Understanding

Prostate Changes

A Health Guide for Men

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U.S. DEPARTMENT

OF HEALTH AND

HUMAN SERVICES

National Institutes

of Health
Table of Contents

Introduction to the Prostate .................................................1

What is the prostate? ................................................................2

How does the prostate change as you get older? .....................3

What prostate changes should you be aware of?.....................4

Prostate Changes That Are Not Cancer.................................5

What is prostatitis and how is it treated? ................................5

What is enlarged prostate or BPH?...........................................9

How is BPH treated?................................................................11

Prostate Cancer....................................................................17

Things to know .......................................................................17

Symptoms................................................................................19

Risk factors ..............................................................................19

Can prostate cancer be prevented?.........................................20

Prostate cancer screening........................................................21

Talking With Your Doctor ....................................................22

Types of Tests .......................................................................23

Health history and current symptoms ...................................23

Digital rectal exam (DRE)........................................................23

Prostate-specific antigen (PSA) test.........................................24

What do PSA results mean? ....................................................25

Free PSA test ............................................................................25

Prostate biopsy ........................................................................26

If a biopsy is positive ..............................................................26

Checklist of questions to ask your doctor..............................28

For More Information ..........................................................29

Words to Know ....................................................................31
Introduction to the Prostate

You may be reading this booklet because you are having prostate

problems. The booklet can help answer your questions about

prostate changes, such as: 

n What are common prostate changes? 

n How are these changes treated? 

n What do I need to know about testing for prostate

changes, including cancer? 

This booklet can give you basic information about common

prostate changes. If you are making decisions about prostate

cancer treatment, there are other resources available. See the 

“For More Information” section on page 29.

1

Important words are in bold, and their meanings

are listed in the “Words to Know” section on 

page 31.
What is the prostate?

The prostate is a small gland in men. It is part of the male

reproductive system. 

The prostate is about the size and shape of a walnut. It sits low in

the pelvis, below the bladder and just in front of the rectum.

The prostate helps make semen, the milky fluid that carries sperm

from the testicles through the penis when a man ejaculates. 

The prostate surrounds part of the urethra, a tube that carries

urine out of the bladder and through the penis.

How does the prostate change as you get older?

Because the prostate gland tends to grow larger with age, it may

squeeze the urethra and cause problems in passing urine.

Sometimes men in their 30s and 40s may begin to have these

urinary symptoms and need medical attention. For others,

symptoms aren't noticed until much later in life. An infection or

a tumor can also make the prostate larger. Be sure to tell your

doctor if you have any of the urinary symptoms listed below.

2 3

Tell your doctor if you have these 

urinary symptoms: 

n Are passing urine more during the day 

n Have an urgent need to pass urine 

n Have less urine flow 

n Feel burning when you pass urine 

n Need to get up many times during the night to

pass urine
4

Prostate Changes That Are Not Cancer

What is prostatitis and how is it treated? 

Prostatitis is an inflammation of the prostate gland that may

result from a bacterial infection. It affects at least half of all men at

some time during their lives. Having this condition does not

increase your risk of any other prostate disease.

5

What prostate changes should you 

be aware of?

Growing older raises your risk of prostate problems. The three

most common prostate problems are:

n Inflammation (prostatitis) 

n Enlarged prostate (BPH, or benign prostatic

hyperplasia) 

n Prostate cancer 

One change does not lead to another. For example, having

prostatitis or an enlarged prostate does not increase your risk of

prostate cancer. It is also possible for you to have more than one

condition at the same time.

Most prostate changes are not cancer.

Prostatitis Symptoms

n Trouble passing urine 

n A burning or stinging feeling or pain when passing urine 

n Strong, frequent urge to pass urine, even when there is

only a small amount of urine 

n Chills and high fever 

n Low back pain or body aches 

n Pain low in the belly, in the groin, or behind the scrotum

n Rectal pressure or pain 

n Urethral discharge with bowel movements 

n Genital and rectal throbbing 

n Sexual problems and loss of sex drive 

n Painful ejaculation (sexual climax) 
n Chronic prostatitis/chronic pelvic pain syndrome

This disorder is the most common but least understood type of

prostatitis. Found in men of any age from late teens to the elderly,

its symptoms can come and go without warning. There can be

pain or discomfort in the groin or bladder area. Infection-fighting

cells are often present, even though no bacteria can be found.

Treatment: There are several different treatments for this

problem, based on your symptoms. These include

anti-inflammatory medications and other pain

control treatments, such as warm baths. Other

medicines, such as alpha-blockers, may also be

given. Alpha-blockers relax muscle tissue in the

prostate to make passing urine easier. Some men are

treated with antibiotics in case the symptoms are

caused by an undetected infection.

n Asymptomatic inflammatory prostatitis

You don’t have symptoms with this condition. It is often found

when you are undergoing tests for other conditions, such as to

determine the cause of infertility or to look for prostate cancer. If

you have this form of prostatitis, your PSA test (see “PSA test” on

page 24) may show a higher number than normal.

Treatment: Men with this condition are usually not treated, but

a repeat PSA test will usually be done if the PSA

number is high. 

