these 

questions before choosing active surveillance: 

•	 If I choose active surveillance, can I change 

my mind later on? 

•	 Is it safe for me to put off treatment? 

•	 How often will I have checkups? Which tests 

will I need? Will I need a repeat biopsy? 

•	 How will we know if the prostate cancer is 

getting worse? 

•	 Between checkups, what problems should I tell 

you about? 

Surgery 

Surgery is an option for men with early (Stage I or 

II) prostate cancer. It’s sometimes an option for men 

with Stage III or IV prostate cancer. The surgeon may 

remove the whole prostate or only part of it. 

Before the surgeon removes the prostate, the lymph 

nodes in the pelvis may be removed. If prostate cancer 

cells are found in the lymph nodes, the disease may 

have spread to other parts of the body. If cancer has 

spread to the lymph nodes, the surgeon does not 

always remove the prostate and may suggest other 

types of treatment. 

18
 
There are several types of surgery for prostate 

cancer. Each type has benefits and risks. You and your 

doctor can talk about the types of surgery and which 

may be right for you: 

•	 Open surgery: The surgeon makes a large incision 

(cut) into your body to remove the tumor. There are 

two approaches: 

—Through the abdomen: The surgeon removes the 

entire prostate through a cut in the abdomen. This 

is called a radical retropubic prostatectomy. 

—Between the scrotum and anus: The surgeon 

removes the entire prostate through a cut between 

the scrotum and the anus. This is called a radical 

perineal prostatectomy. 

•	 Laparoscopic prostatectomy: The surgeon removes 

the entire prostate through small cuts, rather than a 

single long cut in the abdomen. A thin, lighted tube 

(a laparoscope) helps the surgeon remove the 

prostate. 

•	 Robotic laparoscopic surgery: The surgeon 

removes the entire prostate through small cuts. A 

laparoscope and a robot are used to help remove the 

prostate. The surgeon uses handles below a 

computer display to control the robot’s arms. 

•	 Cryosurgery: For some men, cryosurgery is an 

option. The surgeon inserts a tool through a small 

cut between the scrotum and anus. The tool freezes 

and kills prostate tissue. Cryosurgery is under study. 

See the section on Taking Part in Cancer Research 

on page 32. 

19
 
•	 TURP: A man with advanced prostate cancer may 

choose TURP (transurethral resection of the 

prostate) to relieve symptoms. The surgeon inserts a 

long, thin scope through the urethra. A cutting tool 

at the end of the scope removes tissue from the 

inside of the prostate. TURP may not remove all of 

the cancer, but it can remove tissue that blocks the 

flow of urine. 

You may be uncomfortable for the first few days or 

weeks after surgery. However, medicine can help 

control the pain. Before surgery, you should discuss the 

plan for pain relief with your doctor or nurse. After 

surgery, your doctor can adjust the plan if you need 

more pain relief. 

The time it takes to heal after surgery is different for 

each man and depends on the type of surgery. You may 

be in the hospital for one to three days. 

After surgery, the urethra needs time to heal. You’ll 

have a catheter. A catheter is a tube put through the 

urethra into the bladder to drain urine. You’ll have the 

catheter for 5 days to 3 weeks. Your nurse or doctor 

will show you how to care for it. 

After surgery, some men may lose control of the 

flow of urine (urinary incontinence). Most men regain 

at least some bladder control after a few weeks. 

Surgery can damage the nerves around the prostate. 

Damaging these nerves can make a man impotent 

(unable to have an erection). In some cases, your 

surgeon can protect the nerves that control erection. 

But if you have a large tumor or a tumor that’s very 

close to the nerves, surgery may cause impotence. 

Impotence can be permanent. You can talk with your 

doctor about medicine and other ways to help manage 

the sexual side effects of cancer treatment. 

20
 
If your prostate is removed, you will no longer 

produce semen. You’ll have dry orgasms. If you wish 

to father children, you may consider sperm banking or 

a sperm retrieval procedure before surgery. 

You may want to ask your doctor these 

questions before choosing surgery: 

•	 What kinds of surgery can I consider? Which 

operation do you recommend for me? Why? 

•	 How long will I be in the hospital after 

surgery? 

•	 How will I feel after the operation? 

•	 If I have pain, how can we control it? 

•	 Will I have any lasting side effects? What is 

the chance that the surgery will cause 

incontinence or impotence? 

•	 Is there someone that I can talk with who has 

had the same surgery that I’ll be having? 

•	 How often will I need checkups? 

Radiation Therapy 

Radiation therapy is an option for men with any 

stage of prostate cancer. Men with early stage prostate 

cancer may choose radiation therapy instead of surgery. 

It also may be used after surgery to destroy any cancer 

cells that remain in the area. In later stages of prostate 

cancer, radiation treatment may be used to help relieve 

pain. 

Radiation therapy (also called radiotherapy) uses 

high-energy rays to kill cancer cells. It affects cells only 

in the treated area. 

21
 
Doctors use two types of radiation therapy to treat 

prostate cancer. Some men receive both types: 

•	 External radiation: The radiation comes from a 

large machine outside the body. You will go to a 

hospital or clinic for treatment. Treatments are 

usually 5 days a week for several weeks. Many men 

receive 3-dimensional conformal radiation therapy 

or intensity-modulated radiation therapy. These 

types of treatment use computers to more closely 

target the cancer to lessen the damage to healthy 

tissue near the prostate. 

•	 Internal radiation (implant radiation or 

brachytherapy): The radiation comes from 

radioactive material usually contained in very small 

implants called seeds. Dozens of seeds are placed 

inside needles, and the needles are inserted into the 

prostate. The needles are removed, leaving the seeds 

behind. The seeds give off radiation for months. 

They don’t need to be removed once the radiation is 

gone. 

Side effects depend mainly on the dose and type of 

radiation. You’re likely to be very tired during radiation 

therapy, especially in the later weeks of treatment. 

Resting is important, but doctors usually advise 

patients to try to stay active, unless it leads to pain or 

other problems. 

If you have external radiation, you may have 

diarrhea or frequent and uncomfortable urination. 

Some men have lasting bowel or urinary problems. 

Your skin in the treated area may become red, dry, and 

tender. You may lose hair in the treated area. The hair 

may not grow back. 

Internal radiation therapy may cause incontinence. 

This side effect usually goes away. 

22
 
Both internal and external radiation can cause 

impotence. You can talk with your doctor about ways 

to help cope with this side effect. 

You may find it helpful to read the NCI booklet 

Radiation Therapy and You. 

You may want to ask your doctor these 

questions before choosing radiation therapy: 

•	 Which type of radiation therapy can I 

consider? Are both types an option for me? 

