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<div class="pre-content"><div><div class="bk_prnt"><p class="small">NCBI Bookshelf. A service of the National Library of Medicine, National Institutes of Health.</p><p>PDQ Cancer Information Summaries [Internet]. Bethesda (MD): National Cancer Institute (US); 2002-. </p></div><div class="iconblock clearfix whole_rhythm no_top_margin bk_noprnt"><a class="img_link icnblk_img" title="Table of Contents Page" href="/books/n/pdqcis/"><img class="source-thumb" src="/corehtml/pmc/pmcgifs/bookshelf/thumbs/th-pdqcis-lrg.png" alt="Cover of PDQ Cancer Information Summaries" height="100px" width="80px" /></a><div class="icnblk_cntnt eight_col"><h2>PDQ Cancer Information Summaries [Internet].</h2><a data-jig="ncbitoggler" href="#__NBK65915_dtls__">Show details</a><div style="display:none" class="ui-widget" id="__NBK65915_dtls__"><div>Bethesda (MD): <a href="http://www.cancer.gov/" ref="pagearea=page-banner&targetsite=external&targetcat=link&targettype=publisher">National Cancer Institute (US)</a>; 2002-.</div></div><div class="half_rhythm"></div><div class="bk_noprnt"><form method="get" action="/books/n/pdqcis/" id="bk_srch"><div class="bk_search"><label for="bk_term" class="offscreen_noflow">Search term</label><input type="text" title="Search this book" id="bk_term" name="term" value="" data-jig="ncbiclearbutton" /> <input type="submit" class="jig-ncbibutton" value="Search this book" submit="false" style="padding: 0.1em 0.4em;" /></div></form></div></div></div></div></div>
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<div class="main-content lit-style" itemscope="itemscope" itemtype="http://schema.org/CreativeWork"><div class="meta-content fm-sec"><h1 id="_NBK65915_"><span class="title" itemprop="name">Prostate Cancer Treatment (PDQ®)</span></h1><div class="subtitle whole_rhythm">Patient Version</div><p class="contrib-group"><span itemprop="author">PDQ Adult Treatment Editorial Board</span>.</p><p class="small">Published online: June 26, 2020.</p></div><div class="jig-ncbiinpagenav body-content whole_rhythm" data-jigconfig="allHeadingLevels: ['h2'],smoothScroll: false" itemprop="text"><div id="_abs_rndgid_" itemprop="description"><p id="CDR0000062965__324">This PDQ cancer information summary has current information about the treatment of prostate cancer. It is meant to inform and help patients, families, and caregivers. It does not give formal guidelines or recommendations for making decisions about health care.</p><p id="CDR0000062965__325">Editorial Boards write the PDQ cancer information summaries and keep them up to date. These Boards are made up of experts in cancer treatment and other specialties related to cancer. The summaries are reviewed regularly and changes are made when there is new information. The date on each summary ("Date Last Modified") is the date of the most recent change. The information in this patient summary was taken from the health professional version, which is reviewed regularly and updated as needed, by the PDQ Adult Treatment Editorial Board.</p></div><div id="CDR0000062965__102"><h2 id="_CDR0000062965__102_">General Information About Prostate Cancer</h2><div id="CDR0000062965__102.kp" class="box"><h4><span class="title">Key Points for This Section</span></h4><ul><li class="half_rhythm"><div><a href="#CDR0000062965__103">Prostate cancer is a disease in which malignant (cancer) cells
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form in the tissues of the prostate.</a></div></li><li class="half_rhythm"><div><a href="#CDR0000062965__107">Signs of prostate cancer include a weak flow of urine
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or frequent urination. </a></div></li><li class="half_rhythm"><div><a href="#CDR0000062965__111">Tests that examine the prostate and blood are used to diagnose prostate cancer.</a></div></li><li class="half_rhythm"><div><a href="#CDR0000062965__1381">A biopsy is done to diagnose prostate cancer and find out the grade of the cancer (Gleason score).</a></div></li><li class="half_rhythm"><div><a href="#CDR0000062965__206">Certain factors affect prognosis (chance of recovery) and treatment options.</a></div></li></ul></div><div id="CDR0000062965__103"><h3>Prostate cancer is a disease in which malignant (cancer) cells
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form in the tissues of the prostate.</h3><p id="CDR0000062965__105">The <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000046539/" class="def">prostate</a> is a
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<a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000046386/" class="def">gland</a> in the male
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<a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000046564/" class="def">reproductive system</a>. It lies just
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below the <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000046501/" class="def">bladder</a> (the <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000257523/" class="def">organ</a> that
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collects and empties <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000046642/" class="def">urine</a>) and in
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front of the <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000046555/" class="def">rectum</a> (the lower part
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of the <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000046335/" class="def">intestine</a>). It is about the
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size of a walnut and surrounds part of the <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000046640/" class="def">urethra</a> (the tube that empties urine from the
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bladder). The prostate gland makes <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000044669/" class="def">fluid</a> that is part of the <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000046703/" class="def">semen</a>.<div id="CDR0000062965__219" class="figure bk_fig"><div class="graphic"><a href="/core/lw/2.0/html/tileshop_pmc/tileshop_pmc_inline.html?title=Anatomy%20of%20the%20male%20reproductive%20and%20urinary%20systems%2C%20showing%20the%20prostate%2C%20testicles%2C%20bladder%2C%20and%20other%20organs&p=BOOKS&id=558685_CDR0000450023.jpg" target="tileshopwindow" class="inline_block pmc_inline_block ts_canvas img_link" title="Click on image to zoom"><div class="ts_bar small" title="Click on image to zoom"></div><img src="/books/NBK65915.13/bin/CDR0000450023.jpg" alt="Anatomy of the male reproductive and urinary systems; drawing shows front and side views of ureters, lymph nodes, rectum, bladder, prostate gland, vas deferens, penis, testicles, urethra, seminal vesicle, and ejaculatory duct." class="tileshop" title="Click on image to zoom" /></a></div><div class="caption"><p>Anatomy of the male reproductive and urinary systems, showing the prostate, testicles, bladder, and other organs.</p></div></div></p><p id="CDR0000062965__106"><a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000445079/" class="def">Prostate cancer</a> is most common in older men. In the U.S., about 1 out of 5 men will be <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000046450/" class="def">diagnosed</a> with prostate cancer. </p></div><div id="CDR0000062965__107"><h3>Signs of prostate cancer include a weak flow of urine
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or frequent urination. </h3><p id="CDR0000062965__109">These and other <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000750109/" class="def">signs</a> and <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000045022/" class="def">symptoms</a> may be caused by prostate cancer or by other <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000651193/" class="def">conditions</a>. Check with your doctor if you have any of the following:</p><ul id="CDR0000062965__110"><li class="half_rhythm"><div>Weak or interrupted ("stop-and-go") flow of urine.</div></li><li class="half_rhythm"><div>Sudden urge to urinate.</div></li><li class="half_rhythm"><div>Frequent urination (especially at night).</div></li><li class="half_rhythm"><div>Trouble starting the flow of urine.</div></li><li class="half_rhythm"><div>Trouble emptying the bladder completely.</div></li><li class="half_rhythm"><div>Pain or burning while urinating.</div></li><li class="half_rhythm"><div><a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000270735/" class="def">Blood</a> in the urine or semen.</div></li><li class="half_rhythm"><div>A pain in the back, hips, or
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<a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000046246/" class="def">pelvis</a> that doesn't go away.</div></li><li class="half_rhythm"><div>Shortness of breath, feeling very tired, fast heartbeat, dizziness, or pale skin caused by <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000045360/" class="def">anemia</a>.</div></li></ul><p id="CDR0000062965__285">Other conditions may cause the same symptoms. As men age, the prostate may get bigger and block the
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urethra or bladder. This may cause trouble urinating or sexual problems. The condition is called <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000046509/" class="def">benign prostatic hyperplasia</a> (BPH), and although
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it is not cancer, <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000045570/" class="def">surgery</a> may be
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needed. The symptoms
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of benign prostatic hyperplasia or of other problems in the prostate may be
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like symptoms of prostate cancer.</p><div id="CDR0000062965__220" class="figure bk_fig"><div class="graphic"><img src="/books/NBK65915.13/bin/CDR0000462221.jpg" alt="Two-panel drawing shows normal male reproductive and urinary anatomy and benign prostatic hyperplasia (BPH). Panel on the left shows the normal prostate and flow of urine from the bladder through the urethra. Panel on the right shows an enlarged prostate pressing on the bladder and urethra, blocking the flow of urine." /></div><div class="caption"><p>Normal prostate and benign prostatic hyperplasia (BPH). A normal prostate does not block the flow of urine from the bladder. An enlarged prostate presses on the bladder and urethra and blocks the flow of urine. </p></div></div></div><div id="CDR0000062965__111"><h3>Tests that examine the prostate and blood are used to diagnose prostate cancer.</h3><p id="CDR0000062965__113">The following tests and procedures may be used:</p><ul id="CDR0000062965__114"><li class="half_rhythm"><div><b><a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000270871/" class="def">Physical exam</a> and health history</b>: An exam of the body to check general signs of health, including checking for signs of disease, such as lumps or anything else that seems unusual. A history of the patient’s health habits and past illnesses and treatments will also be taken.</div></li><li class="half_rhythm"><div><b><a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000045668/" class="def">Digital rectal
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exam</a> (DRE)</b>: An exam of the rectum. The doctor or <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000269445/" class="def">nurse</a> inserts a lubricated, gloved finger into the rectum and feels the prostate through the rectal wall for lumps or <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000044636/" class="def">abnormal</a> areas. <div id="CDR0000062965__221" class="figure bk_fig"><div class="graphic"><a href="/core/lw/2.0/html/tileshop_pmc/tileshop_pmc_inline.html?title=Digital%20rectal%20exam%20(DRE)&p=BOOKS&id=558685_CDR0000457840.jpg" target="tileshopwindow" class="inline_block pmc_inline_block ts_canvas img_link" title="Click on image to zoom"><div class="ts_bar small" title="Click on image to zoom"></div><img src="/books/NBK65915.13/bin/CDR0000457840.jpg" alt="Digital rectal exam; drawing shows a side view of the male reproductive anatomy and the urinary anatomy, including the prostate, rectum, and bladder. Also shown is a gloved, lubricated finger inserted into the rectum to feel the rectum, anus, and prostate." class="tileshop" title="Click on image to zoom" /></a></div><div class="caption"><p>Digital rectal exam (DRE). The doctor inserts a gloved, lubricated finger into the rectum and feels the rectum, anus, and prostate (in males) to check for anything abnormal.</p></div></div></div></li><li class="half_rhythm"><div>
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<b><a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000322878/" class="def">Prostate-specific antigen (PSA) test</a></b>: A test that measures the level of <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000044867/" class="def">PSA</a> in the blood. PSA is a substance made by the prostate that may be found in higher than normal amounts in the blood of men who have prostate cancer. PSA levels may also be high in men who have an <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000045364/" class="def">infection</a> or <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000044042/" class="def">inflammation</a> of the prostate or BPH (an enlarged, but noncancerous, prostate).</div></li><li class="half_rhythm"><div>
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<b><a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000046632/" class="def">Transrectal
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ultrasound</a></b>: A procedure in which a <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000367430/" class="def">probe</a> that is about the size of a finger is inserted into the rectum to check the prostate. The probe is used to bounce high-energy sound waves (<a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000046157/" class="def">ultrasound</a>) off internal <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000046683/" class="def">tissues</a> or organs and make echoes. The echoes form a picture of body tissues called a <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000046587/" class="def">sonogram</a>. Transrectal ultrasound may be used during a <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000045164/" class="def">biopsy</a> procedure. This is called transrectal ultrasound guided biopsy.<div id="CDR0000062965__222" class="figure bk_fig"><div class="graphic"><a href="/core/lw/2.0/html/tileshop_pmc/tileshop_pmc_inline.html?title=Transrectal%20ultrasound&p=BOOKS&id=558685_CDR0000446202.jpg" target="tileshopwindow" class="inline_block pmc_inline_block ts_canvas img_link" title="Click on image to zoom"><div class="ts_bar small" title="Click on image to zoom"></div><img src="/books/NBK65915.13/bin/CDR0000446202.jpg" alt="Transrectal ultrasound; drawing shows a side view of the male reproductive and urinary anatomy including the prostate, anus, rectum, and bladder; also shows an ultrasound probe inserted into the rectum to check the prostate. Inset shows patient lying on back on a table having a transrectal ultrasound procedure." class="tileshop" title="Click on image to zoom" /></a></div><div class="caption"><p>Transrectal ultrasound. An ultrasound probe is inserted into the rectum to check the prostate. The probe bounces sound waves off body tissues to make echoes that form a sonogram (computer picture) of the prostate.</p></div></div></div></li><li class="half_rhythm"><div><b>Transrectal <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000045997/" class="def">magnetic resonance imaging</a> (MRI)</b>: A procedure that uses a strong magnet, <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000651209/" class="def">radio waves</a>, and a computer to make a series of detailed pictures of areas inside the body. A probe that gives off radio waves is inserted into the rectum near the prostate. This helps the MRI machine make clearer pictures of the prostate and nearby tissue. A transrectal MRI is done to find out if the cancer has spread outside the prostate into nearby tissues. This procedure is also called nuclear magnetic resonance imaging (NMRI). Transrectal MRI may be used during a biopsy procedure. This is called transrectal MRI guided biopsy.