6

Several tests, such as DRE and a urine test, can be done to see if

you have prostatitis. Correct diagnosis of your exact type of

prostatitis is key to getting the best treatment. Even if you have no

symptoms you should follow your doctor’s advice to complete

treatment. 

There are four types of prostatitis:

n Acute bacterial prostatitis

This type is caused by a bacterial infection and comes on

suddenly (acute). Symptoms include severe chills and fever. There

is often blood in the urine. Your PSA level (see “PSA test” on page

24) may be higher than normal. You must go to the doctor’s office

or emergency room for treatment. It’s the least common of the

four types, yet it’s the easiest to diagnose and treat.

Treatment: Most cases can be cured with a high dose of

antibiotics, taken for 7 to 14 days, and then lower

doses for several weeks. You may also need drugs to

help with pain or discomfort. If your PSA level was

high, it will likely return to normal once the

infection is cleared up. 

n Chronic bacterial prostatitis

Also caused by bacteria, this type of prostatitis doesn’t come on

suddenly, but it can be bothersome. The only symptom you may

have is bladder infections that keep coming back. The cause may be a

defect in the prostate that lets bacteria collect in the urinary tract.

Treatment: Antibiotic treatment over a longer period of time is

best for this type. Treatment lasts from 4 to 12 weeks.

This type of treatment clears up about 60 percent of

cases. Long-term, low-dose antibiotics may help

relieve symptoms in cases that won’t clear up. 

7
What is enlarged prostate or BPH?

BPH stands for benign prostatic hyperplasia.

Benign means “not cancer,” and hyperplasia means abnormal

cell growth. The result is that the prostate becomes enlarged. BPH

is not linked to cancer and does not increase your risk of getting

prostate cancer—yet the symptoms for BPH and prostate cancer

can be similar. 

9

“Changes happen so slowly that you don’t

even realize they’re happening.”

BPH Symptoms

BPH symptoms usually start after the age of 50. 

They can include: 

n Trouble starting a urine stream or making more than a dribble 

n Passing urine often, especially at night 

n Feeling that the bladder has not fully emptied 

n A strong or sudden urge to pass urine 

n Weak or slow urine stream 

n Stopping and starting again several times while passing urine 

n Pushing or straining to begin passing urine 

At its worst, BPH can lead to: 

n A weak bladder 

n Backflow of urine, causing bladder or kidney infections 

n Complete block in the flow of urine 

n Kidney failure
10 11

How is BPH treated?

Some men with BPH eventually find their symptoms to be

bothersome enough to need treatment. BPH cannot be cured, but

drugs or surgery can often relieve its symptoms. 

There are three ways to manage BPH:

n Watchful waiting (regular follow-up with your doctor) 

n Drug therapy 

n Surgery 

Talk with your doctor about the best choice for you. Your

symptoms may change over time, so be sure to tell your doctor

about any new changes.

Watchful waiting

Men with mild symptoms of BPH who do not find them

bothersome often choose this approach.

Watchful waiting means getting annual check-ups. The check-ups

can include DREs and other tests (see “Types of Tests” on page 23).

Treatment is started only when the symptoms become too much

of a problem.

If you choose watchful waiting, these simple steps may help lessen

your symptoms:

n Limit drinking in the evening, especially drinks with

alcohol or caffeine. 

n Empty your bladder all the way when you pass urine. 

n Use the restroom often. Don’t wait for long periods

without passing urine. 

BPH affects most men as they get older. It can lead to urinary

problems like those with prostatitis. BPH rarely causes symptoms

before age 40, but more than half of men in their 60s and most

men in their 70s and 80s will have signs of BPH. 

The prostate gland is about the size of a walnut when a man is in

his 20s. By the time he is 40, it may have grown slightly larger, to

the size of an apricot. By age 60, it may be the size of a lemon. 

The enlarged prostate can press against the bladder and the urethra.

This can slow down or block urine flow. Some men might find it

hard to start a urine stream, even though they feel the need to go.

Once the urine stream has started, it may be hard to stop. Other

men may feel like they need to pass urine all the time, or they are

awakened during sleep with the sudden need to pass urine. 

Early BPH symptoms take many years to turn into bothersome

problems. These early symptoms are a cue to see your doctor. 

Urine flow in a normal (left) and enlarged (right) prostate. In diagram on

the left, urine flows freely. On the right, urine flow is affected because the

enlarged prostate is pressing on the bladder and urethra.
Some medications can make BPH symptoms worse, so talk with

your doctor or pharmacist about any medicines you are taking,

such as:

n Over-the-counter cold and cough medicines (especially

antihistamines) 

n Tranquilizers 

n Antidepressants

n Blood pressure medicine 

Your doctor may be able to prescribe other medication that does

not increase BPH symptoms.

Drug therapy

Many American men with mild to moderate BPH symptoms have

chosen prescription drugs over surgery since the early 1990s.

Two main types of drugs are used. One type relaxes muscles near

the prostate, and the other type shrinks the prostate gland. Some

evidence shows that taking both drugs together may work best to

keep BPH symptoms from getting worse.

n Alpha-blockers

These drugs (see the table on page 14) help relax muscles near the

prostate to relieve pressure and let urine flow more freely, but they

don’t shrink the size of the prostate. For many men, these drugs can

improve urine flow and reduce the symptoms of BPH within days.