•	 When will treatment start? When will it end? 

How often will I have treatments? 

•	 Will I need to stay in the hospital? 

•	 What can I do to take care of myself before, 

during, and after treatment? 

•	 How will I feel during treatment? Will I be 

able to drive myself to and from treatment? 

•	 How will we know the treatment is working? 

•	 How will I feel after the radiation therapy? 

•	 Are there any lasting effects? 

•	 What is the chance that the cancer will come 

back in my prostate? 

•	 How often will I need checkups? 

Hormone Therapy 

A man with prostate cancer may have hormone 

therapy before, during, or after radiation therapy. 

Hormone therapy is also used alone for prostate cancer 

that has returned after treatment. 

23
 
Male hormones (androgens) can cause prostate 

cancer to grow. Hormone therapy keeps prostate cancer 

cells from getting the male hormones they need to 

grow. The testicles are the body’s main source of the 

male hormone testosterone. The adrenal gland makes 

other male hormones and a small amount of 

testosterone. 

Hormone therapy uses drugs or surgery: 

•	 Drugs: Your doctor may suggest a drug that can 

block natural hormones: 

—Luteinizing hormone-releasing hormone 

(LH-RH) agonists: These drugs can prevent the 

testicles from making testosterone. Examples are 

leuprolide, goserelin, and triptorelin. The 

testosterone level falls slowly. Without 

testosterone, the tumor shrinks, or its growth 

slows. These drugs are also called gonadotropinreleasing hormone (GnRH) agonists. 

—Antiandrogens: These drugs can block the action 

of male hormones. Examples are flutamide, 

bicalutamide, and nilutamide. 

—Other drugs: Some drugs can prevent the
 

adrenal gland from making testosterone.
 

Examples are ketoconazole and
 

aminoglutethimide.
 

•	 Surgery: Surgery to remove the testicles is called 

orchiectomy. 

After orchiectomy or treatment with an LH-RH 

agonist, your body no longer gets testosterone from the 

testicles, the major source of male hormones. Because 

the adrenal gland makes small amounts of male 

hormones, you may receive an antiandrogen to block 

the action of the male hormones that remain. This 

24
 
combination of treatments is known as total androgen 

blockade (also called combined androgen blockade). 

However, studies have shown that total androgen 

blockade is no more effective than surgery or an 

LH-RH agonist alone. 

Hormone therapy causes side effects such as 

impotence, hot flashes, and loss of sexual desire. Also, 

any treatment that lowers hormone levels can weaken 

your bones. Your doctor can suggest medicines that 

may reduce your risk of bone fractures. 

An LH-RH agonist may make your symptoms 

worse for a short time at first. This temporary problem 

is called “flare.” To prevent flare, your doctor may give 

you an antiandrogen for a few weeks along with the 

LH-RH agonist. 

An LH-RH agonist such as leuprolide can increase 

body fat, especially around the waist. The levels of 

sugar and cholesterol in your blood may increase too. 

Because these changes increase the risk of diabetes and 

heart disease, your health care team will monitor you 

for these side effects. 

Antiandrogens (such as nilutamide) can cause 

nausea, diarrhea, or breast growth or tenderness. 

Rarely, they may cause liver problems (pain in the 

abdomen, yellow eyes, or dark urine). Some men who 

use nilutamide may have shortness of breath or 

develop heart failure. Some may have trouble adjusting 

to sudden changes in light. 

If you receive total androgen blockade, you may 

have more side effects than if you have just one type of 

hormone treatment. 

If used for a long time, ketoconazole may cause 

liver problems, and aminoglutethimide can cause skin 

rashes. 

25
 
Doctors usually treat prostate cancer that has spread 

to other parts of the body with hormone therapy. For 

some men, the cancer will be controlled for two or 

three years, but others will have a much shorter 

response to hormone therapy. In time, most prostate 

cancers can grow with very little or no male hormones, 

and hormone therapy alone is no longer helpful. At that 

time, your doctor may suggest chemotherapy or other 

forms of treatment that are under study. In many cases, 

the doctor may suggest continuing with hormone 

therapy because it may still be effective against some 

of the cancer cells. 

You may want to ask your doctor these 

questions before choosing hormone therapy: 

•	 Which kind of hormone therapy can I 

consider? Would you recommend drugs or 

surgery? Why? 

•	 If I have drugs, when will treatment start? How 

often will I have treatments? When will 

treatment end? 

•	 If I have surgery, how long will I need to stay 

in the hospital? 

•	 How will I feel during treatment? 

•	 What can I do to take care of myself during 

treatment? 

•	 How will we know the treatment is working? 

•	 Which side effects should I tell you about? 

•	 Will there be lasting side effects? 

•	 How often will I need checkups? 

26
 
Chemotherapy 

Chemotherapy may be used for prostate cancer that 

has spread and no longer responds to hormone therapy. 

Chemotherapy uses drugs to kill cancer cells. The 

drugs for prostate cancer are usually given through a 

vein (intravenous). You may receive chemotherapy in a 

clinic, at the doctor’s office, or at home. Some men 

need to stay in the hospital during treatment. 

The side effects depend mainly on which drugs are 

given and how much. Chemotherapy kills fast-growing 

cancer cells, but the drugs can also harm normal cells 

that divide rapidly: 

•	 Blood cells: When chemotherapy lowers the levels 

of healthy blood cells, you’re more likely to get 

infections, bruise or bleed easily, and feel very weak 

and tired. Your health care team will check for low 

levels of blood cells. If your levels are low, your 

health care team may stop the chemotherapy for a 

while or reduce the dose of drug. There are also 

medicines that can help your body make new blood 

cells. 

•	 Cells in hair roots: Chemotherapy may cause hair 

loss. If you lose your hair, it will grow back, but it 

may change in color and texture. 

•	 Cells that line the digestive tract: Chemotherapy 

can cause a poor appetite, nausea and vomiting, or 

diarrhea. Your health care team can give you 

medicines and suggest other ways to help with these 

problems. 

Other side effects include shortness of breath and a 

problem with your body holding extra water. Your 

health care team can give you medicine to protect 

against too much water building up in the body. Also, 

chemotherapy may cause a skin rash, tingling or 

numbness in your hands and feet, and watery eyes. 

Your health care team can suggest ways to control 

27
 
many of these problems. Most go away when treatment 

ends. 

You may wish to read the NCI booklet 

Chemotherapy and You. 

You may want to ask your doctor these 

questions before choosing chemotherapy: 

•	 Why do I need this treatment? 

•	 Which drug or drugs will I have? 

•	 How do the drugs work? 

•	 What are the expected benefits of the 

treatment? 

•	 What are the risks and possible side effects of 

treatment? What can we do about them? 