</div></li></ul></div><div id="CDR0000062965__1381"><h3>A biopsy is done to diagnose prostate cancer and find out the grade of the cancer (Gleason score).</h3><p id="CDR0000062965__1383">A <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000322891/" class="def">transrectal biopsy</a> is used to diagnose prostate cancer. A transrectal biopsy is the removal of tissue from the prostate by inserting a thin needle through the rectum and into the prostate. This procedure may be done using transrectal ultrasound or transrectal MRI to help guide where samples of tissue are taken from. A <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000046244/" class="def">pathologist</a> views the tissue under a <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000638184/" class="def">microscope</a> to look for cancer <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000046476/" class="def">cells</a>. <div id="CDR0000062965__223" class="figure bk_fig"><div class="graphic"><a href="/core/lw/2.0/html/tileshop_pmc/tileshop_pmc_inline.html?title=Transrectal%20biopsy&p=BOOKS&id=558685_CDR0000446226.jpg" target="tileshopwindow" class="inline_block pmc_inline_block ts_canvas img_link" title="Click on image to zoom"><div class="ts_bar small" title="Click on image to zoom"></div><img src="/books/NBK65915.13/bin/CDR0000446226.jpg" alt="Transrectal biopsy; drawing shows a side view of the prostate, bladder, and rectum. Drawing also shows an ultrasound probe with a needle inserted into the rectum to remove a tissue sample from the prostate." class="tileshop" title="Click on image to zoom" /></a></div><div class="caption"><p>Transrectal biopsy. An ultrasound probe is inserted into the rectum to show where the tumor is. Then a needle is inserted through the rectum into the prostate to remove tissue from the prostate.</p></div></div></p><p id="CDR0000062965__1385">Sometimes a biopsy is done using a sample of tissue that was removed during a <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000045932/" class="def">transurethral resection of the prostate</a> (TURP) to treat benign prostatic hyperplasia.</p><p id="CDR0000062965__1384">If cancer is found, the pathologist will give the cancer a <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000774694/" class="def">grade</a>. The grade of the cancer describes how <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000044636/" class="def">abnormal</a> the cancer cells look under a microscope and how quickly the cancer is likely to grow and spread. The grade of the cancer is called the <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000045696/" class="def">Gleason score</a>.</p><p id="CDR0000062965__1386">To give the cancer a grade, the pathologist checks the prostate tissue samples to see how much the <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000046634/" class="def">tumor</a> tissue is like the normal prostate tissue and to find the two main cell patterns. The primary pattern describes the most common tissue pattern, and the secondary pattern describes the next most common pattern. Each pattern is given a grade from 3 to 5, with grade 3 looking the most like normal prostate tissue and grade 5 looking the most abnormal. The two grades are then added to get a Gleason score.</p><p id="CDR0000062965__1387">The Gleason score can range from 6 to 10. The higher the Gleason score, the more likely the cancer will grow and spread quickly. A Gleason score of 6 is a <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000386213/" class="def">low-grade</a> cancer; a score of 7 is a medium-grade cancer; and a score of 8, 9, or 10 is a <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000386205/" class="def">high-grade</a> cancer. For example, if the most common tissue pattern is grade 3 and the secondary pattern is grade 4, it means that most of the cancer is grade 3 and less of the cancer is grade 4. The grades are added for a Gleason score of 7, and it is a medium-grade cancer. The Gleason score may be written as 3+4=7, Gleason 7/10, or combined Gleason score of 7.</p></div><div id="CDR0000062965__206"><h3>Certain factors affect prognosis (chance of recovery) and treatment options.</h3><p id="CDR0000062965__208">The <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000045849/" class="def">prognosis</a> and treatment options depend on the following:</p><ul id="CDR0000062965__209"><li class="half_rhythm"><div>The <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000045885/" class="def">stage</a> of the cancer (level of PSA, Gleason score, Grade Group, how much of the prostate is affected by the cancer, and whether the cancer has spread to other places in the
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body).</div></li><li class="half_rhythm"><div>The patient’s age.</div></li><li class="half_rhythm"><div>Whether the cancer has just been diagnosed or has <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000046556/" class="def">recurred</a> (come back).</div></li></ul><p id="CDR0000062965__212">Treatment options also may depend on the following:</p><ul id="CDR0000062965__287"><li class="half_rhythm"><div>Whether the patient has other health problems.</div></li><li class="half_rhythm"><div>The expected <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000046580/" class="def">side effects</a> of treatment.</div></li><li class="half_rhythm"><div>Past treatment for prostate cancer.</div></li><li class="half_rhythm"><div>The wishes of the patient.</div></li></ul><p id="CDR0000062965__288">Most men diagnosed with prostate cancer do not die of it.</p></div></div><div id="CDR0000062965__120"><h2 id="_CDR0000062965__120_">Stages of Prostate Cancer</h2><div id="CDR0000062965__120.kp" class="box"><h4><span class="title">Key Points for This Section</span></h4><ul><li class="half_rhythm"><div><a href="#CDR0000062965__121">After prostate cancer has been diagnosed, tests are done to
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find out if cancer cells have spread within the prostate or to other parts of
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the body. </a></div></li><li class="half_rhythm"><div><a href="#CDR0000062965__236">There are three ways that cancer spreads in the body.</a></div></li><li class="half_rhythm"><div><a href="#CDR0000062965__313">Cancer may spread from where it began to other parts of the body.</a></div></li><li class="half_rhythm"><div><a href="#CDR0000062965__1336">
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The Grade Group and PSA level are used to stage prostate cancer.</a></div></li><li class="half_rhythm"><div><a href="#CDR0000062965__126">The following stages are used for prostate cancer:</a></div><ul><li class="half_rhythm"><div><a href="#CDR0000062965__128">Stage I</a></div></li><li class="half_rhythm"><div><a href="#CDR0000062965__131">Stage II</a></div></li><li class="half_rhythm"><div><a href="#CDR0000062965__134">Stage III</a></div></li><li class="half_rhythm"><div><a href="#CDR0000062965__137">Stage IV</a></div></li></ul></li><li class="half_rhythm"><div><a href="#CDR0000062965__1412">Prostate cancer may recur (come back) after it has been treated.</a></div></li></ul></div><div id="CDR0000062965__121"><h3>After prostate cancer has been diagnosed, tests are done to
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find out if cancer cells have spread within the prostate or to other parts of
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the body. </h3><p id="CDR0000062965__123">The process used to find out if <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000045333/" class="def">cancer</a> has spread within the
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<a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000046539/" class="def">prostate</a> or to other parts of the
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body is called <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000046597/" class="def">staging</a>. The information gathered from the
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staging process determines the <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000045885/" class="def">stage</a> of the disease. It is
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important to know the stage in order to plan treatment. The results of the tests used to <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000046450/" class="def">diagnose</a>
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<a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000445079/" class="def">prostate cancer</a> are often also used to stage the disease. (See the <a href="#CDR0000062965__111">General Information section</a>.) In prostate cancer, staging tests may not be done unless the patient has <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000045022/" class="def">symptoms</a> or signs that the cancer has spread, such as bone pain, a high <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000044867/" class="def">PSA</a> level, or a high <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000045696/" class="def">Gleason score</a>.</p><p id="CDR0000062965__289">The following tests and procedures also may be used in the staging process:</p><ul id="CDR0000062965__124"><li class="half_rhythm"><div>
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<b><a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000046499/" class="def">Bone
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scan</a></b>: A procedure to check if there are rapidly dividing <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000046476/" class="def">cells</a>, such as cancer cells, in the bone. A very small amount of <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000046550/" class="def">radioactive</a> material is <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000044678/" class="def">injected</a> into a <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000476471/" class="def">vein</a> and travels through the bloodstream. The radioactive material collects in the bones with cancer and is detected by a <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000046570/" class="def">scanner</a>.
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<div id="CDR0000062965__229" class="figure bk_fig"><div class="graphic"><a href="/core/lw/2.0/html/tileshop_pmc/tileshop_pmc_inline.html?title=Bone%20scan&p=BOOKS&id=558685_CDR0000466541.jpg" target="tileshopwindow" class="inline_block pmc_inline_block ts_canvas img_link" title="Click on image to zoom"><div class="ts_bar small" title="Click on image to zoom"></div><img src="/books/NBK65915.13/bin/CDR0000466541.jpg" alt="Bone scan; drawing shows patient lying on a table that slides under the scanner, a technician operating the scanner, and a monitor that will show images made during the scan." class="tileshop" title="Click on image to zoom" /></a></div><div class="caption"><p>Bone scan. A small amount of radioactive material is injected into the patient's bloodstream and collects in abnormal cells in the bones. As the patient lies on a table that slides under the scanner, the radioactive material is detected and images are made on a computer screen or film.</p></div></div></div></li><li class="half_rhythm"><div>
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<b><a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000045788/" class="def">MRI</a> (magnetic
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resonance imaging)</b>: A procedure that uses a magnet, <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000651209/" class="def">radio waves</a>, and a computer to make a series of detailed pictures of areas inside the body. This procedure is also called nuclear magnetic resonance imaging (NMRI).</div></li><li class="half_rhythm"><div><b><a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000046033/" class="def">CT scan</a> (CAT scan)</b>:
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A procedure that makes a series of detailed pictures of areas inside the body, taken from different angles. The pictures are made by a computer linked to an <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000045944/" class="def">x-ray</a> machine. A <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000409764/" class="def">dye</a> may be injected into a vein or swallowed to help the <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000257523/" class="def">organs</a> or <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000046683/" class="def">tissues</a> show up more clearly. This procedure is also called computed tomography, computerized tomography, or computerized axial tomography.</div></li><li class="half_rhythm"><div><b><a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000322876/" class="def">Pelvic lymphadenectomy</a></b>:
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A <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000045570/" class="def">surgical</a> procedure to remove the <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000045762/" class="def">lymph nodes</a> in the <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000046246/" class="def">pelvis</a>. A <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000046244/" class="def">pathologist</a> views the tissue under a <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000638184/" class="def">microscope</a> to look for cancer cells.</div></li><li class="half_rhythm"><div><b><a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000322882/" class="def">Seminal vesicle biopsy</a></b>: The removal of <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000044669/" class="def">fluid</a> from the <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000046576/" class="def">seminal vesicles</a> (<a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000046386/" class="def">glands</a> that make <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000046703/" class="def">semen</a>) using a needle. A pathologist views the fluid under a microscope to look for cancer cells.</div></li><li class="half_rhythm"><div><b><a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000597165/" class="def">ProstaScint scan</a></b>: A procedure to check for cancer that has spread from the prostate to other parts of the body, such as the lymph nodes. A very small amount of radioactive material is injected into a vein and travels through the bloodstream. The radioactive material attaches to prostate cancer cells and is detected by a scanner. The radioactive material shows up as a bright spot on the picture in areas where there are a lot of prostate cancer cells.</div></li></ul></div><div id="CDR0000062965__236"><h3>There are three ways that cancer spreads in the body.</h3><p id="CDR0000062965__236_69">Cancer can spread through <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000046683/" class="def">tissue</a>, the <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000045764/" class="def">lymph system</a>, and the <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000270735/" class="def">blood</a>:</p><ul id="CDR0000062965__236_70"><li class="half_rhythm"><div>Tissue. The cancer spreads from where it began by growing into nearby areas.
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</div></li><li class="half_rhythm"><div>Lymph system. The cancer spreads from where it began by getting into the lymph system. The cancer travels through the <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000269462/" class="def">lymph vessels</a> to other parts of the body.
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</div></li><li class="half_rhythm"><div>Blood. The cancer spreads from where it began by getting into the blood. The cancer travels through the <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000045020/" class="def">blood vessels</a> to other parts of the body.