Possible side effects include dizziness, headache, and fatigue.

n 5-alpha reductase inhibitors

These drugs (see the table on page 14) help shrink the prostate.

They relieve symptoms by blocking the activity of an enzyme

known as 5-alpha reductase. This enzyme changes the male

hormone testosterone into dihydrotestosterone (DHT), which

stimulates prostate growth. When the action of 5-alpha reductase

is blocked, DHT production is lowered and prostate growth slows.

13

“My doctor and I decide visit by visit about

how long I should stay on watchful waiting

for my BPH.”
Surgery

The number of prostate surgeries has gone down over the years.

But operations for BPH are still among the most common surgeries

for American men. Surgery is used when symptoms are severe or

drug therapy has not worked well.

Types of surgery for BPH include:

n TURP (transurethral resection of the prostate). The most

common surgery for BPH, TURP accounts for 90 percent of all

BPH surgeries. The doctor passes an instrument through the

urethra and trims away extra prostate tissue. A spinal block

(anesthesia) is used to numb the area. Tissue is sent to the

laboratory to check for prostate cancer. 

TURP generally avoids the two main dangers linked to another

type of surgery called open prostatectomy (complete removal

of the prostate gland through a cut in the lower abdomen):

• Incontinence (not being able to hold in urine) 

• Impotence (not being able to have an erection)

However, TURP can have serious side effects, such as bleeding.

In addition, men may have to stay in the hospital and need a

catheter for a few days after surgery.

n TUIP (transurethral incision of the prostate). This surgery,

which is similar to TURP, is used on slightly enlarged prostate

glands. The surgeon places one or two small cuts in the

prostate. This relieves pressure without trimming away tissue.

It has a low risk of side effects. Like TURP, this treatment helps

with urine flow by widening the urethra.

n TUNA (transurethral needle ablation). Radio waves are used

to burn away excess prostate tissue. TUNA helps with urine

flow, relieves symptoms, and may have fewer side effects than

TURP. Most men need a catheter to drain urine for a period of

time after the procedure.

This helps shrink the prostate, reduce blockage, and limit the need

for surgery. 

Taking these drugs can help increase urine flow and reduce your

symptoms. You must continue to take these drugs to prevent

symptoms from coming back.

5-alpha reductase inhibitors can cause the following side effects in

a small percentage of men:

n Decreased interest in sex 

n Trouble getting or keeping an erection

n Smaller amount of semen with ejaculation 

It’s important to note that taking these drugs may lower your PSA

test number. There is also evidence that these drugs lower the risk

of getting prostate cancer, but whether they can help lower the

risk of dying from prostate cancer is still unclear. 

14 15

BPH Medications

Category

Alpha-blockers

5-alpha

reductase

inhibitors

Activity

Relax muscles

near prostate

Slows prostate 

growth, shrinks

prostate

Generic Name

alfuzosin

doxazosin

silodosin

tamsulosin

terazosin

finasteride

dutasteride

Brand Name

Uroxatral

Cardura

Rapaflo

Flomax

Hytrin

Proscar or

Propecia

Avodart
Prostate Cancer

Things to know

Prostate cancer means that cancer cells form in the tissues of the

prostate. It is the most common cancer in American men after

skin cancer.

Prostate cancer tends to grow slowly compared with most other

cancers. Cell changes may begin 10, 20, or even 30 years before a

tumor gets big enough to cause symptoms. Eventually, cancer cells

may spread (metastasize) throughout the body. By the time

symptoms appear, the cancer may already be advanced. 

By age 50, very few men have symptoms of prostate cancer, yet

some precancerous or cancer cells may be present. More 

than half of all American men have some cancer in their prostate

glands by the age of 80. Most of these cancers never pose a

problem. They may never cause symptoms or become a serious

threat to health. 

Most men with prostate cancer do not die from this disease.

16

n TUMT (transurethral microwave thermotherapy).

Microwaves sent through a catheter are used to destroy excess

prostate tissue. This can be an option for men who should not

have major surgery because they have other medical problems.

n TUVP (transurethral electroevaporation of the prostate).

An electrical current is used to vaporize prostate tissue.

n Laser surgery. The doctor passes a laser fiber through the

urethra into the prostate, using a cystoscope, and then

delivers several bursts of laser energy. The laser energy destroys

prostate tissue and helps improve urine flow. Like TURP, laser

surgery requires anesthesia. One advantage of laser surgery

over TURP is that laser surgery causes little blood loss. The

recovery period for laser surgery may be shorter too. However,

laser surgery may not be effective on larger prostates. 

n Open prostatectomy. This may be the only option in rare

cases, such as when the obstruction is severe, the prostate is

very large, or other procedures can’t be done. General

anesthesia or a spinal block is used, and a catheter remains 

for 3 to 7 days after the surgery. This surgery carries the

highest risk of complications. Tissue is sent to the laboratory

to check for prostate cancer.

Be sure to discuss options with your doctor and ask about the

potential short- and long-term benefits and risks with each

procedure. For a list of questions to ask, see the “Checklist of

Questions for Your Doctor” on page 28. 

17

n About 16 percent of American men are diagnosed with

prostate cancer at some point in their lives. 

n About 3 percent of American men will die of prostate cancer.
Symptoms

The symptoms of prostate cancer can be similar to the symptoms

of BPH. 