•	 When will treatment start? When will it end? 

•	 How will treatment affect my normal 

activities? 

Second Opinion 

Before starting treatment, you might want a second 

opinion about your diagnosis and treatment plan. You 

may even want to talk to several different doctors about 

all of the treatment options, their side effects, and the 

expected results. For example, you may want to talk to 

a urologist, radiation oncologist, and medical 

oncologist. 

Some people worry that the doctor will be offended 

if they ask for a second opinion. Usually the opposite is 

true. Most doctors welcome a second opinion. And 

many health insurance companies will pay for a second 

opinion if you or your doctor requests it. 

28
 
If you get a second opinion, the doctor may agree 

with your first doctor’s diagnosis and treatment plan. 

Or, the second doctor may suggest another approach. 

Either way, you have more information and perhaps a 

greater sense of control. You can feel more confident 

about the decisions you make, knowing that you’ve 

looked at your options. 

It may take some time and effort to gather your 

medical records and see another doctor. In most cases, 

it’s not a problem to take several weeks to get a second 

opinion. The delay in starting treatment usually will 

not make treatment less effective. To make sure, you 

should discuss this delay with your doctor. 

There are many ways to find a doctor for a second 

opinion. You can ask your doctor, a local or state 

medical society, a nearby hospital, or a medical school 

for names of specialists. NCI’s Cancer Information 

Service at 1–800–4–CANCER can tell you about 

nearby treatment centers. Other sources can be found 

in the NCI fact sheet How To Find a Doctor or 

Treatment Facility If You Have Cancer. 

Nutrition and Physical Activity 

It’s important for you to take care of yourself by 

eating well and staying as active as you can. 

You need the right amount of calories to maintain a 

good weight. You also need enough protein to keep up 

your strength. Eating well may help you feel better and 

have more energy. 

Your doctor, a registered dietitian, or another health 

care provider can suggest a healthy diet. Also, the NCI 

booklet Eating Hints for Cancer Patients has many 

useful ideas and recipes. 

29
 
Research shows that people with cancer feel better 

when they are active. Walking, yoga, swimming, and 

other activities can increase your energy. Exercise may 

reduce pain and make treatment easier to handle. It 

also can help relieve stress. Whatever physical activity 

you choose, be sure to talk to your doctor before you 

start. Also, if your activity causes you pain or other 

problems, be sure to let your doctor or nurse know 

about it. You shouldn’t try to exercise to the point of 

exhaustion. 

Follow-up Care 

You’ll need regular checkups after treatment for 

prostate cancer. Checkups help ensure that any changes 

in your health are noted and treated if needed. If you 

have any health problems between checkups, you 

should contact your doctor. 

Your doctor will check for return of cancer. Even 

when the cancer seems to have been completely 

removed or destroyed, the disease sometimes returns 

because undetected cancer cells remained somewhere 

in the body after treatment. 

Checkups may include a digital rectal exam and a 

PSA test. A rise in PSA level can mean that cancer has 

returned after treatment. Your doctor may also order a 

biopsy, a bone scan, CT scans, an MRI, or other tests. 

The NCI has publications to help answer questions 

about follow-up care and other concerns. You may find 

it helpful to read the NCI booklet Facing Forward: 

Life After Cancer Treatment. You may also want to 

read the NCI fact sheet Follow-up Care After Cancer 

Treatment: Questions and Answers. 

30
 
You may want to ask your doctor these 

questions after you have finished treatment: 

•	 How often will I need checkups? 

•	 Which follow-up tests do you suggest for me? 

•	 Between checkups, what health problems or 

symptoms should I tell you about? 

Sources of Support 

Learning you have prostate cancer can change your 

life and the lives of those close to you. These changes 

can be hard to handle. It’s normal for you, your family, 

and your friends to need help coping with the feelings 

that a diagnosis of cancer can bring. 

Concerns about treatments and managing side 

effects, hospital stays, and medical bills are common. 

You may also worry about caring for your family, 

keeping your job, or continuing daily activities. 

Here’s where you can go for support: 

•	 Doctors, nurses, and other members of your health 

care team can answer questions about treatment, 

working, or other activities. 

•	 Social workers, counselors, or members of the 

clergy can be helpful if you want to talk about your 

feelings or concerns. Often, social workers can 

suggest resources for financial aid, transportation, 

home care, or emotional support. 

31
 
•	 Support groups also can help. In these groups, 

patients or their family members meet with other 

patients or their families to share what they have 

learned about coping with the disease and the effects 

of treatment. Groups may offer support in person, 

over the telephone, or on the Internet. You may want 

to talk with a member of your health care team 

about finding a support group. 

•	 Information specialists at 1–800–4–CANCER and 

at LiveHelp (http://www.cancer.gov/help) can help 

you locate programs, services, and publications. 

They can send you a list of organizations that offer 

services to people with cancer. 

•	 Your doctor or a sex counselor may be helpful if 

you and your partner are concerned about the effects 

of prostate cancer on your sexual relationship. Ask 

your doctor about possible treatment of side effects 

and whether these effects are likely to last. Whatever 

the outlook, you and your partner may find it helps 

to discuss your concerns. 

For tips on coping, you may want to read the NCI 

booklet Taking Time: Support for People With Cancer. 

Taking Part in Cancer Research 

Cancer research has led to real progress in prostate 

cancer detection, treatment, and supportive care. 

Because of research, men with prostate cancer can look 

forward to a better quality of life and less chance of 

dying from the disease. Continuing research offers 

hope that, in the future, even more men with this 

disease will be treated successfully. 

32
 
Doctors all over the country are conducting many 

types of clinical trials (research studies in which people 

volunteer to take part). Clinical trials are designed to 

answer important questions and to find out whether 

new approaches are safe and effective. 

Doctors are studying many types of treatment and 

their combinations: 

•	 Active surveillance: Doctors are comparing having 

surgery or radiation right away to choosing active 

surveillance. The results of the study will help 

doctors know whether to treat early stage prostate 

cancer right away, or only when symptoms appear 

or get worse. 

•	 Cryosurgery: Surgeons are studying a tool that 

freezes and kills prostate tissue in men with early 

prostate cancer. 

•	 High-intensity focused ultrasound (HIFU): Doctors 

are testing HIFU in men with early prostate cancer. 

A probe is placed in the rectum. The probe gives off 

high-intensity ultrasound waves that heat up and 

destroy the prostate tumor. 

•	 Radiation therapy: Doctors are using different 

doses or schedules of radiation therapy. They are 

looking at the use of radioactive implants after 

external radiation. And they are combining radiation 

therapy with other treatments, such as hormone 

therapy. 