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</div></li></ul></div><div id="CDR0000062965__313"><h3>Cancer may spread from where it began to other parts of the body.</h3><p id="CDR0000062965__313_66">When cancer spreads to another part of the body, it is called <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000046710/" class="def">metastasis</a>. Cancer <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000046476/" class="def">cells</a> break away from where they began (the <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000045847/" class="def">primary tumor</a>) and travel through the lymph system or blood.</p><ul id="CDR0000062965__313_67"><li class="half_rhythm"><div>Lymph system. The cancer gets into the lymph system, travels through the lymph vessels, and forms a <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000046634/" class="def">tumor</a> (<a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000044058/" class="def">metastatic</a> tumor) in another part of the body.</div></li><li class="half_rhythm"><div>Blood. The cancer gets into the blood, travels through the blood vessels, and forms a tumor (metastatic tumor) in another part of the body.</div></li></ul><p id="CDR0000062965__315">The metastatic tumor is the same type of cancer as the primary tumor. For example, if prostate cancer spreads to the bone, the cancer cells in the bone are actually prostate cancer cells. The disease is metastatic prostate cancer, not bone cancer.</p><p id="CDR0000062965__322"><a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000514443/" class="def">Denosumab</a>, a <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000046066/" class="def">monoclonal antibody</a>, may be used to <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000439419/" class="def">prevent</a>
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<a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000045317/" class="def">bone metastases</a>.</p><div id="CDR0000062965__333" class="box"><h3><span class="title">metastasis: how cancer spreads</span></h3><div class="caption"><p>Many cancer deaths are caused when cancer moves from the original tumor and spreads to other tissues and organs. This is called metastatic cancer. This animation shows how cancer cells travel from the place in the body where they first formed to other parts of the body.</p></div><p><a href="https://www.youtube.com/watch?v=fQwar_-QdiQ" ref="pagearea=body&targetsite=external&targetcat=link&targettype=uri">YouTube</a></p></div></div><div id="CDR0000062965__1336"><h3>
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The Grade Group and PSA level are used to stage prostate cancer.</h3><p id="CDR0000062965__1338">The stage of the cancer is based on the results of the staging and <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000689569/" class="def">diagnostic tests</a>, including the <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000322878/" class="def">prostate-specific antigen (PSA) test</a> and the Grade Group. The tissue samples removed during the <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000045164/" class="def">biopsy</a> are used to find out the Gleason score. The Gleason score ranges from 2 to 10 and describes how different the cancer cells look from normal cells under a <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000638184/" class="def">microscope</a> and how likely it is that the <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000046634/" class="def">tumor</a> will spread. The lower the number, the more cancer cells look like normal cells and are likely to grow and spread slowly.</p><p id="CDR0000062965__1339">The Grade Group depends on the Gleason score. See the <a href="#CDR0000062965__1381">General Information</a> section for more information about the Gleason score.</p><ul id="CDR0000062965__1340"><li class="half_rhythm"><div>Grade Group 1 is a Gleason score of 6 or less. </div></li><li class="half_rhythm"><div>Grade Group 2 or 3 is a Gleason score of 7. </div></li><li class="half_rhythm"><div>Grade Group 4 is a Gleason score 8. </div></li><li class="half_rhythm"><div>Grade Group 5 is a Gleason score of 9 or 10.</div></li></ul><p id="CDR0000062965__1341">The PSA test measures the level of PSA in the blood. PSA is a substance made by the prostate that may be found in an increased amount in the blood of men who have prostate cancer. </p></div><div id="CDR0000062965__126"><h3>The following stages are used for prostate cancer:</h3><div id="CDR0000062965__128"><h4>Stage I</h4><div id="CDR0000062965__1356" class="figure bk_fig"><div class="graphic"><a href="/core/lw/2.0/html/tileshop_pmc/tileshop_pmc_inline.html?title=Stage%20I%20prostate%20cancer&p=BOOKS&id=558685_CDR0000795013.jpg" target="tileshopwindow" class="inline_block pmc_inline_block ts_canvas img_link" title="Click on image to zoom"><div class="ts_bar small" title="Click on image to zoom"></div><img src="/books/NBK65915.13/bin/CDR0000795013.jpg" alt="Two panel drawing of stage I prostate cancer; the top panel shows cancer in less than one-half of the right side of the prostate found by needle biopsy. The bottom panel shows cancer in less than one-half of the left side of the prostate found by digital rectal exam. In both panels, the PSA level is less than 10 and the Grade Group is 1. The bladder, rectum, and urethra are also shown." class="tileshop" title="Click on image to zoom" /></a></div><div class="caption"><p>Stage I prostate cancer. Cancer is found in the prostate only. The cancer is not felt during a digital rectal exam and is found by needle biopsy done for high prostate-specific antigen (PSA) level or in a sample of tissue removed during surgery for other reasons. The PSA level is less than 10 and the Grade Group is 1; OR the cancer is felt during a digital rectal exam and is found in one-half or less of one side of the prostate. The PSA level is less than 10 and the Grade Group is 1.</p></div></div><p id="CDR0000062965__130">In <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000045129/" class="def">stage I</a>, <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000045333/" class="def">cancer</a> is
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found in the <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000046539/" class="def">prostate</a> only. The cancer: </p><ul id="CDR0000062965__1342"><li class="half_rhythm"><div>is not felt during a <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000045668/" class="def">digital rectal exam</a> and is found by <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000045798/" class="def">needle biopsy</a> (done for a high <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000044867/" class="def">PSA</a> level) or in a sample of <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000046683/" class="def">tissue</a> removed during <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000045570/" class="def">surgery</a> for other reasons (such as <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000046509/" class="def">benign prostatic hyperplasia</a>). The PSA level is lower than 10 and the Grade Group is 1; or</div></li><li class="half_rhythm"><div>is felt during a digital rectal exam and is found in one-half or less of one side of the prostate. The PSA level is lower than 10 and the Grade Group is 1.</div></li></ul></div><div id="CDR0000062965__131"><h4>Stage II</h4><p id="CDR0000062965__133">In <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000045130/" class="def">stage II</a>, <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000045333/" class="def">cancer</a> is
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more advanced than in <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000045129/" class="def">stage I</a>, but has not spread outside the <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000046539/" class="def">prostate</a>. Stage II is divided into stages IIA, IIB, and IIC.</p><div id="CDR0000062965__1357" class="figure bk_fig"><div class="graphic"><a href="/core/lw/2.0/html/tileshop_pmc/tileshop_pmc_inline.html?title=Stage%20IIA%20prostate%20cancer&p=BOOKS&id=558685_CDR0000795014.jpg" target="tileshopwindow" class="inline_block pmc_inline_block ts_canvas img_link" title="Click on image to zoom"><div class="ts_bar small" title="Click on image to zoom"></div><img src="/books/NBK65915.13/bin/CDR0000795014.jpg" alt="Two-panel drawing of stage IIA prostate cancer; the top panel shows cancer in one-half or less of one side of the prostate. The PSA level is at least 10 but less than 20 and the Grade Group is 1. The bottom panel shows cancer in more than one-half of one side of the prostate. The PSA level is less than 20 and the Grade Group is 1. In both panels, the bladder, rectum, and urethra are also shown." class="tileshop" title="Click on image to zoom" /></a></div><div class="caption"><p>Stage IIA prostate cancer. Cancer is found in the prostate only. Cancer is found in one-half or less of one side of the prostate. The prostate-specific antigen (PSA) level is at least 10 but less than 20 and the Grade Group is 1; OR cancer is found in more than one-half of one side of the prostate or in both sides of the prostate. The PSA level is less than 20 and the Grade Group is 1.</p></div></div><p id="CDR0000062965__1365">In stage IIA, <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000045333/" class="def">cancer</a>:</p><ul id="CDR0000062965__1366"><li class="half_rhythm"><div>is found in one-half or less of one side of the <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000046539/" class="def">prostate</a>. The <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000044867/" class="def">PSA</a> level is at least 10 but lower than 20 and the Grade Group is 1; or </div></li><li class="half_rhythm"><div>is found in more than one-half of one side of the prostate or in both sides of the prostate. The PSA level is lower than 20 and the Grade Group is 1. </div></li></ul><div id="CDR0000062965__1358" class="figure bk_fig"><div class="graphic"><a href="/core/lw/2.0/html/tileshop_pmc/tileshop_pmc_inline.html?title=Stage%20IIB%20prostate%20cancer&p=BOOKS&id=558685_CDR0000795015.jpg" target="tileshopwindow" class="inline_block pmc_inline_block ts_canvas img_link" title="Click on image to zoom"><div class="ts_bar small" title="Click on image to zoom"></div><img src="/books/NBK65915.13/bin/CDR0000795015.jpg" alt="Stage IIB prostate cancer; drawing shows cancer in one side of the prostate. The PSA level is less than 20 and the Grade Group is 2. Also shown are the bladder, rectum, and urethra." class="tileshop" title="Click on image to zoom" /></a></div><div class="caption"><p>Stage IIB prostate cancer. Cancer is found in the prostate only. Cancer is found in one or both sides of the prostate. The prostate-specific antigen level is less than 20 and the Grade Group is 2.</p></div></div><p id="CDR0000062965__1367">In stage IIB, <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000045333/" class="def">cancer</a>:</p><ul id="CDR0000062965__1368"><li class="half_rhythm"><div>is found in one or both sides of the <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000046539/" class="def">prostate</a>. The <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000044867/" class="def">PSA</a> level is lower than 20 and the Grade Group is 2.</div></li></ul><div id="CDR0000062965__1359" class="figure bk_fig"><div class="graphic"><a href="/core/lw/2.0/html/tileshop_pmc/tileshop_pmc_inline.html?title=Stage%20IIC%20prostate%20cancer&p=BOOKS&id=558685_CDR0000795016.jpg" target="tileshopwindow" class="inline_block pmc_inline_block ts_canvas img_link" title="Click on image to zoom"><div class="ts_bar small" title="Click on image to zoom"></div><img src="/books/NBK65915.13/bin/CDR0000795016.jpg" alt="Stage IIC prostate cancer; drawing shows cancer in both sides of the prostate. The PSA level is less than 20 and the Grade Group is 3 or 4. Also shown are the bladder, rectum, and urethra." class="tileshop" title="Click on image to zoom" /></a></div><div class="caption"><p>Stage IIC prostate cancer. Cancer is found in the prostate only. Cancer is found in one or both sides of the prostate. The prostate-specific antigen level is less than 20 and the Grade Group is 3 or 4.</p></div></div><p id="CDR0000062965__1369">In stage IIC, <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000045333/" class="def">cancer</a>:</p><ul id="CDR0000062965__1370"><li class="half_rhythm"><div>is found in one or both sides of the <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000046539/" class="def">prostate</a>. The <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000044867/" class="def">PSA</a> level is lower than 20 and the Grade Group is 3 or 4.</div></li></ul></div><div id="CDR0000062965__134"><h4>Stage III</h4><p id="CDR0000062965__1347"><a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000045131/" class="def">Stage III</a> is divided into stages IIIA, IIIB, and IIIC.</p><div id="CDR0000062965__1360" class="figure bk_fig"><div class="graphic"><a href="/core/lw/2.0/html/tileshop_pmc/tileshop_pmc_inline.html?title=Stage%20IIIA%20prostate%20cancer&p=BOOKS&id=558685_CDR0000795017.jpg" target="tileshopwindow" class="inline_block pmc_inline_block ts_canvas img_link" title="Click on image to zoom"><div class="ts_bar small" title="Click on image to zoom"></div><img src="/books/NBK65915.13/bin/CDR0000795017.jpg" alt="Stage IIIA prostate cancer; drawing shows cancer in one side of the prostate. The PSA level is at least 20 and the Grade Group is 1, 2, 3, or 4. Also shown are the bladder, rectum, and urethra." class="tileshop" title="Click on image to zoom" /></a></div><div class="caption"><p>Stage IIIA prostate cancer. Cancer is found in the prostate only. Cancer is found in one or both sides of the prostate. The prostate-specific antigen level is at least 20 and the Grade Group is 1, 2, 3, or 4.</p></div></div><p id="CDR0000062965__1371">In stage IIIA, <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000045333/" class="def">cancer</a>:</p><ul id="CDR0000062965__1372"><li class="half_rhythm"><div>is found in one or both sides of the <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000046539/" class="def">prostate</a>. The <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000044867/" class="def">PSA</a> level is at least 20 and the Grade Group is 1, 2, 3, or 4. </div></li></ul><div id="CDR0000062965__1361" class="figure bk_fig"><div class="graphic"><a href="/core/lw/2.0/html/tileshop_pmc/tileshop_pmc_inline.html?title=Stage%20IIIB%20prostate%20cancer&p=BOOKS&id=558685_CDR0000795018.jpg" target="tileshopwindow" class="inline_block pmc_inline_block ts_canvas img_link" title="Click on image to zoom"><div class="ts_bar small" title="Click on image to zoom"></div><img src="/books/NBK65915.13/bin/CDR0000795018.jpg" alt="Stage IIIB prostate cancer; drawing shows cancer that has spread from the prostate to the seminal vesicles and to nearby tissue. The PSA can be any level and the Grade Group is 1, 2, 3, or 4. Also shown are the pelvic wall, bladder, and rectum." class="tileshop" title="Click on image to zoom" /></a></div><div class="caption"><p>Stage IIIB prostate cancer. Cancer has spread from the prostate to the seminal vesicles or to nearby tissue or organs, such as the rectum, bladder, or pelvic wall. The prostate-specific antigen can be any level and the Grade Group is 1, 2, 3, or 4.</p></div></div><p id="CDR0000062965__1373">In stage IIIB, <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000045333/" class="def">cancer</a>:</p><ul id="CDR0000062965__1374"><li class="half_rhythm"><div>has spread from the <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000046539/" class="def">prostate</a> to the <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000046576/" class="def">seminal vesicles</a> or to nearby <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000046683/" class="def">tissue</a> or <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000257523/" class="def">organs</a>, such as the <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000046555/" class="def">rectum</a>, <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000046501/" class="def">bladder</a>, or <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000410631/" class="def">pelvic wall</a>. The <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000044867/" class="def">PSA</a> can be any level and the Grade Group is 1, 2, 3, or 4. </div></li></ul><div id="CDR0000062965__1362" class="figure bk_fig"><div class="graphic"><a href="/core/lw/2.0/html/tileshop_pmc/tileshop_pmc_inline.html?title=Stage%20IIIC%20prostate%20cancer&p=BOOKS&id=558685_CDR0000795019.jpg" target="tileshopwindow" class="inline_block pmc_inline_block ts_canvas img_link" title="Click on image to zoom"><div class="ts_bar small" title="Click on image to zoom"></div><img src="/books/NBK65915.13/bin/CDR0000795019.jpg" alt="Stage IIIC prostate cancer; drawing shows cancer in one side of the prostate. The PSA can be any level and the Grade Group is 5. Also shown are the bladder, rectum, and urethra." class="tileshop" title="Click on image to zoom" /></a></div><div class="caption"><p>Stage IIIC prostate cancer. Cancer is found in one or both sides of the prostate and may have spread to the seminal vesicles or to nearby tissue or organs, such as the rectum, bladder, or pelvic wall. The prostate-specific antigen can be any level and the Grade Group is 5.