Prostate cancer can spread to the lymph nodes of the pelvis. 

Or it may spread throughout the body. It tends to spread to the

bones. So bone pain, especially in the back, can be a symptom 

of advanced prostate cancer.

Risk factors

Some risk factors have been linked to prostate cancer. A risk factor 

is something that can raise your chance of developing a disease.

Having one or more risk factors doesn’t mean that you will get 

prostate cancer. It just means that your risk of the disease is greater.

n Age. Men who are 50 or older have a higher risk of 

prostate cancer. 

n Race. African-American men have the highest risk of prostate

cancer—the disease tends to start at younger ages and grows

19

“When I first learned I might have a prostate

problem, I was afraid it was cancer.”

Prostate Cancer Symptoms

n Trouble passing urine 

n Frequent urge to pass urine, especially at night 

n Weak or interrupted urine stream 

n Pain or burning when passing urine 

n Blood in the urine or semen 

n Painful ejaculation 

n Nagging pain in the back, hips, or pelvis
20 21

Prostate Cancer Screening 

Screening means testing for cancer before you have any

symptoms. A screening test may help find cancer at an early

stage, when it is less likely to have spread and may be easier

to treat. By the time symptoms appear, the cancer may have

started to spread. 

The most useful screening tests are those that have been

proven to lower a person’s risk of dying from cancer. Doctors

do not yet know whether prostate cancer screening lowers the

risk of dying from prostate cancer. Therefore, large research

studies, with thousands of men, are now going on to study

prostate cancer screening. The National Cancer Institute is

studying the combination of PSA testing and DRE as a way 

to get more accurate results.

Although some people feel it is best to treat any cancer that is

found, including cancers found through screening, prostate

cancer treatment can cause serious and sometimes permanent

side effects. Some doctors are concerned that many men

whose cancer is detected by screening are being treated—

and experiencing side effects—unnecessarily.

Talk with your doctor about your risk 

of prostate cancer and your need for 

screening tests.

faster than in men of other races. After African-American men,

prostate cancer is most common among white men, followed

by Hispanic and Native American men. Asian-American men

have the lowest rates of prostate cancer. 

n Family history. Men whose fathers or brothers have had

prostate cancer have a 2 to 3 times higher risk of prostate

cancer than men who do not have a family history of the

disease. A man who has 3 immediate family members with

prostate cancer has about 10 times the risk of a man who does

not have a family history of prostate cancer. The younger a

man’s relatives are when they have prostate cancer, the greater

his risk for developing the disease. Prostate cancer risk also

appears to be slightly higher for men from families with a

history of breast cancer. 

n Diet. The risk of prostate cancer may be higher for men who

eat high-fat diets. 

Can prostate cancer be prevented?

Large research studies are looking at how prostate cancer can be

prevented. Studies have shown that 5-alpha reductase inhibitors

finasteride and dutasteride can lower the risk of developing

prostate cancer, but whether they can decrease the risk of dying 

of prostate cancer is still unclear. 

To find out more, see the “For More Information” section on 

page 29. 
Types of Tests

These types of tests are most often used to check the prostate:

Health history and current symptoms

This first step lets your doctor hear and understand the “story” 

of your prostate concerns. You’ll be asked whether you have

symptoms, how long you’ve had them, and how much they affect

your lifestyle. Your personal medical history also includes any

risk factors, pain, fever, or trouble passing urine. You may be asked

to give a urine sample for testing.

Digital rectal exam (DRE)

DRE is a standard way to check the prostate. With a gloved and

lubricated finger, your doctor feels the prostate from the rectum.

The test lasts about 10-15 seconds. 

This exam checks for:

n The size, firmness, and texture of the prostate 

n Any hard areas, lumps, or growth spreading beyond the

prostate 

n Any pain caused

by touching or

pressing the

prostate 

The DRE allows the doctor

to feel only one side of the

prostate. A PSA test is

another way to help your

doctor check the health of

your prostate.

22

Talking With Your Doctor

Different kinds of doctors and other health care professionals

manage prostate health. They can help you find the best care,

answer your questions, and address your concerns. These health

care professionals include:

n Family doctors and internists 

n Physician assistants (PAs) and nurse practitioners (NPs) 

n Urologists, who are experts in diseases of the urinary tract

system and the male reproductive system

n Urologic oncologists, who are experts in treating cancers 

of the urinary system and the male reproductive system 

n Radiation oncologists, who use radiation therapy to 

treat cancer

n Medical oncologists, who treat cancer with medications

such as hormone treatments and chemotherapy 

n Pathologists, who identify diseases by studying cells and

tissues under a microscope 

View these professionals as your partners—expert advisors and

helpers in your health care. Talking openly with your doctors 

can help you learn more about your prostate changes and the 

tests to expect. 

23

It is a good idea to get a copy of your pathology report

from your doctor and carry it with you as you talk with

your health care providers. 
What do PSA results mean?

PSA levels are measured in terms of the amount of PSA per volume

of fluid tested. Doctors often use a value of 4 nanograms (ng) or

higher per milliliter of blood as a sign that further tests, such as a

prostate biopsy, are needed.