•	 Hormone therapy: Researchers are studying 

different schedules of hormone therapy, and they are 

combining it with other treatments. 

•	 Chemotherapy: Researchers are testing anticancer 

drugs and combining them with hormone therapy or 

biological therapy. Chemotherapy allows some men 

to live longer and with a better quality of life. 

33
 
•	 Biological therapy: New biological therapies are 

under study. For example, doctors are testing cancer 

vaccines that help the immune system kill cancer 

cells. 

Doctors are also testing ways to manage the 

problems caused by prostate cancer and its treatment. 

For example, they are studying ways to manage or 

prevent bone pain, bone thinning, hot flashes, and 

impotence. 

Even if the men in a trial do not benefit directly, 

they may still make an important contribution by 

helping doctors learn more about prostate cancer and 

how to control it. Although clinical trials may pose 

some risks, doctors do all they can to protect their 

patients. 

If you’re interested in being part of a clinical trial, 

talk with your doctor. You may want to read the NCI 

booklet Taking Part in Cancer Treatment Research 

Studies. It describes how treatment studies are carried 

out and explains their possible benefits and risks. 

NCI’s Web site includes a section on clinical trials 

at http://www.cancer.gov/clinicaltrials. It has 

general information about clinical trials as well as 

detailed information about specific ongoing studies of 

prostate cancer. NCI’s Information Specialists at 

1–800–4–CANCER or at LiveHelp at 

http://www.cancer.gov/help can answer questions 

and provide information about clinical trials. 

34
 
Dictionary 

Definitions of thousands of terms are on the NCI 

Web site in the NCI Dictionary of Cancer Terms. You 

can access it at http://www.cancer.gov/dictionary. 

3-dimensional conformal radiation therapy (3-dihMEN-shuh-nul kun-FOR-mul RAY-dee-AY-shun 

THAYR-uh-pee): A procedure that uses a computer to 

create a 3-dimensional picture of the tumor. This 

allows doctors to give the highest possible dose of 

radiation to the tumor, while sparing the normal tissue 

as much as possible. 

Abdomen (AB-doh-men): The area of the body that 

contains the pancreas, stomach, intestines, liver, 

gallbladder, and other organs. 

Active surveillance (ser-VAY-lents): Closely 

monitoring a patient’s condition but withholding 

treatment until symptoms appear or change. Also 

called observation, watchful waiting, or expectant 

management. 

Adrenal gland (uh-DREE-nul): A small gland that 

makes steroid hormones, adrenaline, and 

noradrenaline. These hormones help control heart rate, 

blood pressure, and other important body functions. 

There are two adrenal glands, one on top of each 

kidney. Also called suprarenal gland. 

Aminoglutethimide (a-MEE-no-gloo-TETH-ih-mide): 

An anticancer drug that belongs to the family of drugs 

called nonsteroidal aromatase inhibitors. It is used to 

decrease the production of sex hormones (estrogen in 

women or testosterone in men) and suppress the 

growth of tumors that need sex hormones to grow. 

Androgen (AN-droh-jen): A type of hormone that 

promotes the development and maintenance of male 

sex characteristics. 

35
 
Antiandrogen (AN-tee-AN-droh-jen): A substance that
 

prevents cells from making or using androgens
 

(hormones that play a role in the formation of male sex
 

characteristics). 

Anus (AY-nus): The opening of the rectum to the
 

outside of the body.
 

Benign (beh-NINE): Not cancerous. Benign tumors
 

may grow larger but do not spread to other parts of the
 

body. 

Benign prostatic hyperplasia (beh-NINE prah-STA-tik
 

HY-per-PLAY-zhuh): BPH. A benign (noncancerous)
 

condition in which an overgrowth of prostate tissue
 

pushes against the urethra and the bladder, blocking the
 

flow of urine. Also called benign prostatic hypertrophy.
 

Bicalutamide (bye-ka-LOO-ta-mide): An anticancer
 

drug that belongs to the family of drugs called
 

antiandrogens.
 

Biological therapy (BY-oh-LAH-jih-kul THAYR-uhpee): Treatment to boost or restore the ability of the
 

immune system to fight cancer, infections, and other
 

diseases. Also used to lessen certain side effects that
 

may be caused by some cancer treatments. Also called
 

immunotherapy, biotherapy, biological response
 

modifier therapy, and BRM therapy.
 

Biopsy (BY-op-see): The removal of cells or tissues for
 

examination by a pathologist. The pathologist may
 

study the tissue under a microscope or perform other
 

tests on the cells or tissue. There are many different
 

types of biopsy procedures. The most common types
 

include: (1) incisional biopsy, in which only a sample
 

of tissue is removed; (2) excisional biopsy, in which
 

an entire lump or suspicious area is removed; and
 

(3) needle biopsy, in which a sample of tissue or fluid 

is removed with a needle. When a wide needle is used, 

the procedure is called a core biopsy. When a thin 

needle is used, the procedure is called a fine-needle 

aspiration biopsy. 

36
 
Bladder (BLA-der): The organ that stores urine. 

Bone scan: A technique 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. 

Brachytherapy (BRAY-kee-THAYR-uh-pee): A type of 

radiation therapy in which radioactive material sealed 

in needles, seeds, wires, or catheters is placed directly 

into or near a tumor. Also called radiation 

brachytherapy, internal radiation therapy, and implant 

radiation therapy. 

BRCA1: A gene on chromosome 17 that normally 

helps to suppress cell growth. A person who inherits a 

mutated (changed) BRCA1 gene has a higher risk of 

getting breast, ovarian, or prostate cancer. 

BRCA2: A gene on chromosome 13 that normally 

helps to suppress cell growth. A person who inherits a 

mutated (changed) BRCA2 gene has a higher risk of 

getting breast, ovarian, or prostate cancer. 

Cancer (KAN-ser): A term for diseases in which 

abnormal cells divide without control. Cancer cells can 

invade nearby tissues and can spread to other parts of 

the body through the blood and lymph systems. 

Catheter (KA-theh-ter): A flexible tube used to deliver 

fluids into or withdraw fluids from the body. 

Cell: The individual unit that makes up the tissues of 

the body. All living things are made up of one or more 

cells. 

Chemotherapy (KEE-moh-THAYR-uh-pee): 

Treatment with drugs that kill cancer cells. 

Cholesterol (kuh-LESS-tuh-rawl): A waxy, fat-like 

substance made in the liver and found in the blood and 

in all cells of the body. Cholesterol also comes from 

eating foods taken from animals such as egg yolks, 

meat, and whole-milk dairy products. 

37
 
Chromosome (KROH-muh-some): Part of a cell that
 

contains genetic information. Except for sperm and
 

eggs, all human cells contain 46 chromosomes. 