</p></div></div><p id="CDR0000062965__1375">In stage IIIC, <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000045333/" class="def">cancer</a>:</p><ul id="CDR0000062965__1376"><li class="half_rhythm"><div>is found in one or both sides of the <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000046539/" class="def">prostate</a> and may have spread to the <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000046576/" class="def">seminal vesicles</a> or to nearby <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000046683/" class="def">tissue</a> or <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000257523/" class="def">organs</a>, such as the <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000046555/" class="def">rectum</a>, <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000046501/" class="def">bladder</a>, or <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000410631/" class="def">pelvic wall</a>. The <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000044867/" class="def">PSA</a> can be any level and the Grade Group is 5.</div></li></ul></div><div id="CDR0000062965__137"><h4>Stage IV</h4><p id="CDR0000062965__1352"><a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000045132/" class="def">Stage IV</a> is divided into stages IVA and IVB.</p><div id="CDR0000062965__1363" class="figure bk_fig"><div class="graphic"><a href="/core/lw/2.0/html/tileshop_pmc/tileshop_pmc_inline.html?title=Stage%20IVA%20prostate%20cancer&p=BOOKS&id=558685_CDR0000795020.jpg" target="tileshopwindow" class="inline_block pmc_inline_block ts_canvas img_link" title="Click on image to zoom"><div class="ts_bar small" title="Click on image to zoom"></div><img src="/books/NBK65915.13/bin/CDR0000795020.jpg" alt="Stage IVA prostate cancer; drawing shows cancer in one side of the prostate and in nearby lymph nodes. The PSA can be any level and the Grade Group is 1 ,2, 3, 4, or 5. Also shown are the bladder, rectum, and urethra." class="tileshop" title="Click on image to zoom" /></a></div><div class="caption"><p>Stage IVA prostate cancer. Cancer is found in one or both sides of the prostate and may have spread to the seminal vesicles or to nearby tissue or organs, such as the rectum, bladder, or pelvic wall. Cancer has spread to nearby lymph nodes. The prostate-specific antigen can be any level and the Grade Group is 1, 2, 3, 4, or 5.</p></div></div><p id="CDR0000062965__1377">In stage IVA, <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000045333/" class="def">cancer</a>:</p><ul id="CDR0000062965__1378"><li class="half_rhythm"><div>is found in one or both sides of the <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000046539/" class="def">prostate</a> and may have spread to the <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000046576/" class="def">seminal vesicles</a> or to nearby <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000046683/" class="def">tissue</a> or <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000257523/" class="def">organs</a>, such as the <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000046555/" class="def">rectum</a>, <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000046501/" class="def">bladder</a>, or <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000410631/" class="def">pelvic wall</a>. Cancer has spread to nearby <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000045762/" class="def">lymph nodes</a>. The <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000044867/" class="def">PSA</a> can be any level and the Grade Group is 1, 2, 3, 4, or 5. </div></li></ul><div id="CDR0000062965__1364" class="figure bk_fig"><div class="graphic"><a href="/core/lw/2.0/html/tileshop_pmc/tileshop_pmc_inline.html?title=Stage%20IVB%20prostate%20cancer&p=BOOKS&id=558685_CDR0000795021.jpg" target="tileshopwindow" class="inline_block pmc_inline_block ts_canvas img_link" title="Click on image to zoom"><div class="ts_bar small" title="Click on image to zoom"></div><img src="/books/NBK65915.13/bin/CDR0000795021.jpg" alt="Stage IVB prostate cancer; drawing shows other parts of the body where prostate cancer may spread, including the distant lymph nodes and bones. An inset shows cancer cells spreading from the prostate, through the blood and lymph system, to another part of the body where metastatic cancer has formed." class="tileshop" title="Click on image to zoom" /></a></div><div class="caption"><p>Stage IVB prostate cancer. Cancer has spread to other parts of the body, such as the bones or distant lymph nodes. </p></div></div><p id="CDR0000062965__1379">In stage IVB, <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000045333/" class="def">cancer</a>:</p><ul id="CDR0000062965__1380"><li class="half_rhythm"><div>has spread to other parts of the body, such as the bones or distant <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000045762/" class="def">lymph nodes</a>. <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000445079/" class="def">Prostate cancer</a> often spreads to the bones. </div></li></ul></div></div><div id="CDR0000062965__1412"><h3>Prostate cancer may recur (come back) after it has been treated.</h3><p id="CDR0000062965__1414">The cancer may come back in the <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000046539/" class="def">prostate</a> or
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in other parts of the body. </p></div></div><div id="CDR0000062965__142"><h2 id="_CDR0000062965__142_">Treatment Option Overview</h2><div id="CDR0000062965__142.kp" class="box"><h4><span class="title">Key Points for This Section</span></h4><ul><li class="half_rhythm"><div><a href="#CDR0000062965__143">There are different types of treatment for patients with prostate cancer.
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</a></div></li><li class="half_rhythm"><div><a href="#CDR0000062965__147">Seven types of standard treatment are used:</a></div><ul><li class="half_rhythm"><div><a href="#CDR0000062965__149">Watchful waiting
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or active surveillance</a></div></li><li class="half_rhythm"><div><a href="#CDR0000062965__152">Surgery </a></div></li><li class="half_rhythm"><div><a href="#CDR0000062965__159">Radiation therapy and radiopharmaceutical therapy
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</a></div></li><li class="half_rhythm"><div><a href="#CDR0000062965__1389">Hormone therapy</a></div></li><li class="half_rhythm"><div><a href="#CDR0000062965__272">Chemotherapy</a></div></li><li class="half_rhythm"><div><a href="#CDR0000062965__277">Immunotherapy</a></div></li><li class="half_rhythm"><div><a href="#CDR0000062965__303">Bisphosphonate therapy</a></div></li></ul></li><li class="half_rhythm"><div><a href="#CDR0000062965__316">There are treatments for bone pain caused by bone metastases or hormone therapy.
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</a></div></li><li class="half_rhythm"><div><a href="#CDR0000062965__169">New types of treatment are being tested in clinical
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trials.</a></div><ul><li class="half_rhythm"><div><a href="#CDR0000062965__171">Cryosurgery</a></div></li><li class="half_rhythm"><div><a href="#CDR0000062965__215">High-intensity–focused ultrasound therapy</a></div></li><li class="half_rhythm"><div><a href="#CDR0000062965__257">Proton beam radiation therapy</a></div></li><li class="half_rhythm"><div><a href="#CDR0000062965__1333">Photodynamic therapy</a></div></li></ul></li><li class="half_rhythm"><div><a href="#CDR0000062965__334">Treatment for prostate cancer may cause side effects.</a></div></li><li class="half_rhythm"><div><a href="#CDR0000062965__248">Patients may want to think about taking part in a clinical trial.</a></div></li><li class="half_rhythm"><div><a href="#CDR0000062965__250">Patients can enter clinical trials before, during, or after starting their cancer treatment.</a></div></li><li class="half_rhythm"><div><a href="#CDR0000062965__252">Follow-up tests may be needed.</a></div></li></ul></div><div id="CDR0000062965__143"><h3>There are different types of treatment for patients with prostate cancer.
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</h3><p id="CDR0000062965__145">Different types of treatment are available for patients with
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<a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000445079/" class="def">prostate cancer</a>. Some treatments are <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000044930/" class="def">standard</a> (the currently used treatment), and some
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are being tested in <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000045961/" class="def">clinical trials</a>.
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A treatment clinical trial is a <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000651211/" class="def">research study</a> meant to help
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improve current treatments or obtain information on new treatments for patients
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with <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000045333/" class="def">cancer</a>. When clinical trials show that a new treatment is better than the
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standard treatment, the new
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treatment may become the standard treatment. Patients may want to think about taking part in a clinical trial. Some clinical trials are open only to patients who have not started treatment.</p></div><div id="CDR0000062965__147"><h3>Seven types of standard treatment are used:</h3><div id="CDR0000062965__149"><h4>Watchful waiting
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or active surveillance</h4><p id="CDR0000062965__291"><a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000045942/" class="def">Watchful waiting</a> and <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000616060/" class="def">active surveillance</a> are treatments used for older men who do not have <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000750109/" class="def">signs</a> or <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000045022/" class="def">symptoms</a> or have other medical <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000651193/" class="def">conditions</a> and for men whose prostate cancer is found during a <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000046171/" class="def">screening</a> test.</p><p id="CDR0000062965__151">Watchful waiting is closely <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000454803/" class="def">monitoring</a> a patient’s condition without giving any treatment until signs or symptoms appear or change. Treatment is given to relieve symptoms and improve <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000045417/" class="def">quality of life</a>.</p><p id="CDR0000062965__282">Active surveillance is closely following a patient's condition without giving any treatment unless there are changes in test results. It is used to find early signs that the condition is getting worse. In active surveillance, patients are given certain exams and tests, including <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000045668/" class="def">digital rectal exam</a>, <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000651204/" class="def">PSA test</a>, <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000046632/" class="def">transrectal ultrasound</a>, and transrectal <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000045798/" class="def">needle biopsy</a>, to check if the cancer is growing. When the cancer begins to grow, treatment is given to <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000318813/" class="def">cure</a> the cancer.</p><p id="CDR0000062965__292">Other terms that are used to describe not giving treatment to cure prostate cancer right after <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000046450/" class="def">diagnosis</a> are observation, watch and wait, and expectant management.</p></div><div id="CDR0000062965__152"><h4>Surgery </h4><p id="CDR0000062965__154">Patients in good health whose <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000046634/" class="def">tumor</a> is in the <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000046539/" class="def">prostate</a>
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<a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000046386/" class="def">gland</a> only may be treated with <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000045570/" class="def">surgery</a> to remove the tumor. The following types of surgery are used: </p><ul id="CDR0000062965__155"><li class="half_rhythm"><div><a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000046549/" class="def">Radical
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prostatectomy</a>: A surgical procedure to remove the prostate, surrounding <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000046683/" class="def">tissue</a>, and <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000046576/" class="def">seminal vesicles</a>. Removal of nearby <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000045762/" class="def">lymph nodes</a> may be done at the same time. The main types of radical prostatectomy include:
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<dl id="CDR0000062965__1411" class="temp-labeled-list"><dt>-</dt><dd><p class="no_top_margin"><a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000651201/" class="def">Open radical prostatectomy</a>: An <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000046353/" class="def">incision</a> (cut) is made in the retropubic area (lower <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000046684/" class="def">abdomen</a>) or the <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000321384/" class="def">perineum</a> (the area between the <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000046523/" class="def">anus</a> and <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000046573/" class="def">scrotum</a>). Surgery is performed through the incision. It is harder for the surgeon to spare the <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000373935/" class="def">nerves</a> near the prostate or to remove nearby lymph nodes with the perineum approach.</p></dd><dt>-</dt><dd><p class="no_top_margin"><a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000373934/" class="def">Radical laparoscopic prostatectomy</a>: Several small incisions (cuts) are made in the wall of the abdomen. A <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000044360/" class="def">laparoscope</a> (a thin, tube-like instrument with a light and <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000572035/" class="def">lens</a> for viewing) is inserted through one opening to guide the surgery. Surgical instruments are inserted through the other openings to do the surgery.</p></dd><dt>-</dt><dd><p class="no_top_margin">Robot-assisted laparoscopic radical prostatectomy: Several small cuts are made in the wall of the abdomen, as in regular laparoscopic prostatectomy. The surgeon inserts an instrument with a camera through one of the openings and surgical instruments through the other openings using robotic arms. The camera gives the surgeon a <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000045582/" class="def">3-dimensional</a> view of the prostate and surrounding structures. The surgeon uses the robotic arms to do the surgery while sitting at a computer monitor near the operating table.</p></dd></dl><div id="CDR0000062965__227" class="figure bk_fig"><div class="graphic"><a href="/core/lw/2.0/html/tileshop_pmc/tileshop_pmc_inline.html?title=Two%20types%20of%20radical%20prostatectomy&p=BOOKS&id=558685_CDR0000442274.jpg" target="tileshopwindow" class="inline_block pmc_inline_block ts_canvas img_link" title="Click on image to zoom"><div class="ts_bar small" title="Click on image to zoom"></div><img src="/books/NBK65915.13/bin/CDR0000442274.jpg" alt="Two panel drawing showing two ways of doing a radical prostatectomy; in the first panel, dotted line shows where incision is made through the wall of the abdomen for a retropubic prostatectomy; in the second panel, dotted line shows where incision is made in area between the scrotum and the anus for a perineal prostatectomy." class="tileshop" title="Click on image to zoom" /></a></div><div class="caption"><p>Two types of radical prostatectomy. In a retropubic prostatectomy, the prostate is removed through an incision in the wall of the abdomen. In a perineal prostatectomy, the prostate is removed through an incision in the area between the scrotum and the anus.</p></div></div></div></li><li class="half_rhythm"><div><a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000322876/" class="def">Pelvic lymphadenectomy</a>: A surgical procedure to remove the lymph nodes in the <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000046246/" class="def">pelvis</a>. A <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000046244/" class="def">pathologist</a> views the tissue under a <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000638184/" class="def">microscope</a> to look for cancer <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000046476/" class="def">cells</a>. If the lymph nodes contain cancer,
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the doctor will not remove the prostate and may recommend other
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treatment.</div></li><li class="half_rhythm"><div>
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<a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000045932/" class="def">Transurethral resection of the