Your doctor may monitor your PSA velocity, which means the rate

of change in your PSA level over time. Rapid increases in PSA

readings may suggest cancer. If you have a mildly elevated PSA

level, you and your doctor may choose to do PSA tests on a

scheduled basis and watch for any change in the PSA velocity. 

Free PSA test

This test is used for men who have higher PSA levels. The standard

PSA test measures total PSA, which includes both PSA that is

attached, or bound, to other proteins and PSA that is free, or not

bound. The free PSA test measures free PSA only. Free PSA is linked

to benign prostate conditions, such as BPH, whereas bound PSA is

linked to cancer. The percentage of free PSA can help tell what

kind of prostate problem you have.

n If both total PSA and free PSA are higher than normal

(high percentage of free PSA), this suggests BPH rather 

than cancer. 

n If total PSA is high but free PSA is not (low percentage of

free PSA), cancer is more likely. More testing, such as a

biopsy, should be done. 

You and your doctor should talk about your personal risk and free

PSA results. Then you can decide together whether to have followup biopsies and, if so, how often.

25

Prostate-specific antigen (PSA) test

The U.S. Food and Drug Administration (FDA) has approved

the use of the PSA test along with a DRE to help detect prostate

cancer in men age 50 and older. 

PSA is a protein made by prostate cells. It is normally secreted

into ducts in the prostate, where it helps make semen, but

sometimes it leaks into the blood. When PSA is in the blood, 

it can be measured with a blood test called the PSA test. 

In prostate cancer, more PSA gets into the blood than is normal.

However, a high PSA blood level is not proof of cancer, and many

other things can cause a false-positive test result. For example,

blood PSA levels are often increased in men with prostatitis or

BPH. Even things that disturb the prostate gland—such as riding 

a bicycle or motorcycle, or having a DRE, an orgasm within the

past 24 hours, a prostate biopsy, or prostate surgery—may

increase PSA levels. 

Also, some prostate glands naturally produce more PSA than

others. PSA levels go up with age. African-American men tend to

have higher PSA levels in general than men of other races. And

some drugs, such as finasteride and dutasteride, can cause a man’s

PSA level to go down.

PSA tests are often used to follow men after prostate cancer

treatment to check for signs of cancer recurrence. 

It is not yet known for certain whether PSA testing to screen for

prostate cancer can reduce a man’s risk of dying from the disease.

Researchers are working to learn more about:

n The PSA test’s ability to help doctors tell the difference

between prostate cancer and benign prostate problems 

n The best thing to do if a man has a high PSA level 

For now, men and their doctors use PSA readings over time as a

guide to see if more follow-up is needed. 

24
26

Treatment options depend on the stage (or extent) of the cancer

(stages range from 1 to 4), Gleason score, PSA level, and your age

and general health. This information will be available from your

doctor and is listed on your pathology report.

Reaching a decision about treatment of your prostate cancer is a

complex process. Many men find it helpful to talk with their doctors,

family, friends, and other men who have faced similar decisions. 

Prostate biopsy

If your symptoms or test results suggest prostate cancer, your

doctor will refer you to a specialist (a urologist) for a prostate

biopsy. A biopsy is usually done in the doctor's office.

For a biopsy, small tissue samples are taken directly from the

prostate. Your doctor will take samples from several areas of the

prostate gland. This can help lower the chance of missing any

areas of the gland that may have cancer cells. Like other cancers,

prostate cancer can be diagnosed only by looking at tissue under 

a microscope.

Most men who have biopsies after prostate cancer screening exams

do not have cancer.

If a biopsy is positive

A positive test result after a biopsy means prostate cancer is

present. A pathologist will check your biopsy sample for cancer

cells and will give it a Gleason score. The Gleason score ranges

from 2 to 10 and describes how likely it is that a tumor will

spread. The lower the number, the less aggressive the tumor is

and the less likely it will spread. 

“While it’s important to make your own decision

about cancer screening, everybody should

consider getting a second opinion before 

getting something like a biopsy.”

“There is no magic PSA level below which a man can be assured of

having no risk of prostate cancer or above which a biopsy should

automatically be performed. A man’s decision to have a prostate

biopsy requires a thoughtful discussion with his physician,

considering not only the PSA level, but also his other risk factors,

his overall health status, and how he perceives the risks and

benefits of early detection.”

—Dr. Howard Parnes, Chief of the Prostate and Urologic Cancer Research

Group, Division of Cancer Prevention, National Cancer Institute
For More Information

National Cancer Institute

National Cancer Institute Services

NCI has comprehensive research-based information on cancer

prevention, screening, diagnosis, treatment, genetics, and

supportive care. We also have a clinical trials database and can

offer tailored searches. 

Phone ....................1-800-4-CANCER (1-800-422-6237)

TTY ........................1-800-332-8615

Web site................www.cancer.gov or 

www.cancer.gov/espanol

LiveHelp ................www.cancer.gov/livehelp

Email......................cancergovstaff@mail.nih.gov

Order publications at www.cancer.gov/publications or by calling 1-

800-4-CANCER

Get help with quitting smoking at 1-877-44U-QUIT (1-877-448-7848).