Clinical trial: A type of research study that tests how
 

well new medical approaches work in people. These
 

studies test new methods of screening, prevention,
 

diagnosis, or treatment of a disease.
 

Contrast material: A dye or other substance that helps
 

to show abnormal areas inside the body. It is given by
 

injection into a vein, by enema, or by mouth. Contrast
 

material may be used with x-rays, CT scans, MRI, or
 

other imaging tests. 

Cryosurgery (KRY-oh-SER-juh-ree): A procedure in
 

which tissue is frozen to destroy abnormal cells. This is
 

usually done with a special instrument that contains
 

liquid nitrogen or liquid carbon dioxide. Also called
 

cryoablation.
 

CT scan: Computed tomography scan (kum-PYOO-ted
 

tuh-MAH-gruh-fee skan). A series of detailed pictures
 

of areas inside the body taken from different angles;
 

the pictures are created by a computer linked to an
 

x-ray machine. Also called computerized tomography
 

and computerized axial tomography (CAT) scan.
 

Digestive tract (dy-JES-tiv): The organs through which
 

food and liquids pass when they are swallowed,
 

digested, and eliminated. These organs are the mouth,
 

esophagus, stomach, small and large intestines, and
 

rectum.
 

Digital rectal examination (DIH-jih-tul REK-tul
 

eg-zam-ih-NAY-shun): DRE. An examination in which
 

a doctor inserts a lubricated, gloved finger into the
 

rectum to feel for abnormalities. 

Dry orgasm: Sexual climax without the release of
 

semen from the penis. 

Ejaculation (i-JAK-yoo-LAY-shun): The release of
 

semen through the penis during orgasm.
 

38
 
Erection (ih-REK-shun): In medicine, the swelling of
 

the penis with blood, causing it to become firm.
 

External radiation therapy (RAY-dee-AY-shun
 

THAYR-uh-pee): A type of radiation therapy that uses
 

a machine to aim high-energy rays at the cancer from
 

outside of the body. Also called external beam
 

radiation therapy.
 

Flutamide (FLOO-ta-mide): An anticancer drug that is
 

a type of antiandrogen.
 

Gene: The functional and physical unit of heredity
 

passed from parent to offspring. Genes are pieces of
 

DNA, and most genes contain the information for
 

making a specific protein.
 

Genome: The complete genetic material of an
 

organism.
 

Gland: An organ that makes one or more substances,
 

such as hormones, digestive juices, sweat, tears, saliva,
 

or milk. 

Gleason score (GLEE-sun): A system of grading
 

prostate cancer tissue based on how it looks under a
 

microscope. Gleason scores range from 2 to 10 and
 

indicate how likely it is that a tumor will spread. A low
 

Gleason score means the cancer tissue is similar to
 

normal prostate tissue and the tumor is less likely to
 

spread; a high Gleason score means the cancer tissue is
 

very different from normal and the tumor is more
 

likely to spread.
 

Gonadotropin-releasing hormone agonist: A hormone
 

made in the laboratory that has the same effect as the
 

gonadotropin-releasing hormone (GnRH) produced
 

naturally by the body.
 

Goserelin (go-SAIR-uh-lin): A drug that belongs to the
 

family of drugs called gonadotropin-releasing hormone
 

analogs. Goserelin is used to block hormone
 

production in the ovaries or testicles.
 

39
 
Grade: The grade of a tumor depends on how 

abnormal the cancer cells look under a microscope and 

how quickly the tumor is likely to grow and spread. 

Grading systems are different for each type of cancer. 

Green tea extract: A substance that is being studied in 

the prevention of cancer. It is made from decaffeinated 

green tea, and contains chemicals called catechins, 

which are antioxidants. Also called Polyphenon E. 

High-intensity focused ultrasound (UL-truhSOWND): HIFU. A type of therapy that is being 

studied for certain cancers. A probe gives off highintensity ultrasound waves that heat up and destroy the 

tumor. 

Hormone (HOR-mone): One of many chemicals made 

by glands in the body. Hormones circulate in the 

bloodstream and control the actions of certain cells or 

organs. Some hormones can also be made in the 

laboratory. 

Hormone therapy (HOR-mone THAYR-uh-pee): 

Treatment that adds, blocks, or removes hormones. For 

certain conditions (such as diabetes or menopause), 

hormones are given to adjust low hormone levels. To 

slow or stop the growth of certain cancers (such as 

prostate or breast cancer), synthetic hormones or other 

drugs may be given to block the body’s natural 

hormones. Sometimes surgery is needed to remove the 

gland that makes a certain hormone. Also called 

hormonal therapy, hormone treatment, or endocrine 

therapy. 

Immune system (ih-MYOON): The complex group of 

organs and cells that defends the body against 

infections and other diseases. 

Implant radiation therapy (RAY-dee-AY-shun 

THAYR-uh-pee): A type of radiation therapy in which 

radioactive material sealed in needles, seeds, wires, or 

catheters is placed directly into or near a tumor. Also 

40
 
called brachytherapy, radiation brachytherapy, and
 

internal radiation therapy.
 

Impotent (IM-po-tent): In medicine, describes the
 

inability to have an erection of the penis adequate for
 

sexual intercourse.
 

Incision (in-SIH-zhun): A cut made in the body to
 

perform surgery.
 

Incontinence (in-KAHN-tih-nens): Inability to control
 

the flow of urine from the bladder (urinary
 

incontinence) or the escape of stool from the rectum
 

(fecal incontinence).
 

Inflammation (IN-fluh-MAY-shun): Redness, swelling,
 

pain, and/or a feeling of heat in an area of the body.
 

This is a protective reaction to injury, disease, or
 

irritation of the tissues.
 

Injection: Use of a syringe and needle to push fluids or
 

drugs into the body; often called a “shot.”
 

Intensity-modulated radiation therapy (in-TEN-sihtee-MAH-juh-LAY-tid RAY-dee-AY-shun THAYR-uhpee): A type of 3-dimensional radiation therapy that
 

uses computer-generated images to show the size and
 

shape of the tumor. Thin beams of radiation of different
 

intensities are aimed at the tumor from many angles.
 

This type of radiation therapy reduces the damage to
 

healthy tissue near the tumor.
 

Internal radiation therapy (in-TER-nul RAY-dee-AYshun THAYR-uh-pee): A type of radiation therapy in
 

which radioactive material sealed in needles, seeds,
 

wires, or catheters is placed directly into or near a
 

tumor. Also called brachytherapy, radiation
 

brachytherapy, and implant radiation therapy. 

Intravenous (IN-truh-VEE-nus): IV. Into or within a
 

vein. Intravenous usually refers to a way of giving a
 

drug or other substance through a needle or tube
 

inserted into a vein.
 