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prostate</a> (TURP): A surgical procedure to remove tissue from the prostate using a <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000482456/" class="def">resectoscope</a> (a thin, lighted tube with a cutting tool) inserted through the <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000046640/" class="def">urethra</a>. This procedure is done to treat <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000044372/" class="def">benign prostatic hypertrophy</a> and it is sometimes done to relieve symptoms caused by a tumor before other cancer treatment is given. TURP may
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also be done in men whose tumor is in the prostate only and who cannot have a radical prostatectomy.<div id="CDR0000062965__228" class="figure bk_fig"><div class="graphic"><a href="/core/lw/2.0/html/tileshop_pmc/tileshop_pmc_inline.html?title=Transurethral%20resection%20of%20the%20prostate%20(TURP)&p=BOOKS&id=558685_CDR0000442342.jpg" target="tileshopwindow" class="inline_block pmc_inline_block ts_canvas img_link" title="Click on image to zoom"><div class="ts_bar small" title="Click on image to zoom"></div><img src="/books/NBK65915.13/bin/CDR0000442342.jpg" alt="Transurethral resection of the prostate; drawing shows removal of tissue from the prostate using a resectoscope (a thin, lighted tube with a cutting tool at the end) inserted through the urethra." class="tileshop" title="Click on image to zoom" /></a></div><div class="caption"><p>Transurethral resection of the prostate (TURP). Tissue is removed from the prostate using a resectoscope (a thin, lighted tube with a cutting tool at the end) inserted through the urethra. Prostate tissue that is blocking the urethra is cut away and removed through the resectoscope. </p></div></div></div></li></ul><p id="CDR0000062965__310">In some cases, the nerves that control penile erection can be saved with nerve-sparing surgery. However, this may not be possible in men with
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large tumors or tumors that are very close to the nerves. </p><p id="CDR0000062965__311">Possible problems after prostate cancer surgery include the following:</p><ul id="CDR0000062965__312"><li class="half_rhythm"><div><a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000321376/" class="def">Impotence</a>.</div></li><li class="half_rhythm"><div>Leakage of <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000046642/" class="def">urine</a> from the <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000046501/" class="def">bladder</a> or <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000046605/" class="def">stool</a> from the <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000046555/" class="def">rectum</a>. </div></li><li class="half_rhythm"><div>Shortening of the <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000257215/" class="def">penis</a> (1 to 2 <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000354457/" class="def">centimeters</a>). The exact reason for this is not known.</div></li><li class="half_rhythm"><div>Inguinal <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000630906/" class="def">hernia</a> (bulging of fat or part of the <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000046582/" class="def">small intestine</a> through weak muscles into the <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000046375/" class="def">groin</a>). Inguinal hernia may occur more often in men treated with radical prostatectomy than in men who have some other types of prostate surgery, <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000044971/" class="def">radiation therapy</a>, or prostate <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000045164/" class="def">biopsy</a> alone. It is most likely to occur within the first 2 years after radical prostatectomy.</div></li></ul></div><div id="CDR0000062965__159"><h4>Radiation therapy and radiopharmaceutical therapy
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</h4><p id="CDR0000062965__161">Radiation therapy is a cancer treatment that uses high-energy <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000045944/" class="def">x-rays</a> or other types of <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000045072/" class="def">radiation</a> to kill cancer cells or keep them from growing. There are different types of radiation therapy: </p><ul id="CDR0000062965__290"><li class="half_rhythm"><div class="half_rhythm"><a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000046686/" class="def">External radiation therapy</a> uses a machine outside the body to send radiation toward the cancer. <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000270731/" class="def">Conformal radiation</a> is a type of external radiation therapy that uses a computer to make a <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000045582/" class="def">3-dimensional</a> (3-D) picture of the tumor and shapes the radiation beams to fit the tumor. This allows a high dose of radiation to reach the tumor and causes less damage to nearby healthy tissue.</div><div class="half_rhythm"><a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000558902/" class="def">Hypofractionated radiation therapy</a> may be given because it has a more convenient treatment schedule. Hypofractionated radiation therapy is radiation treatment in which a larger than usual total <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000044664/" class="def">dose</a> of radiation is given once a day over a shorter period of time (fewer days) compared to standard radiation therapy. Hypofractionated radiation therapy may have worse <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000046580/" class="def">side effects</a> than standard radiation therapy, depending on the schedules used.</div></li><li class="half_rhythm"><div class="half_rhythm"><a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000046345/" class="def">Internal radiation therapy</a> uses a <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000046550/" class="def">radioactive</a> substance sealed in needles, <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000257219/" class="def">seeds</a>, wires, or <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000045637/" class="def">catheters</a> that are placed directly into or near the cancer. In <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000561398/" class="def">early-stage</a> prostate cancer, the radioactive seeds are placed in the prostate using needles that are inserted through the skin between the scrotum and rectum. The placement of the radioactive seeds in the prostate is guided by images from <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000046632/" class="def">transrectal ultrasound</a> or <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000045560/" class="def">computed tomography</a> (CT). The needles are removed after the radioactive seeds are placed in the prostate.</div></li><li class="half_rhythm"><div class="half_rhythm"><a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000046023/" class="def">Radiopharmaceutical</a>
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<a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000044737/" class="def">therapy</a> uses a <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000046550/" class="def">radioactive</a> substance to treat cancer. Radiopharmaceutical therapy includes the following:<ul id="CDR0000062965__323"><li class="half_rhythm"><div><a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000759898/" class="def">Alpha emitter radiation therapy</a> uses a radioactive substance to treat prostate cancer that has spread to the bone. A radioactive substance called <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000749669/" class="def">radium-223</a> is <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000044678/" class="def">injected</a> into a <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000476471/" class="def">vein</a> and travels through the bloodstream. The radium-223 collects in areas of bone with cancer and kills the cancer cells.</div></li></ul></div></li></ul><p id="CDR0000062965__284">The way the radiation therapy is given depends on the type and <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000045885/" class="def">stage</a> of the cancer being treated. External radiation therapy, internal radiation therapy, and radiopharmaceutical therapy are used to treat prostate cancer.</p><p id="CDR0000062965__256">Men treated with radiation therapy for prostate cancer have an increased risk of having <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000444968/" class="def">bladder</a> and/or <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000045692/" class="def">gastrointestinal</a> cancer.</p><p id="CDR0000062965__162">Radiation therapy can cause <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000321376/" class="def">impotence</a> and <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000044093/" class="def">urinary</a> problems that may get worse with age.</p></div><div id="CDR0000062965__1389"><h4>Hormone therapy</h4><p id="CDR0000062965__165"><a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000045110/" class="def">Hormone therapy</a> is a cancer treatment that removes <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000045713/" class="def">hormones</a> or blocks their action and stops cancer cells from growing. Hormones are substances made by <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000046386/" class="def">glands</a> in the body and circulated in the bloodstream. In prostate cancer, male sex hormones can cause prostate cancer to grow.
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<a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000348921/" class="def">Drugs</a>, surgery, or other hormones are used to reduce the amount of male hormones or block them from working. This is called <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000559086/" class="def">androgen deprivation therapy</a> (ADT).</p><p id="CDR0000062965__166"> Hormone therapy for prostate cancer may
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include the following:</p><ul id="CDR0000062965__167"><li class="half_rhythm"><div><a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000641969/" class="def">Abiraterone acetate</a> can prevent prostate cancer cells from making <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000045592/" class="def">androgens</a>. It is used in men with <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000478743/" class="def">advanced</a> prostate cancer that has not gotten better with other hormone therapy. </div></li><li class="half_rhythm"><div><a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000045441/" class="def">Orchiectomy</a> is
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a surgical procedure to remove one or both <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000046611/" class="def">testicles</a>, the main source of male hormones, such as <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000045581/" class="def">testosterone</a>, to decrease
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the amount of hormone being made. </div></li><li class="half_rhythm"><div><a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000046076/" class="def">Estrogens</a>
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(hormones that promote female sex characteristics) can prevent the
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testicles from making
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testosterone. However, estrogens are seldom used today in the treatment of
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prostate cancer because of the risk of serious side effects.</div></li><li class="half_rhythm"><div><a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000046304/" class="def">Luteinizing hormone-releasing
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hormone agonists</a> can stop the testicles from making
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testosterone. Examples are <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000595341/" class="def">leuprolide</a>, <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000045289/" class="def">goserelin</a>, and <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000045180/" class="def">buserelin</a>.</div></li><li class="half_rhythm"><div>
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<a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000046052/" class="def">Antiandrogens</a>
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can block the action of androgens
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(hormones that promote male sex characteristics), such as testosterone. Examples are
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<a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000045264/" class="def">flutamide</a>, <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000045354/" class="def">bicalutamide</a>, <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000740024/" class="def">enzalutamide</a>, apalutamide, and <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000045300/" class="def">nilutamide</a>.</div></li><li class="half_rhythm"><div>Drugs that can prevent the <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000046678/" class="def">adrenal glands</a> from making androgens include
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<a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000045222/" class="def">ketoconazole</a>, <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000045170/" class="def">aminoglutethimide</a>, <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000045205/" class="def">hydrocortisone</a>, and <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000045158/" class="def">progesterone</a>.</div></li></ul><p id="CDR0000062965__168"><a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000256567/" class="def">Hot flashes</a>, <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000454756/" class="def">impaired</a> sexual function, loss of desire for sex, and weakened bones
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may occur in men treated with hormone therapy. Other side effects include <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000306496/" class="def">diarrhea</a>, <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000390302/" class="def">nausea</a>, and itching.</p><p id="CDR0000062965__270">See <a href="https://www.cancer.gov/about-cancer/treatment/drugs/prostate" ref="pagearea=body&targetsite=external&targetcat=link&targettype=uri">Drugs Approved for Prostate Cancer</a> for more information.</p></div><div id="CDR0000062965__272"><h4>Chemotherapy</h4><p id="CDR0000062965__274"><a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000045214/" class="def">Chemotherapy</a> is a cancer treatment that uses drugs to stop the growth of cancer cells, either by killing the cells or by stopping them from dividing. When chemotherapy is taken by mouth or <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000044678/" class="def">injected</a> into a <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000476471/" class="def">vein</a> or muscle, the drugs enter the bloodstream and can reach cancer cells throughout the body (<a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000301626/" class="def">systemic chemotherapy</a>). </p><p id="CDR0000062965__275">See <a href="https://www.cancer.gov/about-cancer/treatment/drugs/prostate" ref="pagearea=body&targetsite=external&targetcat=link&targettype=uri">Drugs Approved for Prostate Cancer</a> for more information.</p></div><div id="CDR0000062965__277"><h4>Immunotherapy</h4><p id="CDR0000062965__279"><a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000045729/" class="def">Immunotherapy</a> is a treatment that uses the patient’s <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000046356/" class="def">immune system</a> to fight cancer. Substances made by the body or made in a laboratory are used to boost, direct, or restore the body’s natural defenses against cancer. <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000579628/" class="def">Sipuleucel-T</a> is a type of immunotherapy used to treat prostate cancer that has <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000046283/" class="def">metastasized</a> (spread to other parts of the body).</p><p id="CDR0000062965__281">See <a href="https://www.cancer.gov/about-cancer/treatment/drugs/prostate" ref="pagearea=body&targetsite=external&targetcat=link&targettype=uri">Drugs Approved for Prostate Cancer</a> for more information.</p></div><div id="CDR0000062965__303"><h4>Bisphosphonate therapy</h4><p id="CDR0000062965__305"><a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000044817/" class="def">Bisphosphonate</a> drugs, such as <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000045405/" class="def">clodronate</a> or <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000045500/" class="def">zoledronate</a>, reduce bone disease when cancer has spread to the bone. Men who are treated with antiandrogen therapy or orchiectomy are at an increased risk of bone loss. In these men, bisphosphonate drugs lessen the risk of bone fracture (breaks). The use of bisphosphonate drugs to prevent or slow the growth of bone <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000046710/" class="def">metastases</a> is being studied in clinical trials.</p></div></div><div id="CDR0000062965__316"><h3>There are treatments for bone pain caused by bone metastases or hormone therapy.