Free resources to ask for include:

• NCI Fact Sheet: Prostate-Specific Antigen (PSA) Test

• What You Need To Know About Prostate Cancer

• Treatment Choices for Men With Early-Stage Prostate Cancer

We invite you to call or go online to talk with our trained

information specialists, who speak English or Spanish, to:

• Get answers to any cancer-related questions you may have

• Get free NCI publications

• Learn more about specific resources and organizations in

your area

• Find information on the NCI Web site, www.cancer.gov

28 29

Checklist of questions to ask your doctor

n What type of prostate problem do I have? 

n Is more testing needed and what will it tell me? 

n If I decide on watchful waiting, what changes in my

symptoms should I look for and how often should I be

tested? 

n What type of treatment do you recommend for my prostate

problem? 

n For men like me, has this treatment worked? 

n How soon would I need to start treatment and how long

would it last? 

n Do I need medicine and how long would I need to take it

before seeing improvement in my symptoms? 

n What are the side effects of the medicine? 

n Are there other medicines that could interfere with this

medication? 

n If I need surgery, what are the benefits and risks? 

n Would I have any side effects from surgery that could affect

my quality of life? 

n Are these side effects temporary or permanent? 

n How long is recovery time after surgery? 

n Will I be able to fully return to normal? 

n How will this affect my sex life? 

n How often should I visit the doctor to monitor my condition? 
Words to Know

5-alpha reductase inhibitor: A drug that shrinks the prostate gland,

used to treat BPH.

acute: Symptoms or signs that begin and get worse quickly. The opposite

of acute is chronic.

aggressive: A quickly growing cancer.

alcohol: A chemical substance found in beer, wine, and liquor. Alcohol

is also found in some medicines, mouthwashes, essential oils (scented

liquid taken from plants), and household products.

alpha-blockers: Drugs that relax muscles in the prostate. Alphablockers are used to treat BPH.

anesthesia: A loss of feeling or awareness caused by drugs or other

substances. Anesthesia keeps patients from feeling pain during surgery or

other procedures. Local anesthesia is a loss of feeling in one small area of

the body. Regional anesthesia is a loss of feeling in a part of the body,

such as an arm or leg. General anesthesia is a loss of feeling and a

complete loss of awareness that feels like a very deep sleep.

antibiotic: A drug used to treat infections caused by bacteria and other

microorganisms.

antidepressants: Drugs used to treat depression.

antihistamine: A type of drug that blocks the action of histamines,

which can cause fever, itching, sneezing, a runny nose, and watery eyes.

Antihistamines are used to prevent fevers in patients receiving blood

transfusions and to treat allergies, coughs, and colds.

asymptomatic: Having no signs or symptoms of disease.

bacteria: A large group of single-cell microorganisms. Some cause

infections and disease in animals and humans. The singular of bacteria is

bacterium.

benign: Not cancerous. Benign tumors do not spread to tissues around

them or to other parts of the body. 

biopsy: The removal of cells or tissues from the body for examination

under a microscope. When doctors remove only a sample of tissue, it is

called an incisional biopsy or core biopsy. When a whole tumor or lesion

31

Other Federal Resources

Centers for Disease Control and Prevention (CDC)

Phone ....................1-800-CDC-INFO (800-232-4636)

TTY ........................1-888-232-6348

E-mail ....................cdcinfo@cdc.gov

Web site................www.cdc.gov/cancer/prostate

Free booklets that are available include:

• Prostate Cancer Screening: A Decision Guide 

• Prostate Cancer Screening: A Decision Guide for 

African Americans

• La Detección del Cáncer de Próstata: Una Guía 

para Hispanos en los Estados Unidos

Medicare

For information about Medicare benefits, contact:

Phone ....................1-800-MEDICARE (1-800-633-4227)

TTY ........................1-877-486-2048

Web site................www.cms.hhs.gov

The National Institute of Diabetes and Digestive

and Kidney Diseases (NIDDK)

NIDDK conducts and supports basic and clinical research on many

of the most serious diseases affecting public health.

National Kidney and Urologic Diseases Information

Clearinghouse is a service of NIDDK. They have free booklets 

on prostate problems, conditions, and research.

Phone ....................1-800-891-5390

Web site................www.niddk.nih.gov

30
muscle growth. High amounts of dihydrotestosterone may increase the

growth of prostate cancer and make it harder to treat. Also called

androstanolone and DHT.

discharge: In medicine, a fluid that comes out of the body. Discharge

can be normal or a sign of disease.

DRE (digital rectal examination): An examination in which a

doctor inserts a lubricated, gloved finger into the rectum to feel for

abnormalities.

duct: In medicine, a tube or vessel of the body through which fluids pass.

dutasteride: A drug used to treat symptoms of an enlarged prostate

gland. It is being studied in the treatment of male hair loss and prostate

cancer. Dutasteride blocks enzymes the body needs to make male sex

hormones. It is a type of 5-alpha reductase inhibitor. Also called Avodart

and GG745.

ejaculation: The release of semen through the penis during orgasm. 

enzyme: A protein that speeds up chemical reactions in the body.

erection: When the penis temporarily gets longer, thicker, and harder.