41
 
Ketoconazole (kee-ta-KOE-na-zol): A drug that treats 

infection caused by a fungus. It is also used as a 

treatment for prostate cancer because it can block the 

production of male sex hormones. 

Laparoscope (LA-puh-ruh-SKOPE): A thin, tube-like 

instrument used to look at tissues and organs inside the 

abdomen. A laparoscope has a light and a lens for 

viewing and may have a tool to remove tissue. 

Laparoscopic prostatectomy (LA-puh-ruh-SKAH-pik 

PROS-tuh-TEK-toh-mee): Surgery to remove all or 

part of the prostate with the aid of a laparoscope. A 

laparoscope is a thin, tube-like instrument with a light 

and a lens for viewing. It may also have a tool to 

remove tissue. 

Leuprolide (LOO-pro-lide): A drug used to treat 

symptoms of advanced prostate cancer. It is also used 

to treat early puberty in children and certain 

gynecologic conditions. It is being studied in the 

treatment of other conditions and types of cancer. 

Leuprolide blocks the body from making testosterone 

(a male hormone) and estradiol (a female hormone). It 

may stop the growth of prostate cancer cells that need 

testosterone to grow. It is a type of gonadotropinreleasing hormone analog. 

Local anesthesia (A-nes-THEE-zhuh): Drugs that 

cause a temporary loss of feeling in one part of the 

body. The patient remains awake but has no feeling in 

the part of the body treated with the anesthetic. 

Luteinizing hormone-releasing hormone agonist 

(LOO-tin-eye-zing. . .AG-o-nist): LH-RH agonist. A 

drug that inhibits the secretion of sex hormones. In 

men, LH-RH agonist causes testosterone levels to fall. 

In women, LH-RH agonist causes the levels of 

estrogen and other sex hormones to fall. 

Lymph node (limf node): A rounded mass of lymphatic 

tissue that is surrounded by a capsule of connective 

tissue. Lymph nodes filter lymph (lymphatic fluid), and 

42
 
they store lymphocytes (white blood cells). They are 

located along lymphatic vessels. Also called a lymph 

gland. 

Lymph vessel (limf): A thin tube that carries lymph 

(lymphatic fluid) and white blood cells through the 

lymphatic system. Also called lymphatic vessel. 

Malignant (muh-LIG-nunt): Cancerous. Malignant 

tumors can invade and destroy nearby tissue and 

spread to other parts of the body. 

Medical oncologist (MEH-dih-kul on-KAH-loh-jist): 

A doctor who specializes in diagnosing and treating 

cancer using chemotherapy, hormonal therapy, and 

biological therapy. A medical oncologist often is the 

main health care provider for someone who has cancer. 

A medical oncologist also gives supportive care and 

may coordinate treatment given by other specialists. 

Metastasis (meh-TAS-tuh-sis): The spread of cancer 

from one part of the body to another. A tumor formed 

by cells that have spread is called a “metastatic tumor” 

or a “metastasis.” The metastatic tumor contains cells 

that are like those in the original (primary) tumor. The 

plural form of metastasis is metastases (meh-TAS-tuhseez). 

MRI: Magnetic resonance imaging (mag-NEH-tik 

REH-zuh-nunts IH-muh-jing). A procedure in which 

radio waves and a powerful magnet linked to a 

computer are used to create detailed pictures of areas 

inside the body. 

Nerve: A bundle of fibers that receives and sends 

messages between the body and the brain. The 

messages are sent by chemical and electrical changes 

in the cells that make up the nerves. 

Nilutamide (ny-LOO-tuh-mide): A drug that blocks the 

effects of male hormones in the body. It is a type of 

antiandrogen. 

43
 
Oncology nurse (on-KAH-loh-jee): A nurse who
 

specializes in caring for people who have cancer.
 

Orchiectomy (or-kee-EK-toh-mee): Surgery to remove
 

one or both testicles. Also called orchidectomy.
 

Organ: A part of the body that performs a specific
 

function. For example, the heart is an organ.
 

Pathologist (puh-THAH-loh-jist): A doctor who
 

identifies diseases by studying cells and tissues under a
 

microscope. 

Pelvis: The lower part of the abdomen, located
 

between the hip bones.
 

Penis: An external male reproductive organ. It contains
 

a tube called the urethra, which carries semen and
 

urine to the outside of the body.
 

Prostate (PROS-tayt): A gland in the male reproductive
 

system. The prostate surrounds the part of the urethra
 

(the tube that empties the bladder) just below the
 

bladder, and produces a fluid that forms part of the
 

semen.
 

Prostate-specific antigen (PROS-tayt-speh-SIH-fik
 

AN-tih-jen): PSA. A substance produced by the
 

prostate that may be found in an increased amount in
 

the blood of men who have prostate cancer, benign
 

prostatic hyperplasia, or infection or inflammation of
 

the prostate.
 

Prostatic intraepithelial neoplasia (prah-STA-tik
 

IN-truh-eh-puh-THEE-lee-ul NEE-oh-PLAY-zhuh):
 

PIN. Noncancerous growth of the cells lining the
 

internal and external surfaces of the prostate gland.
 

Having high-grade PIN may increase the risk of
 

developing prostate cancer.
 

Prostatitis (prah-stuh-TY-tis): Inflammation of the
 

prostate gland.
 

44
 
Radiation (RAY-dee-AY-shun): Energy released in the
 

form of particles or electromagnetic waves. Common
 

sources of radiation include radon gas, cosmic rays
 

from outer space, and medical x-rays.
 

Radiation oncologist (RAY-dee-AY-shun on-KAH-lohjist): A doctor who specializes in using radiation to
 

treat cancer.
 

Radiation therapy (RAY-dee-AY-shun THAYR-uhpee): The use of high-energy radiation from x-rays,
 

gamma rays, neutrons, and other sources to kill cancer
 

cells and shrink tumors. Radiation may come from a
 

machine outside the body (external beam radiation
 

therapy), or it may come from radioactive material
 

placed in the body near cancer cells (internal radiation
 

therapy). Systemic radiation therapy uses a radioactive
 

substance, such as a radiolabeled monoclonal antibody,
 

that travels in the blood to tissues throughout the body.
 

Also called radiotherapy and irradiation. 

Radical perineal prostatectomy (RA-dih-kul PAYR-ihNEE-ul PROS-tuh-TEK-toh-mee): Surgery to remove
 

all of the prostate through an incision between the
 

scrotum and the anus. Nearby lymph nodes are
 

sometimes removed through a separate incision in the
 

wall of the abdomen.
 