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</h3><p id="CDR0000062965__318">Prostate cancer that has spread to the bone and certain types of hormone therapy can weaken bones and lead to bone pain. Treatments for bone pain include the following: </p><ul id="CDR0000062965__319"><li class="half_rhythm"><div>Pain <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000482419/" class="def">medicine</a>.</div></li><li class="half_rhythm"><div>External radiation therapy.</div></li><li class="half_rhythm"><div><a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000549693/" class="def">Strontium-89</a> (a <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000045856/" class="def">radioisotope</a>).</div></li><li class="half_rhythm"><div><a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000270742/" class="def">Targeted therapy</a> with a <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000046066/" class="def">monoclonal antibody</a>, such as <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000514443/" class="def">denosumab</a>.</div></li><li class="half_rhythm"><div>Bisphosphonate therapy.</div></li><li class="half_rhythm"><div><a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000045658/" class="def">Corticosteroids</a>.</div></li></ul><p id="CDR0000062965__321"> See the <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000044271/" class="def">PDQ</a> summary on <a href="/books/n/pdqcis/CDR0000062845/">Pain</a> for more information. </p></div><div id="CDR0000062965__169"><h3>New types of treatment are being tested in clinical
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trials.</h3><p id="CDR0000062965__235">This summary section describes treatments that are being studied in clinical trials. It may not mention every new treatment being studied. Information about clinical trials is available from the <a href="https://www.cancer.gov/about-cancer/treatment/clinical-trials" ref="pagearea=body&targetsite=external&targetcat=link&targettype=uri">NCI website</a>.</p><div id="CDR0000062965__171"><h4>Cryosurgery</h4><p id="CDR0000062965__173"><a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000045407/" class="def">Cryosurgery</a> is a treatment that uses an instrument to freeze and destroy prostate cancer cells. Ultrasound is used to find the area that will be treated. This type of treatment is also called cryotherapy.</p><p id="CDR0000062965__238">Cryosurgery can cause impotence and leakage of urine from the bladder or stool from the rectum.</p></div><div id="CDR0000062965__215"><h4>High-intensity–focused ultrasound therapy</h4><p id="CDR0000062965__217"><a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000599983/" class="def">High-intensity–focused ultrasound therapy</a> is a treatment that uses ultrasound (high-energy sound waves) to destroy cancer cells. To treat prostate cancer, an <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000357580/" class="def">endorectal</a>
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<a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000367430/" class="def">probe</a> is used to make the sound waves.</p></div><div id="CDR0000062965__257"><h4>Proton beam radiation therapy</h4><p id="CDR0000062965__259"><a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000270726/" class="def">Proton beam radiation therapy</a> is a type of high-energy, external radiation therapy that targets tumors with streams of <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000044715/" class="def">protons</a> (small, positively charged particles). This type of radiation therapy is being studied in the treatment of prostate cancer.</p></div><div id="CDR0000062965__1333"><h4>Photodynamic therapy</h4><p id="CDR0000062965__1335">A cancer treatment that uses a drug and a certain type of <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000045748/" class="def">laser</a> light to kill cancer cells. A drug that is not active until it is exposed to light is injected into a vein. The drug collects more in cancer cells than in normal cells. <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000476949/" class="def">Fiberoptic</a> tubes are then used to carry the laser light to the cancer cells, where the drug becomes active and kills the cells. <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000045238/" class="def">Photodynamic therapy</a> causes little damage to healthy tissue. It is used mainly to treat tumors on or just under the skin or in the lining of internal organs.</p></div></div><div id="CDR0000062965__334"><h3>Treatment for prostate cancer may cause side effects.</h3><p id="CDR0000062965__334_73">For information about <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000046580/" class="def">side effects</a> caused by treatment for cancer, see our <a href="https://www.cancer.gov/about-cancer/treatment/side-effects" ref="pagearea=body&targetsite=external&targetcat=link&targettype=uri">Side Effects</a> page.</p></div><div id="CDR0000062965__248"><h3>Patients may want to think about taking part in a clinical trial.</h3><p id="CDR0000062965__248_23">For some patients, taking part in a <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000045961/" class="def">clinical trial</a> may be the best treatment choice. Clinical trials are part of the cancer research process. Clinical trials are done to find out if new cancer treatments are safe and effective or better than the <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000044930/" class="def">standard treatment</a>.</p><p id="CDR0000062965__248_24">Many of today's standard treatments for cancer are based on earlier clinical trials. Patients who take part in a clinical trial may receive the standard treatment or be among the first to receive a new treatment.</p><p id="CDR0000062965__248_25">Patients who take part in clinical trials also help improve the way cancer will be treated in the future. Even when clinical trials do not lead to effective new treatments, they often answer important questions and help move research forward.</p></div><div id="CDR0000062965__250"><h3>Patients can enter clinical trials before, during, or after starting their cancer treatment.</h3><p id="CDR0000062965__250_29">Some clinical trials only include patients who have not yet received treatment. Other trials test treatments for patients whose cancer has not gotten better. There are also clinical trials that test new ways to stop cancer from <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000046556/" class="def">recurring</a> (coming back) or reduce the <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000046580/" class="def">side effects</a> of cancer treatment.</p><p id="CDR0000062965__250_30">Clinical trials are taking place in many parts of the country. Information about clinical trials supported by NCI can be found on NCI’s <a href="https://www.cancer.gov/about-cancer/treatment/clinical-trials/search" ref="pagearea=body&targetsite=external&targetcat=link&targettype=uri">clinical trials search</a> webpage. Clinical trials supported by other organizations can be found on the <a href="https://clinicaltrials.gov/" ref="pagearea=body&targetsite=external&targetcat=link&targettype=uri">ClinicalTrials.gov</a> website.</p></div><div id="CDR0000062965__252"><h3>Follow-up tests may be needed.</h3><p id="CDR0000062965__252_33">Some of the tests that were done to <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000046450/" class="def">diagnose</a> the cancer or to find out the <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000045885/" class="def">stage</a> of the cancer may be repeated. Some tests will be repeated in order to see how well the treatment is working. Decisions about whether to continue, change, or stop treatment may be based on the results of these tests.</p><p id="CDR0000062965__252_34">Some of the tests will continue to be done from time to time after treatment has ended. The results of these tests can show if your <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000651193/" class="def">condition</a> has changed or if the cancer has <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000046556/" class="def">recurred</a> (come back). These tests are sometimes called <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000044671/" class="def">follow-up</a> tests or check-ups.</p></div></div><div id="CDR0000062965__1391"><h2 id="_CDR0000062965__1391_">Treatment of Stage I Prostate Cancer</h2><p id="CDR0000062965__1397">For information about the treatments listed below, see the <a href="#CDR0000062965__147">Treatment Option Overview</a> section.</p><p id="CDR0000062965__1392"><a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000044930/" class="def">Standard treatment</a> of <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000045129/" class="def">stage I prostate
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cancer</a> may include the following:</p><ul id="CDR0000062965__1393"><li class="half_rhythm"><div><a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000045942/" class="def">Watchful
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waiting</a>.</div></li><li class="half_rhythm"><div><a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000616060/" class="def">Active surveillance</a>. If the <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000045333/" class="def">cancer</a> begins to grow, <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000045110/" class="def">hormone
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therapy</a> may be given.</div></li><li class="half_rhythm"><div><a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000046549/" class="def">Radical
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prostatectomy</a>, usually with <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000045087/" class="def">pelvic</a>
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<a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000045763/" class="def">lymphadenectomy</a>. <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000044971/" class="def">Radiation therapy</a> may be given after
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<a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000045570/" class="def">surgery</a>. </div></li><li class="half_rhythm"><div>
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<a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000046686/" class="def">External radiation therapy</a>. Hormone therapy may be given after radiation therapy.</div></li><li class="half_rhythm"><div><a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000046345/" class="def">Internal radiation therapy</a> with <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000257219/" class="def">radioactive seeds</a> .</div></li><li class="half_rhythm"><div>A <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000045961/" class="def">clinical trial</a> of <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000599983/" class="def">high-intensity–focused ultrasound therapy</a>.</div></li><li class="half_rhythm"><div>A clinical trial of <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000045238/" class="def">photodynamic therapy</a>.</div></li><li class="half_rhythm"><div>A clinical trial of <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000045407/" class="def">cryosurgery</a>.</div></li></ul><p id="CDR0000062965__TrialSearch_1391_19">Use our <a href="https://www.cancer.gov/about-cancer/treatment/clinical-trials/search" ref="pagearea=body&targetsite=external&targetcat=link&targettype=uri">clinical trial search</a> to find NCI-supported cancer clinical trials that are accepting patients. You can search for trials based on the type of cancer, the age of the patient, and where the trials are being done. <a href="https://www.cancer.gov/about-cancer/treatment/clinical-trials/" ref="pagearea=body&targetsite=external&targetcat=link&targettype=uri">General information</a> about clinical trials is also available.</p></div><div id="CDR0000062965__1394"><h2 id="_CDR0000062965__1394_">Treatment of Stage II Prostate Cancer</h2><p id="CDR0000062965__1398">For information about the treatments listed below, see the <a href="#CDR0000062965__147">Treatment Option Overview</a> section.</p><p id="CDR0000062965__1395"><a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000044930/" class="def">Standard treatment</a> of <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000045130/" class="def">stage II prostate
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cancer</a> may include the following:</p><ul id="CDR0000062965__1396"><li class="half_rhythm"><div><a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000045942/" class="def">Watchful waiting</a>.</div></li><li class="half_rhythm"><div><a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000616060/" class="def">Active surveillance</a>. If the <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000045333/" class="def">cancer</a> begins to grow, <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000045110/" class="def">hormone
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therapy</a> may be given.</div></li><li class="half_rhythm"><div><a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000046549/" class="def">Radical prostatectomy</a>, usually with <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000322876/" class="def">pelvic lymphadenectomy</a>.
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<a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000044971/" class="def">Radiation therapy</a> may be given after <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000045570/" class="def">surgery</a>. </div></li><li class="half_rhythm"><div><a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000046686/" class="def">External radiation therapy</a>. Hormone therapy may be given after radiation therapy.</div></li><li class="half_rhythm"><div><a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000046345/" class="def">Internal radiation therapy</a> with <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000257219/" class="def">radioactive seeds</a>.</div></li><li class="half_rhythm"><div>A <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000045961/" class="def">clinical trial</a> of <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000045407/" class="def">cryosurgery</a>.</div></li><li class="half_rhythm"><div>A clinical trial of <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000599983/" class="def">high-intensity–focused ultrasound therapy</a>.</div></li><li class="half_rhythm"><div>A clinical trial of <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000270726/" class="def">proton beam radiation therapy</a>.</div></li><li class="half_rhythm"><div>A clinical trial of <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000045238/" class="def">photodynamic therapy</a>.</div></li><li class="half_rhythm"><div>Clinical trials of new types of treatment, such as hormone therapy followed by radical prostatectomy.</div></li></ul><p id="CDR0000062965__TrialSearch_1394_19">Use our <a href="https://www.cancer.gov/about-cancer/treatment/clinical-trials/search" ref="pagearea=body&targetsite=external&targetcat=link&targettype=uri">clinical trial search</a> to find NCI-supported cancer clinical trials that are accepting patients. You can search for trials based on the type of cancer, the age of the patient, and where the trials are being done. <a href="https://www.cancer.gov/about-cancer/treatment/clinical-trials/" ref="pagearea=body&targetsite=external&targetcat=link&targettype=uri">General information</a> about clinical trials is also available.</p></div><div id="CDR0000062965__1399"><h2 id="_CDR0000062965__1399_">Treatment of Stage III Prostate Cancer</h2><p id="CDR0000062965__1400">For information about the treatments listed below, see the <a href="#CDR0000062965__147">Treatment Option Overview</a> section.</p><p id="CDR0000062965__1401"><a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000044930/" class="def">Standard treatment</a> of <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000045131/" class="def">stage III prostate
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cancer</a> may include the following:</p><ul id="CDR0000062965__1402"><li class="half_rhythm"><div><a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000046686/" class="def">External radiation therapy</a>. <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000045110/" class="def">Hormone
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therapy</a> may be given after <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000044971/" class="def">radiation therapy</a>.</div></li><li class="half_rhythm"><div>Hormone therapy. Radiation therapy may be given after hormone therapy.</div></li><li class="half_rhythm"><div><a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000046549/" class="def">Radical prostatectomy</a>.