This happens because the nervous system increases the blood flow to the

veins and spongy tissues of the penis.

false-positive test result: A test result that indicates that a person has

a specific disease or condition when the person actually does not have

the disease or condition.

family history: A record of the relationships among family members

along with their medical histories. This includes current and past

illnesses. A family history may show a pattern of certain diseases in a

family. Also called family medical history.

(FDA) Food and Drug Administration: An agency in the U.S. federal

government whose mission is to protect public health by making sure

that food, cosmetics, and nutritional supplements are safe to use and

truthfully labeled. The Food and Drug Administration also makes sure

that drugs, medical devices, and equipment are safe and effective, and

that blood for transfusions and transplant tissue are safe. 

free PSA: A test that reports the percentage of free PSA (relative to total

PSA) in a man’s blood. Free PSA is a form of PSA that is not attached to

another protein. Levels of both free and attached PSA tend to be higher

in men with BPH, whereas levels of attached but not free PSA are

33

is removed, it is called an excisional biopsy. When doctors use a needle to

remove a sample of tissue or fluid, it is called a needle biopsy or fineneedle biopsy.

bladder: The organ that stores urine.

blood pressure: The force of circulating blood on the walls of the

arteries. Blood pressure is taken using two measurements: systolic

(measured when the heart beats, when blood pressure is at its highest)

and diastolic (measured between heart beats, when blood pressure is at its

lowest). Blood pressure is written with the systolic blood pressure first,

followed by the diastolic blood pressure (for example 120/80).

BPH (benign prostatic hyperplasia): A benign (not cancer)

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.

breast cancer: Cancer that forms in tissues of the breast, usually the ducts

(tubes that carry milk to the nipple) and lobules (glands that make milk). It

occurs in both men and women, although male breast cancer is rare.

caffeine: A substance found in the leaves and beans of the coffee tree, in

tea, yerba mate, guarana berries, and in small amounts in cocoa. It can

also be made in the laboratory, and is added to some soft drinks, foods,

and medicines. Caffeine increases brain activity, alertness, attention, and

energy. It may also increase blood pressure, heart rate, breathing rate, and

the loss of water from the body in urine.

catheter: A flexible tube used to deliver fluids into or withdraw fluids

from the body.

chronic: A disease or condition that stays bad or gets worse over a long

period of time.

complication: In medicine, a medical problem that occurs during a

disease, or after a procedure or treatment. The complication may be caused

by the disease, procedure, or treatment or may be unrelated to them.

cystoscope: A thin, tube-like instrument used to look inside the bladder

and urethra. A cystoscope has a light and a lens for viewing and may

have a tool to remove tissue.

dihydrotestosterone: A hormone made from testosterone in the

prostate, testes, and certain other tissues. It is needed to develop and

maintain male sex characteristics, such as facial hair, deep voice, and

32
laser: A device that concentrates light into an intense, narrow beam used

to cut or destroy tissue. It is used in microsurgery, photodynamic therapy,

and for a variety of diagnostic purposes.

lubricant: An oily or slippery substance.

lubricated: See lubricant.

lymph node: A rounded mass of lymphatic tissue that is surrounded by

a capsule of connective tissue. Lymph nodes filter lymph (lymphatic

fluid), and they store lymphocytes (white blood cells). They are located

along lymphatic vessels. Also called lymph gland. 

medical oncologist: A doctor who specializes in diagnosing and treating

cancer using chemotherapy, hormonal therapy, biological therapy, and

targeted 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.

metastasize: To spread from one part of the body to another. When

cancer cells metastasize and form secondary tumors, the cells in the new

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

nanogram: A measure of weight. One nanogram weighs a billion times

less than one gram, and almost a trillion times less than a pound.

obstruction: Blockage of a passageway.

orgasm: The final part of the sex act, which involves contraction of

sexual organs and a sudden release of endorphins, leading to a feeling of

pleasure. In males, orgasm usually occurs with release of semen.

over-the-counter: A medicine that can be bought without a prescription

(doctor’s order). Examples include analgesics (pain relievers) such as

aspirin and acetaminophen. Also called nonprescription and OTC.

pathologist: A doctor who identifies diseases by studying cells and

tissues under a microscope.

pathology report: The description of cells and tissues made by a

pathologist based on microscopic evidence, and sometimes used to make

a diagnosis of a disease.

pelvis: The lower part of the belly, 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.

35

increased in men with prostate cancer. Measuring free PSA in a man with

a higher PSA level helps to tell what kind of prostate problem he has.

general anesthesia: A temporary loss of feeling and a complete loss of

awareness that feels like a very deep sleep. It is caused by special drugs or

other substances called anesthetics. General anesthesia keeps patients

from feeling pain during surgery or other procedures.

genital: The area around male and female sex organs.

Gleason score: A system of grading prostate cancer cells based on how

they look 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 cells are similar to normal prostate cells and are less

likely to spread; a high Gleason score means the cancer cells are very

different from normal and are more likely to spread.

groin: The area where the thigh meets the abdomen.

hyperplasia: An abnormal increase in the number of cells in an organ

or tissue.

impotence: In medicine, refers to the inability to have an erection of

the penis adequate for sexual intercourse. Also called erectile dysfunction.

incontinence: Inability to control the flow of urine from the bladder

(urinary incontinence) or the escape of stool from the rectum (fecal

incontinence).

infection: Invasion and multiplication of germs in the body. Infections

can occur in any part of the body and can spread throughout the body.