Radical retropubic prostatectomy (RA-dih-kul
 

reh-troh-PYOO-bik PROS-tuh-TEK-toh-mee): Surgery
 

to remove all of the prostate and nearby lymph nodes
 

through an incision in the wall of the abdomen.
 

Radioactive (RAY-dee-oh-AK-tiv): Giving off
 

radiation.
 

Rectum: The last several inches of the large intestine.
 

The rectum ends at the anus. 

45
 
Registered dietitian (dy-eh-TIH-shun): A health
 

professional with special training in the use of diet and
 

nutrition to keep the body healthy. A registered
 

dietitian may help the medical team improve the
 

nutritional health of a patient.
 

Reproductive system (REE-pruh-DUK-tiv): The organs
 

involved in producing offspring. In women, this system
 

includes the ovaries, the fallopian tubes, the uterus
 

(womb), the cervix, and the vagina (birth canal). In
 

men, it includes the prostate, the testes, and the penis.
 

Risk factor: Something that may increase the chance of
 

developing a disease. Some examples of risk factors
 

for cancer include age, a family history of certain
 

cancers, use of tobacco products, certain eating habits,
 

obesity, lack of exercise, exposure to radiation or other
 

cancer-causing agents, and certain genetic changes.
 

Scrotum (SKRO-tum): In males, the external sac that
 

contains the testicles.
 

Selenium (suh-LEE-nee-um): A mineral that is needed
 

by the body to stay healthy. It is being studied in the
 

prevention and treatment of some types of cancer.
 

Selenium is a type of antioxidant.
 

Semen: The fluid that is released through the penis
 

during orgasm. Semen is made up of sperm from the
 

testicles and fluid from the prostate and other sex
 

glands. 

Seminal fluid (SEM-in-al): Fluid from the prostate and
 

other sex glands that helps transport sperm out of the
 

man’s body during orgasm.
 

Seminal vesicle (SEM-in-al VES-ih-kul): A gland that
 

helps produce semen.
 

Side effect: A problem that occurs when treatment
 

affects healthy tissues or organs. Some common side
 

effects of cancer treatment are fatigue, pain, nausea,
 

vomiting, decreased blood cell counts, hair loss, and
 

mouth sores.
 

46
 
Sonogram (SON-o-gram): A computer picture of areas 

inside the body created by bouncing high-energy sound 

waves (ultrasound) off internal tissues or organs. Also 

called an ultrasonogram. 

Sperm: The male reproductive cell, formed in the 

testicle. A sperm unites with an egg to form an embryo. 

Sperm banking: Freezing sperm for use in the future. 

This procedure can allow men to father children after 

loss of fertility. 

Sperm retrieval (rih-TREE-vul): Removal of sperm 

from a man’s testis or epididymis by a doctor using a 

fine needle or another instrument. 

Supportive care: Care given to improve the quality of 

life of patients who have a serious or life-threatening 

disease. The goal of supportive care is to prevent or 

treat as early as possible the symptoms of the disease, 

side effects caused by treatment of the disease, and 

psychological, social, and spiritual problems related to 

the disease or its treatment. Also called palliative care, 

comfort care, and symptom management. 

Surgeon: A doctor who removes or repairs a part of the 

body by operating on the patient. 

Surgery (SER-juh-ree): A procedure to remove or 

repair a part of the body or to find out whether disease 

is present. An operation. 

Testicle (TES-tih-kul): One of two egg-shaped glands 

found inside the scrotum that produce sperm and male 

hormones. Also called a testis. 

Testosterone (tes-TOS-ter-own): A hormone that 

promotes the development and maintenance of male 

sex characteristics. 

Tissue (TISH-oo): A group or layer of cells that work 

together to perform a specific function. 

47
 
Total androgen blockade (AN-droh-jen): Therapy used 

to eliminate male sex hormones (androgens) in the 

body. This may be done with surgery, hormonal 

therapy, or a combination. 

Transrectal biopsy (TRANZ-REK-tul BY-op-see): A 

procedure in which a sample of tissue is removed from 

the prostate using a thin needle that is inserted through 

the rectum and into the prostate. Transrectal ultrasound 

(TRUS) is usually used to guide the needle. The 

sample is examined under a microscope to see if it 

contains cancer. 

Transrectal ultrasound (TRANZ-REK-tul UL-truhSOWND): TRUS. A procedure in which a probe that 

sends out high-energy sound waves is inserted into the 

rectum. The sound waves are bounced off internal 

tissues or organs and make echoes. The echoes form a 

picture of body tissue called a sonogram. TRUS is used 

to look for abnormalities in the rectum and nearby 

structures, including the prostate. Also called 

endorectal ultrasound and ERUS. 

Transurethral resection of the prostate (TRANZ-yooREE-thrul ree-SEK-shun...PROS-tayt): TURP. A 

surgical procedure to remove tissue from the prostate 

using an instrument inserted through the urethra. 

Triptorelin (trip-toh-REL-in): A drug that is used to 

treat advanced prostate cancer and is being studied in 

the treatment of breast cancer. It belongs to the family 

of hormonal drugs called gonadotropin-releasing 

hormone analogs. Also called Trelstar. 

Tumor (TOO-mer): An abnormal mass of tissue that 

results when cells divide more than they should or do 

not die when they should. Tumors may be benign (not 

cancerous) or malignant (cancerous). Also called 

neoplasm. 

48
 
Ultrasound (UL-truh-SOWND): A procedure in which
 

high-energy sound waves (ultrasound) are bounced off
 

internal tissues or organs and make echoes. The echo
 

patterns are shown on the screen of an ultrasound
 

machine, forming a picture of body tissues called a
 

sonogram. Also called ultrasonography. 

Urethra (yoo-REE-thruh): The tube through which
 

urine leaves the body. It empties urine from the
 

bladder.
 

Urinary incontinence (YOOR-in-air-ee in-KAHN-tihnens): Inability to hold urine in the bladder.
 

Urologic oncologist (YOOR-uh-LAH-jik on-KAH-lojist): A doctor who specializes in treating cancers of the
 

urinary system.
 

Urologist (yoo-RAH-loh-jist): A doctor who
 

specializes in diseases of the urinary organs in females
 

and the urinary and sex organs in males.
 

Vaccine: A substance or group of substances meant to
 

cause the immune system to respond to a tumor or to
 

microorganisms, such as bacteria or viruses. A vaccine
 

can help the body recognize and destroy cancer cells or
 

microorganisms.
 

Vasectomy (va-SEK-toh-mee): An operation to cut or
 

tie off the two tubes that carry sperm out of the
 

testicles.
 

Vitamin E: A substance used in cancer prevention. It
 

belongs to the family of drugs called tocopherols.
 