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Radiation therapy may be given after <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000045570/" class="def">surgery</a>.</div></li><li class="half_rhythm"><div><a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000045942/" class="def">Watchful waiting</a>.</div></li><li class="half_rhythm"><div><a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000616060/" class="def">Active surveillance</a>. If the <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000045333/" class="def">cancer</a> begins to grow, hormone
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therapy may be given.</div></li></ul><p id="CDR0000062965__1403">Treatment to control cancer that is in the <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000046539/" class="def">prostate</a> and lessen <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000044093/" class="def">urinary</a>
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<a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000045022/" class="def">symptoms</a> may include the following:</p><ul id="CDR0000062965__1404"><li class="half_rhythm"><div>External radiation therapy.</div></li><li class="half_rhythm"><div><a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000046345/" class="def">Internal radiation therapy</a> with <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000257219/" class="def">radioactive seeds</a>.</div></li><li class="half_rhythm"><div>Hormone therapy.</div></li><li class="half_rhythm"><div><a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000045932/" class="def">Transurethral resection of the
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prostate</a> (TURP).</div></li><li class="half_rhythm"><div>A <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000045961/" class="def">clinical trial</a> of new types of radiation therapy.</div></li><li class="half_rhythm"><div>A clinical trial of <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000045407/" class="def">cryosurgery</a>.</div></li></ul><p id="CDR0000062965__TrialSearch_1399_19">Use our <a href="https://www.cancer.gov/about-cancer/treatment/clinical-trials/search" ref="pagearea=body&targetsite=external&targetcat=link&targettype=uri">clinical trial search</a> to find NCI-supported cancer clinical trials that are accepting patients. You can search for trials based on the type of cancer, the age of the patient, and where the trials are being done. <a href="https://www.cancer.gov/about-cancer/treatment/clinical-trials/" ref="pagearea=body&targetsite=external&targetcat=link&targettype=uri">General information</a> about clinical trials is also available.</p></div><div id="CDR0000062965__1405"><h2 id="_CDR0000062965__1405_">Treatment of Stage IV Prostate Cancer</h2><p id="CDR0000062965__1406">For information about the treatments listed below, see the <a href="#CDR0000062965__147">Treatment Option Overview</a> section.</p><p id="CDR0000062965__1407"><a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000044930/" class="def">Standard treatment</a> of <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000045132/" class="def">stage IV prostate
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cancer</a> may include the following:</p><ul id="CDR0000062965__1408"><li class="half_rhythm"><div><a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000045110/" class="def">Hormone therapy</a>.</div></li><li class="half_rhythm"><div>Hormone therapy combined with <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000045214/" class="def">chemotherapy</a>.</div></li><li class="half_rhythm"><div><a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000044817/" class="def">Bisphosphonate</a> therapy.</div></li><li class="half_rhythm"><div><a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000046686/" class="def">External radiation therapy</a>. Hormone therapy may be given after <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000044971/" class="def">radiation therapy</a>.</div></li><li class="half_rhythm"><div><a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000759898/" class="def">Alpha emitter radiation therapy</a>.</div></li><li class="half_rhythm"><div><a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000045942/" class="def">Watchful waiting</a>.</div></li><li class="half_rhythm"><div><a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000616060/" class="def">Active surveillance</a>. If the <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000045333/" class="def">cancer</a> begins to grow, hormone
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therapy may be given.</div></li><li class="half_rhythm"><div>A <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000045961/" class="def">clinical trial</a> of <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000046549/" class="def">radical prostatectomy</a> with
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<a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000045441/" class="def">orchiectomy</a>.</div></li></ul><p id="CDR0000062965__1409">Treatment to control cancer that is in the <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000046539/" class="def">prostate</a> and lessen <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000044093/" class="def">urinary</a>
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<a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000045022/" class="def">symptoms</a> may include the following:</p><ul id="CDR0000062965__1410"><li class="half_rhythm"><div><a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000045932/" class="def">Transurethral resection of the
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prostate</a> (TURP).</div></li><li class="half_rhythm"><div>Radiation therapy.</div></li></ul><p id="CDR0000062965__TrialSearch_1405_19">Use our <a href="https://www.cancer.gov/about-cancer/treatment/clinical-trials/search" ref="pagearea=body&targetsite=external&targetcat=link&targettype=uri">clinical trial search</a> to find NCI-supported cancer clinical trials that are accepting patients. You can search for trials based on the type of cancer, the age of the patient, and where the trials are being done. <a href="https://www.cancer.gov/about-cancer/treatment/clinical-trials/" ref="pagearea=body&targetsite=external&targetcat=link&targettype=uri">General information</a> about clinical trials is also available.</p></div><div id="CDR0000062965__199"><h2 id="_CDR0000062965__199_">Treatment of Recurrent or Hormone-Resistant Prostate Cancer</h2><p id="CDR0000062965__1332">For information about the treatments listed below, see the <a href="#CDR0000062965__147">Treatment Option Overview</a> section.</p><p id="CDR0000062965__200"><a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000044930/" class="def">Standard treatment</a> of <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000045862/" class="def">recurrent</a>
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or <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000686083/" class="def">hormone-resistant</a>
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<a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000445079/" class="def">prostate cancer</a> may include the following:</p><ul id="CDR0000062965__201"><li class="half_rhythm"><div><a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000045110/" class="def">Hormone
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therapy</a>. </div></li><li class="half_rhythm"><div><a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000045214/" class="def">Chemotherapy</a> for patients already treated with hormone therapy.</div></li><li class="half_rhythm"><div><a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000045617/" class="def">Biologic therapy</a> with <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000579628/" class="def">sipuleucel-T</a> for patients already treated with hormone therapy.</div></li><li class="half_rhythm"><div><a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000046686/" class="def">External radiation therapy</a>.</div></li><li class="half_rhythm"><div><a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000045851/" class="def">Prostatectomy</a> for
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patients already treated with <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000044971/" class="def">radiation therapy</a>.</div></li><li class="half_rhythm"><div>
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<a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000759898/" class="def">Alpha emitter radiation therapy</a>.</div></li></ul><p id="CDR0000062965__TrialSearch_199_19">Use our <a href="https://www.cancer.gov/about-cancer/treatment/clinical-trials/search" ref="pagearea=body&targetsite=external&targetcat=link&targettype=uri">clinical trial search</a> to find NCI-supported cancer clinical trials that are accepting patients. You can search for trials based on the type of cancer, the age of the patient, and where the trials are being done. <a href="https://www.cancer.gov/about-cancer/treatment/clinical-trials/" ref="pagearea=body&targetsite=external&targetcat=link&targettype=uri">General information</a> about clinical trials is also available.</p></div><div id="CDR0000062965__230"><h2 id="_CDR0000062965__230_">To Learn More About Prostate Cancer</h2><p id="CDR0000062965__231">For more information from the <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000044266/" class="def">National Cancer Institute</a> about prostate cancer, see the following:</p><ul id="CDR0000062965__271"><li class="half_rhythm"><div><a href="https://www.cancer.gov/types/prostate" ref="pagearea=body&targetsite=external&targetcat=link&targettype=uri">Prostate Cancer Home Page</a></div></li><li class="half_rhythm"><div><a href="/books/n/pdqcis/CDR0000719565/">Prostate Cancer, Nutrition, and Dietary Supplements</a></div></li><li class="half_rhythm"><div><a href="/books/n/pdqcis/CDR0000062853/">Prostate Cancer Prevention</a></div></li><li class="half_rhythm"><div><a href="/books/n/pdqcis/CDR0000258032/">Prostate Cancer Screening</a></div></li><li class="half_rhythm"><div><a href="https://www.cancer.gov/about-cancer/treatment/drugs/prostate" ref="pagearea=body&targetsite=external&targetcat=link&targettype=uri">Drugs Approved for Prostate Cancer</a></div></li><li class="half_rhythm"><div><a href="https://www.cancer.gov/types/prostate/psa-fact-sheet" ref="pagearea=body&targetsite=external&targetcat=link&targettype=uri">Prostate-Specific Antigen (PSA) Test</a></div></li><li class="half_rhythm"><div><a href="https://www.cancer.gov/types/prostate/prostate-hormone-therapy-fact-sheet" ref="pagearea=body&targetsite=external&targetcat=link&targettype=uri">Hormone Therapy for Prostate Cancer</a></div></li><li class="half_rhythm"><div><a href="https://www.cancer.gov/publications/patient-education/understanding-prostate-cancer-treatment" ref="pagearea=body&targetsite=external&targetcat=link&targettype=uri">Treatment Choices for Men with Early-Stage Prostate Cancer</a></div></li><li class="half_rhythm"><div><a href="https://www.cancer.gov/about-cancer/treatment/types/surgery/cryosurgery-fact-sheet" ref="pagearea=body&targetsite=external&targetcat=link&targettype=uri">Cryosurgery in Cancer Treatment</a></div></li></ul><p id="CDR0000062965__230_40">For general <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000045333/" class="def">cancer</a> information and other resources from the National Cancer Institute, see the following:</p><ul id="CDR0000062965__230_41"><li class="half_rhythm"><div><a href="https://www.cancer.gov/about-cancer" ref="pagearea=body&targetsite=external&targetcat=link&targettype=uri">About Cancer</a></div></li><li class="half_rhythm"><div><a href="https://www.cancer.gov/about-cancer/diagnosis-staging/staging" ref="pagearea=body&targetsite=external&targetcat=link&targettype=uri">Staging</a></div></li><li class="half_rhythm"><div><a href="https://www.cancer.gov/publications/patient-education/chemo-and-you" ref="pagearea=body&targetsite=external&targetcat=link&targettype=uri">Chemotherapy and You: Support for People With Cancer</a></div></li><li class="half_rhythm"><div><a href="https://www.cancer.gov/publications/patient-education/radiation-therapy-and-you" ref="pagearea=body&targetsite=external&targetcat=link&targettype=uri">Radiation Therapy and You: Support for People With Cancer</a></div></li><li class="half_rhythm"><div><a href="https://www.cancer.gov/about-cancer/coping" ref="pagearea=body&targetsite=external&targetcat=link&targettype=uri">Coping with Cancer</a></div></li><li class="half_rhythm"><div><a href="https://www.cancer.gov/about-cancer/coping/questions" ref="pagearea=body&targetsite=external&targetcat=link&targettype=uri">Questions to Ask Your Doctor about Cancer</a></div></li><li class="half_rhythm"><div><a href="https://cancercontrol.cancer.gov/ocs/resources/survivors.html" ref="pagearea=body&targetsite=external&targetcat=link&targettype=uri">For Survivors and Caregivers</a>
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</div></li></ul></div><div id="CDR0000062965__AboutThis_1"><h2 id="_CDR0000062965__AboutThis_1_">About This PDQ Summary</h2><div id="CDR0000062965__AboutThis_2"><h3>About PDQ</h3><p id="CDR0000062965__AboutThis_3">Physician Data Query (PDQ) is the National Cancer Institute's (NCI's) comprehensive cancer information database. The PDQ database contains summaries of the latest published information on cancer prevention, detection, genetics, treatment, supportive care, and complementary and alternative medicine. Most summaries come in two versions. The health professional versions have detailed information written in technical language. The patient versions are written in easy-to-understand, nontechnical language. Both versions have cancer information that is accurate and up to date and most versions are also available in <a href="https://www.cancer.gov/espanol/publicaciones/pdq" ref="pagearea=body&targetsite=external&targetcat=link&targettype=uri">Spanish</a>.</p><p id="CDR0000062965__AboutThis_4">PDQ is a service of the NCI. The NCI is part of the National Institutes of Health (NIH). NIH is the federal government’s center of biomedical research. The PDQ summaries are based on an independent review of the medical literature. They are not policy statements of the NCI or the NIH.</p></div><div id="CDR0000062965__AboutThis_5"><h3>Purpose of This Summary</h3><p id="CDR0000062965__AboutThis_6">This PDQ cancer information summary has current information about the treatment of prostate cancer. It is meant to inform and help patients, families, and caregivers. It does not give formal guidelines or recommendations for making decisions about health care.</p></div><div id="CDR0000062965__AboutThis_7"><h3>Reviewers and Updates</h3><p id="CDR0000062965__AboutThis_8">Editorial Boards write the PDQ cancer information summaries and keep them up to date. These Boards are made up of experts in cancer treatment and other specialties related to cancer. The summaries are reviewed regularly and changes are made when there is new information. The date on each summary ("Updated") is the date of the most recent change.