The germs may be bacteria, viruses, yeast, or fungi. They can cause a fever

and other problems, depending on where the infection occurs. When the

body’s natural defense system is strong, it can often fight the germs and

prevent infection. Some cancer treatments can weaken the natural

defense system.

infertility: The inability to produce children.

inflammation: 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.

kidney: One of a pair of organs in the abdomen. Kidneys remove waste

from the blood (as urine), produce erythropoietin (a substance that

stimulates red blood cell production), and play a role in blood pressure

regulation.

34
reproductive system: 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.

recurrence: Cancer that has recurred (come back), usually after a period

of time during which the cancer could not be detected. The cancer may

come back to the same place as the original (primary) tumor or to

another place in the body. Also called recurrent cancer.

screening: Checking for disease when there are no symptoms. Since

screening may find diseases at an early stage, there may be a better

chance of curing the disease. Examples of cancer screening tests are the

mammogram (breast), colonoscopy (colon), Pap smear (cervix), and PSA

blood level and digital rectal exam (prostate). Screening can also include

checking for a person’s risk of developing an inherited disease by doing a

genetic test.

scrotum: In men, the external sac that contains the testicles.

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.

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.

skin cancer: Cancer that forms in tissues of the skin. There are several

types of skin cancer. Skin cancer that forms in melanocytes (skin cells that

make pigment) is called melanoma. Skin cancer that forms in basal cells

(small, round cells in the base of the outer layer of skin) is called basal cell

carcinoma. Skin cancer that forms in squamous cells (flat cells that form

the surface of the skin) is called squamous cell carcinoma. Skin cancer that

forms in neuroendocrine cells (cells that release hormones in response to

signals from the nervous system) is called neuroendocrine carcinoma of

the skin. Most skin cancers form in older people on parts of the body

exposed to the sun or in people who have weakened immune systems.

37

personal medical history: A collection of information about a

person’s health. It may include information about allergies, illnesses and

surgeries, and dates and results of physical exams, tests, screenings, and

immunizations. It may also include information about medicines taken

and about diet and exercise. Also called personal health record and

personal history.

positive test result: A test result that reveals the presence of a specific

disease or condition for which the test is being done.

precancerous: Describes a condition that may (or is likely to) become

cancer. Also called premalignant.

prescription: A doctor’s order for medicine or another intervention.

prostate: 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 cancer: Cancer that forms in tissues of the prostate (a gland in

the male reproductive system found below the bladder and in front of

the rectum). Prostate cancer usually occurs in older men.

prostatitis: Inflammation of the prostate gland.

protein: A molecule made up of amino acids that are needed for the

body to function properly. Proteins are the basis of body structures such

as skin and hair and of substances such as enzymes, cytokines, and

antibodies.

PSA (prostate-specific antigen): 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.

PSA test: A blood test to measure PSA, a substance produced by prostate

gland cells. This level rises when there is a problem with the prostate

gland. But the PSA test cannot tell whether the problem is cancer or

another condition.

radiation oncologist: A doctor who specializes in using radiation to

treat cancer.

rectal: By or having to do with the rectum. 

rectum: The last several inches of the large intestine, ending at the anus. 

36
urologic oncologist: A doctor who specializes in treating cancers of the

urinary system and the male reproductive system.

urologist: A doctor who specializes in diseases of the urinary organs in

females and the urinary and sex organs in males.

watchful waiting: Closely monitoring a patient’s condition but

withholding treatment until symptoms appear or change. Also called

active surveillance, expectant management, and observation.

39

sperm: The male reproductive cell, formed in the testicle. A sperm joins

with an egg to form an embryo.

spinal block: A type of anesthesia that numbs the lower half of the body.

stage: The extent of a cancer in the body. Staging is usually based on the

size of the tumor, whether lymph nodes contain cancer, and whether the

cancer has spread from the original site to other parts of the body.

surgery: A procedure to remove or repair a part of the body or to find

out whether disease is present. An operation.

symptom: An indication that a person has a condition or disease. Some

examples of symptoms are headache, fever, fatigue, nausea, vomiting,

and pain.

testicle: One of two egg-shaped glands inside the scrotum that produce

sperm and male hormones. Also called testis.

testosterone: A hormone made mainly in the testes (part of the male

reproductive system). It is needed to develop and maintain male sex

characteristics, such as facial hair, deep voice, and muscle growth.

Testosterone may also be made in the laboratory and is used to treat

certain medical conditions.

tissue: A group or layer of cells that work together to perform a 

specific function.

tumor: 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 cancer) or malignant (cancer). Also called neoplasm.

urethra: The tube through which urine leaves the body. It empties urine

from the bladder.

urinary: Having to do with urine or the organs of the body that produce

and get rid of urine.

urinary tract: The organs of the body that produce and discharge

urine. These include the kidneys, ureters, bladder, and urethra.

urine: Fluid containing water and waste products. Urine is made by the

kidneys, stored in the bladder, and leaves the body through the urethra.

38
NIH Publication No. 09-4303

Revised September 2009

For more information, 

or to order free copies 

of this booklet:

Call 1-800-4-CANCER

(1-800-422-6237)

or visit www.cancer.gov