Watchful waiting: Closely monitoring a patient’s
 

condition but withholding treatment until symptoms
 

appear or change. Also called observation. 

X-ray: A type of high-energy radiation. In low doses,
 

x-rays are used to diagnose diseases by making
 

pictures of the inside of the body. In high doses, x-rays
 

are used to treat cancer.
 

49
 
National Cancer Institute Information 

Resources 

You may want more information for yourself, your 

family, and your doctor. The following NCI services 

are available to help you. 

Telephone 

NCI’s Cancer Information Service (CIS) provides 

accurate, up-to-date information about cancer to 

patients and their families, health professionals, and the 

general public. Information specialists translate the 

latest scientific information into plain language, and 

they will respond in English or Spanish, as well as 

through TRS providers for the hearing or speech 

impaired. Calls to the CIS are confidential and free. 

Telephone: 1–800–4–CANCER (1–800–422–6237) 

Internet 

NCI’s Web site provides information from numerous 

NCI sources. It offers current information about cancer 

prevention, screening, diagnosis, treatment, genetics, 

supportive care, and ongoing clinical trials. It has 

information about NCI’s research programs, funding 

opportunities, and cancer statistics. 

Web site: http://www.cancer.gov 

Spanish Web site: http://www.cancer.gov/espanol 

If you’re unable to find what you need on the Web 

site, contact NCI staff. Use the online contact form at 

http://www.cancer.gov/contact or send an email to 

cancergovstaff@mail.nih.gov. 

Also, information specialists provide live, 

online assistance through LiveHelp at 

http://www.cancer.gov/help. 

50
 
National Cancer Institute Publications 

NCI provides publications about cancer, including 

the booklets and fact sheets mentioned in this booklet. 

Many are available in both English and Spanish. 

You may order these publications by telephone, on 

the Internet, or by mail. You may also read them online 

and print your own copy. 

•	 By telephone: People in the United States and its 

territories may order these and other NCI 

publications by calling the NCI’s Cancer 

Information Service at 1–800–4–CANCER. 

•	 On the Internet: Many NCI publications may be 

viewed, downloaded, and ordered from 

http://www.cancer.gov/publications on the 

Internet. People in the United States and its 

territories may use this Web site to order printed 

copies. This Web site also explains how people 

outside the United States can mail or fax their 

requests for NCI booklets. 

•	 By mail: NCI publications may be ordered by 

writing to the address below:
 

Publications Ordering Service
 

National Cancer Institute
 

P.O. Box 24128
 

Baltimore, MD 21227
 

PSA Test and Prostate Changes 

•	 The Prostate-Specific Antigen (PSA) Test: Questions 

and Answers 

•	 Understanding Prostate Changes: A Health Guide 

for Men 

51
 
Prostate Cancer 

•	 Treatment Choices for Men with Early-Stage 

Prostate Cancer 

•	 Early Prostate Cancer: Questions and Answers 

•	 What You Need To Know AboutTM Prostate Cancer 

(also in Spanish) 

Clinical Trials 

•	 Taking Part in Cancer Treatment Research Studies 

Finding a Doctor, Support Groups, or Other 

Organizations 

•	 How To Find a Doctor or Treatment Facility If You 

Have Cancer (also in Spanish) 

•	 Cancer Support Groups: Questions and Answers 

•	 National Organizations That Offer Services to 

People With Cancer and Their Families (also in 

Spanish) 

Cancer Treatment and Supportive Care 

•	 Radiation Therapy and You (also in Spanish) 

•	 Understanding Radiation Therapy: What To Know 

About External Beam Radiation Therapy (also in 

Spanish) 

•	 Understanding Radiation Therapy: What To Know 

About Brachytherapy (A Type of Internal Radiation 

Therapy) (also in Spanish) 

•	 Chemotherapy and You (also in Spanish) 

•	 Cryosurgery in Cancer Treatment: Questions and 

Answers 

•	 Eating Hints for Cancer Patients (also in Spanish) 

•	 Pain Control (also in Spanish) 

52
 
Coping with Cancer 

•	 Taking Time: Support for People with Cancer 

•	 Managing Radiation Therapy Side Effects: What 

Men Can Do About Changes in Sexuality and 

Fertility Side Effects (also in Spanish) 

•	 Managing Radiation Therapy Side Effects: What To 

Do About Changes When You Urinate (also in 

Spanish) 

•	 Managing Radiation Therapy Side Effects: What To 

Do When You Feel Weak or Tired (Fatigue) (also in 

Spanish) 

Life After Cancer Treatment 

•	 Facing Forward: Life After Cancer Treatment (also 

in Spanish) 

•	 Follow-up Care After Cancer Treatment: Questions 

and Answers 

•	 Facing Forward: Ways You Can Make a Difference 

in Cancer 

Advanced or Recurrent Cancer 

•	 Coping With Advanced Cancer 

•	 When Cancer Returns 

Complementary Medicine 

•	 Thinking about Complementary & Alternative 

Medicine: A guide for people with cancer 

•	 Complementary and Alternative Medicine in Cancer 

Treatment: Questions and Answers (also in Spanish) 

53
 
Caregivers 

•	 When Someone You Love Is Being Treated for 

Cancer: Support for Caregivers 

•	 When Someone You Love Has Advanced Cancer: 

Support for Caregivers 

•	 Facing Forward: When Someone You Love Has 

Completed Cancer Treatment 

•	 Caring for the Caregiver: Support for Cancer 

Caregivers 

54
 
The National Cancer Institute 

The National Cancer Institute (NCI), part of the 

National Institutes of Health, is the Federal 

Government’s principal agency for cancer research 

and training. NCI conducts and supports basic and 

clinical research to find better ways to prevent, 

diagnose, and treat cancer. The Institute also supports 

education and training for cancer research and 

treatment programs. In addition, NCI is responsible 

for communicating its research findings to the 

medical community and the public. 

Copyright permission 

You must have permission to use or reproduce the 

artwork in this booklet for other purposes. The 

artwork was created by private sector illustrators, 

designers, and/or photographers, and they retain the 

copyrights to artwork they develop under contract to 

NCI. In many cases, artists will grant you permission, 

but they may require a credit line and/or usage fees. 

To inquire about permission to reproduce NCI 

artwork, please write to: 

Office of Communications and Education 

National Cancer Institute 

6116 Executive Boulevard, Room 3066 

MSC 8323 

Rockville, MD 20892–8323 

You do not need our permission to reproduce or 

translate NCI written text. The written text of this 

NCI booklet is in the public domain, and it is not 

subject to copyright restrictions. However, we would 

appreciate a credit line and a copy of your translation 

of this NCI booklet. 
NIH Publication No. 08-1576
 

Revised September 2008
 

Printed September 2008