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</p><p id="CDR0000062965__AboutThis_9">The information in this patient summary was taken from the health professional version, which is reviewed regularly and updated as needed, by the <a href="https://www.cancer.gov/publications/pdq/editorial-boards/adult-treatment" ref="pagearea=body&targetsite=external&targetcat=link&targettype=uri">PDQ Adult Treatment Editorial Board</a>.
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</p></div><div id="CDR0000062965__AboutThis_10"><h3>Clinical Trial Information</h3><p id="CDR0000062965__AboutThis_11">A clinical trial is a study to answer a scientific question, such as whether one treatment is better than another. Trials are based on past studies and what has been learned in the laboratory. Each trial answers certain scientific questions in order to find new and better ways to help cancer patients. During treatment clinical trials, information is collected about the effects of a new treatment and how well it works. If a clinical trial shows that a new treatment is better than one currently being used, the new treatment may become "standard." Patients may want to think about taking part in a clinical trial. Some clinical trials are open only to patients who have not started treatment.
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</p><p id="CDR0000062965__AboutThis_12">Clinical trials can be found online at <a href="https://www.cancer.gov/about-cancer/treatment/clinical-trials" ref="pagearea=body&targetsite=external&targetcat=link&targettype=uri">NCI's website</a>. For more information, call the <a href="https://www.cancer.gov/contact/contact-center" ref="pagearea=body&targetsite=external&targetcat=link&targettype=uri">Cancer Information Service</a> (CIS), NCI's contact center, at 1-800-4-CANCER (1-800-422-6237).
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</p></div><div id="CDR0000062965__AboutThis_13"><h3>Permission to Use This Summary</h3><p id="CDR0000062965__AboutThis_14">PDQ is a registered trademark. The content of PDQ documents can be used freely as text. It cannot be identified as an NCI PDQ cancer information summary unless the whole summary is shown and it is updated regularly. However, a user would be allowed to write a sentence such as “NCI’s PDQ cancer information summary about breast cancer prevention states the risks in the following way: [include excerpt from the summary].”
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</p><p id="CDR0000062965__AboutThis_15">The best way to cite this PDQ summary is:</p><p id="CDR0000062965__AboutThis_21">PDQ® Adult Treatment Editorial Board. PDQ Prostate Cancer Treatment. Bethesda, MD: National Cancer Institute. Updated <MM/DD/YYYY>. Available at: <a href="https://www.cancer.gov/types/prostate/patient/prostate-treatment-pdq" ref="pagearea=body&targetsite=external&targetcat=link&targettype=uri">https://www.cancer.gov/types/prostate/patient/prostate-treatment-pdq</a>. Accessed <MM/DD/YYYY>. [PMID: 26389353]</p><p id="CDR0000062965__AboutThis_16">Images in this summary are used with permission of the author(s), artist, and/or publisher for use in the PDQ summaries only. If you want to use an image from a PDQ summary and you are not using the whole summary, you must get permission from the owner. It cannot be given by the National Cancer Institute. Information about using the images in this summary, along with many other images related to cancer can be found in <a href="https://visualsonline.cancer.gov/" ref="pagearea=body&targetsite=external&targetcat=link&targettype=uri">Visuals Online</a>. Visuals Online is a collection of more than 3,000 scientific images.
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</p></div><div id="CDR0000062965__AboutThis_17"><h3>Disclaimer</h3><p id="CDR0000062965__AboutThis_18">The information in these summaries should not be used to make decisions about insurance reimbursement. More information on insurance coverage is available on Cancer.gov on the <a href="https://www.cancer.gov/about-cancer/managing-care" ref="pagearea=body&targetsite=external&targetcat=link&targettype=uri">Managing Cancer Care</a> page.</p></div><div id="CDR0000062965__AboutThis_19"><h3>Contact Us</h3><p id="CDR0000062965__AboutThis_20">More information about contacting us or receiving help with the Cancer.gov website can be found on our <a href="https://www.cancer.gov/contact" ref="pagearea=body&targetsite=external&targetcat=link&targettype=uri">Contact Us for Help</a> page. Questions can also be submitted to Cancer.gov through the website’s <a href="https://www.cancer.gov/contact/email-us" ref="pagearea=body&targetsite=external&targetcat=link&targettype=uri">E-mail Us</a>.</p></div></div></div></div>
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<div class="post-content"><div><div class="half_rhythm"><a href="/books/about/copyright/">Copyright Notice</a></div><div class="small"><span class="label">Bookshelf ID: NBK65915</span><span class="label">PMID: <a href="https://pubmed.ncbi.nlm.nih.gov/26389353" title="PubMed record of this page" ref="pagearea=meta&targetsite=entrez&targetcat=link&targettype=pubmed">26389353</a></span></div></div></div>
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<div xmlns:np="http://ncbi.gov/portal/XSLT/namespace" xmlns:xsi="http://www.w3.org/2001/XMLSchema-instance"></div><div class="portlet"><div class="portlet_head"><div class="portlet_title"><h3><span>Views</span></h3></div><a name="Shutter" sid="1" href="#" class="portlet_shutter" title="Show/hide content" remembercollapsed="true" pgsec_name="PDF_download" id="Shutter"></a></div><div class="portlet_content"><ul xmlns:np="http://ncbi.gov/portal/XSLT/namespace" xmlns:xsi="http://www.w3.org/2001/XMLSchema-instance" class="simple-list"><li><a href="/books/NBK65915.13/?report=reader">PubReader</a></li><li><a href="/books/NBK65915.13/?report=printable">Print View</a></li><li><a data-jig="ncbidialog" href="#_ncbi_dlg_citbx_NBK65915" data-jigconfig="width:400,modal:true">Cite this Page</a><div id="_ncbi_dlg_citbx_NBK65915" style="display:none" title="Cite this Page"><div class="bk_tt">PDQ Adult Treatment Editorial Board. Prostate Cancer Treatment (PDQ®): Patient Version. 2020 Jun 26. In: PDQ Cancer Information Summaries [Internet]. 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class="portlet_content"><ul xmlns:np="http://ncbi.gov/portal/XSLT/namespace" xmlns:xsi="http://www.w3.org/2001/XMLSchema-instance" class="simple-list"><li><a href="#CDR0000062965__102" ref="log$=inpage&link_id=inpage">General Information About Prostate Cancer</a></li><li><a href="#CDR0000062965__120" ref="log$=inpage&link_id=inpage">Stages of Prostate Cancer</a></li><li><a href="#CDR0000062965__142" ref="log$=inpage&link_id=inpage">Treatment Option Overview</a></li><li><a href="#CDR0000062965__1391" ref="log$=inpage&link_id=inpage">Treatment of Stage I Prostate Cancer</a></li><li><a href="#CDR0000062965__1394" ref="log$=inpage&link_id=inpage">Treatment of Stage II Prostate Cancer</a></li><li><a href="#CDR0000062965__1399" ref="log$=inpage&link_id=inpage">Treatment of Stage III Prostate Cancer</a></li><li><a href="#CDR0000062965__1405" ref="log$=inpage&link_id=inpage">Treatment of Stage IV Prostate Cancer</a></li><li><a href="#CDR0000062965__199" ref="log$=inpage&link_id=inpage">Treatment of Recurrent or Hormone-Resistant Prostate Cancer</a></li><li><a href="#CDR0000062965__230" ref="log$=inpage&link_id=inpage">To Learn More About Prostate Cancer</a></li><li><a href="#CDR0000062965__AboutThis_1" ref="log$=inpage&link_id=inpage">About This PDQ Summary</a></li></ul></div></div><div class="portlet"><div class="portlet_head"><div class="portlet_title"><h3><span>Related publications</span></h3></div><a name="Shutter" sid="1" href="#" class="portlet_shutter" title="Show/hide content" remembercollapsed="true" pgsec_name="document-links" id="Shutter"></a></div><div class="portlet_content"><ul xmlns:np="http://ncbi.gov/portal/XSLT/namespace" xmlns:xsi="http://www.w3.org/2001/XMLSchema-instance" class="simple-list"><li><a href="/books/NBK66036/">Health Professional Version</a></li></ul></div></div><div class="portlet"><div class="portlet_head"><div class="portlet_title"><h3><span>Similar articles in PubMed</span></h3></div><a 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Screening and Prevention Editorial Board. </em><em xmlns:np="http://ncbi.gov/portal/XSLT/namespace" xmlns:xsi="http://www.w3.org/2001/XMLSchema-instance" class="cit">PDQ Cancer Information Summaries. 2002</em></div></div></li><li class="brieflinkpopper two_line"><a class="brieflinkpopperctrl" href="/pubmed/26389388" ref="ordinalpos=1&linkpos=2&log$=relatedreviews&logdbfrom=pubmed"><span xmlns:np="http://ncbi.gov/portal/XSLT/namespace" xmlns:xsi="http://www.w3.org/2001/XMLSchema-instance" class="invert">Review</span> Melanoma Treatment (PDQ®): Patient Version.</a><span class="source">[PDQ Cancer Information Summari...]</span><div class="brieflinkpop offscreen_noflow"><span xmlns:np="http://ncbi.gov/portal/XSLT/namespace" xmlns:xsi="http://www.w3.org/2001/XMLSchema-instance" class="invert">Review</span> Melanoma Treatment (PDQ®): Patient Version.<div class="brieflinkpopdesc"><em xmlns:np="http://ncbi.gov/portal/XSLT/namespace" xmlns:xsi="http://www.w3.org/2001/XMLSchema-instance" class="author">PDQ Adult Treatment Editorial Board. </em><em xmlns:np="http://ncbi.gov/portal/XSLT/namespace" xmlns:xsi="http://www.w3.org/2001/XMLSchema-instance" class="cit">PDQ Cancer Information Summaries. 2002</em></div></div></li><li class="brieflinkpopper two_line"><a class="brieflinkpopperctrl" href="/pubmed/26389278" ref="ordinalpos=1&linkpos=3&log$=relatedreviews&logdbfrom=pubmed"><span xmlns:np="http://ncbi.gov/portal/XSLT/namespace" xmlns:xsi="http://www.w3.org/2001/XMLSchema-instance" class="invert">Review</span> Neuroblastoma Treatment (PDQ®): Patient Version.</a><span class="source">[PDQ Cancer Information Summari...]</span><div class="brieflinkpop offscreen_noflow"><span xmlns:np="http://ncbi.gov/portal/XSLT/namespace" xmlns:xsi="http://www.w3.org/2001/XMLSchema-instance" class="invert">Review</span> Neuroblastoma Treatment (PDQ®): Patient Version.<div class="brieflinkpopdesc"><em xmlns:np="http://ncbi.gov/portal/XSLT/namespace" xmlns:xsi="http://www.w3.org/2001/XMLSchema-instance" class="author">PDQ Pediatric Treatment Editorial Board. </em><em xmlns:np="http://ncbi.gov/portal/XSLT/namespace" xmlns:xsi="http://www.w3.org/2001/XMLSchema-instance" class="cit">PDQ Cancer Information Summaries. 2002</em></div></div></li><li class="brieflinkpopper two_line"><a class="brieflinkpopperctrl" href="/pubmed/26389197" ref="ordinalpos=1&linkpos=4&log$=relatedreviews&logdbfrom=pubmed"><span xmlns:np="http://ncbi.gov/portal/XSLT/namespace" xmlns:xsi="http://www.w3.org/2001/XMLSchema-instance" class="invert">Review</span> Retinoblastoma Treatment (PDQ®): Patient Version.</a><span class="source">[PDQ Cancer Information Summari...]</span><div class="brieflinkpop offscreen_noflow"><span xmlns:np="http://ncbi.gov/portal/XSLT/namespace" xmlns:xsi="http://www.w3.org/2001/XMLSchema-instance" class="invert">Review</span> Retinoblastoma Treatment (PDQ®): Patient Version.<div class="brieflinkpopdesc"><em xmlns:np="http://ncbi.gov/portal/XSLT/namespace" xmlns:xsi="http://www.w3.org/2001/XMLSchema-instance" class="author">PDQ Pediatric Treatment Editorial Board. </em><em xmlns:np="http://ncbi.gov/portal/XSLT/namespace" xmlns:xsi="http://www.w3.org/2001/XMLSchema-instance" class="cit">PDQ Cancer Information Summaries. 2002</em></div></div></li><li class="brieflinkpopper two_line"><a class="brieflinkpopperctrl" href="/pubmed/26389322" ref="ordinalpos=1&linkpos=5&log$=relatedreviews&logdbfrom=pubmed"><span xmlns:np="http://ncbi.gov/portal/XSLT/namespace" xmlns:xsi="http://www.w3.org/2001/XMLSchema-instance" class="invert">Review</span> Cancer Pain (PDQ®): Patient Version.</a><span class="source">[PDQ Cancer Information Summari...]</span><div class="brieflinkpop offscreen_noflow"><span xmlns:np="http://ncbi.gov/portal/XSLT/namespace" xmlns:xsi="http://www.w3.org/2001/XMLSchema-instance" class="invert">Review</span> Cancer Pain (PDQ®): Patient Version.<div class="brieflinkpopdesc"><em 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