Frequently Asked Questions About Prostate Cancer

Q: What is the prostate?

A: The prostate is a gland of the male reproductive system. It produces fluid for semen, which transports sperm during the male orgasm. Click here for an image of the prostate.

Normally, the prostate is quite small — it is nearly the same size and shape as a chestnut. It is located in front of the rectum, just below the bladder, and wraps around the urethra, the tube that carries urine from the bladder out through the tip of the penis. The prostate is made up of approximately 30% muscular tissue, and the rest is glandular tissue.

Q: What is prostate cancer?

A: Prostate cancer is a malignant tumor that begins growing in the prostate gland. Early prostate cancer may not have any symptoms. As the tumor grows, it may spread from one part of the prostate to surrounding areas. Men may experience a change in urination, including increased frequency, hesitancy or dribbling of urine, as the tumor grows.

Prostate cancer can spread from the prostate to nearby lymph nodes, bones or other organs. This spread is called metastasis.

Q: What causes prostate cancer?

A: While researchers still do not know the exact answer to this question, they have identified some risk factors. These include environment, genetics and family history.

Q: What are the stages of prostate cancer?

A: Staging assesses the size and location of prostate cancer. Determining the stage of the cancer helps your doctor decide which treatment is best.

Stage A is early cancer. The tumor is located within the prostate gland and cannot be felt during a digital rectal exam (DRE).
In Stage B, the tumor is considered to be within the prostate and can be felt during a DRE.
In Stage C, the tumor has spread outside the prostate to some surrounding areas. This stage of cancer can usually be detected by a DRE.
In Stage D, the cancer has spread to the nearby organs and usually to other sites, such as the bones or lymph nodes.

Q: What are the major treatment options for prostate cancer?

A: The major treatment options for prostate cancer include:

Watchful waiting (observation)
Surgery
External beam radiation therapy
Brachytherapy
Cryotherapy
Chemotherapy

Your treatment options will depend on several factors, including your age, the stage of cancer and the advice of your physician.

Q: Who treats prostate cancer?

A: If prostate problems are discovered, your physician may refer you to an urologist, a doctor who specializes in disorders of the urinary system and the male reproductive system. In some cases, patients may be referred to an oncologist, a specialist in treating cancer, for additional consultation.

Q: What can I do about impotence and incontinence?

A: The two most feared side effects from prostate cancer treatments are incontinence and erectile dysfunction (impotence). Incontinence is the inability to control urinary function and impotence is the inability to sustain an erection suitable for intercourse. Often times, these side effects are only temporary. Both incontinence and impotence are treatable.

Incontinence is quite common after surgery or radiation due to the irritation of the bladder, urethra and sphincter muscles that hold urine in the bladder. Recovery of urinary control can happen immediately or take many months to resolve. A small percentage of men never fully recover urinary control.

There are a number of methods and exercises that can help you deal with the unpleasantness of incontinence.

Medication can often help in controlling urination. Collagen injections, external and internal catheters or a penile clamp can also alleviate incontinence. For very severe cases, an artificial sphincter can be surgically implanted. Many men have found the procedure to be a welcome relief to long-term incontinence.

It is not unusual to be incontinent to some degree for a few months after radical surgery. This usually improves with time, but you should be honest with your doctor if it is bothersome. Healing is an individual process and varies from one man to another.

Erectile dysfunction, or impotence, is another common side effect of prostate cancer treatment. If the nerves that control an erection are preserved during a radical prostatectomy, impotence is often a temporary condition. It's important to your doctor about your concerns and treatment options.

Medications can be very effective in treating impotence. While these medications are generally well tolerated, they can be dangerous if taken with nitrates.

If oral medications are not effective, other methods can help. One therapy, known as MUSE, uses a small pellet that is inserted into the urethra to produce an erection. A similar therapy delivers the medication by injecting it into the base of the penis. A vacuum pump is a non-invasive method that helps achieve an erection. If all else fails, a device can be surgically implanted to help with erectile dysfunction.

Q: How does my diet affect my risk of prostate cancer?

A: Several studies suggest that a high fat diet stimulates prostate cancer to grow. In particular, beef and high fat dairy products appear to be stimulators of prostate cancer. Conversely, a low fat diet rich in fruits and vegetables my help decrease the risk of prostate cancer. Such "healthy" foods include soy (tofu and soy milk), tomatoes, green tea and citrus.

Soy contains substances called phytoestrogens, which resemble the female sex hormone estrogen. In dietary doses — that is amounts normally found in foods, not the amounts in supplements — phytoestrogens can decrease the risk of prostate cancer. Green tea contains antioxidants, which are chemicals that help prevent changes in cells and reduce damage that can cause cells to become cancerous.
Vitamin E is a free-radical scavenger and is also associated with a decreased risk of prostate cancer. Men with a history of bleeding problems or who take blood thinners should discuss the use of vitamin E with their doctor before taking it.
High levels of fructose, a form of sugar, have been associated with a lower risk of prostate cancer.
Selenium has been associated with a decreased risk of prostate cancer.
Lycopene, a cartenoid (chemicals that give orange, red, or yellow coloring to plants), is associated with a decreased risk of prostate cancer. Lycopene is found in high levels in tomatoes and is beneficial only if the fruit is cooked (for instance, in tomato sauce).

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