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Your Guide to Prostate Cancer Treatment and Health Your Guide to
Your Guide to
Prostate Cancer
Prostate Cancer
Treatment and Health
Treatment and Health
Michigan Urology Center
At the University of Michigan
Comprehensive Cancer Center Introduction
Introduction
Our goals
Our goals
Our ultimate goal is to partner with you in improving and
maintaining your health, thats why weve produced this
guidebook for you and your family. We hope it will prove to be
a valuable resource as we embark on this journey together.
How this guide will work for you
How this guide will work for you
This guidebook is designed to provide answers to commonly
asked questions, explain the various phases of treatment of
prostate conditions, and provide helpful resources to support
you and your loved ones.
Because your path to treatment will be unique, just as you are
unique, this guidebook may not answer all of your questions.
It should be used as a tool for helping you to generate
questions to ask your physician or the nursing staff and meet
your individual needs.
Please bring this guidebook with you to each of your visits
and feel free to contact the Michigan Urology Center at any
time if you have questions or concerns about the information
provided.
How to ask for help
How to ask for help
The best way to reach an experienced oncology nurse during
normal business hours is to call
1-800-865-1125
. If you need
help after 5:00 P.M., Please dial 734-936-6267 and ask for the
urology resident on call. Contents
Contents
Understanding Your Prostate and Prostate Conditions...
Understanding Your Prostate and Prostate Conditions...
What it is, where it is, and what can happen
What it is, where it is, and what can happen
PSA, Gleasons Grade and Biopsy
PSA, Gleasons Grade and Biopsy
What are they and what do the scores mean
What are they and what do the scores mean
Your Options for Treatment in Early Stage Prostate Cancer
Your Options for Treatment in Early Stage Prostate Cancer
What they are and what to expect
What they are and what to expect
Risk factors associated with treatment of cancer located
only In the prostate gland
Frequently asked questions
If You Choose Surgery
If You Choose Surgery
What to expect before and after your surgery date
What to expect before and after your surgery date
What you need to know prior to being admitted to the
hospital
What you need at home after leaving the hospital
Post Treatment Implications
Post Treatment Implications
How to know if your treatment has worked
What options exist if the cancer returns
Frequently asked questions
Nutrition and Dietary Supplements
Nutrition and Dietary Supplements
What You Need to Know if Coming from Outside of Ann Arbor
What You Need to Know if Coming from Outside of Ann Arbor
Maps of Ann Arbor and the University Health System
Information about the Med Inn Hotel at the hospital and
other local hotels, including discounted rates
Other Helpful Information
Other Helpful Information
Who you call if you have a problem
How you find additional support or information
Glossary
Glossary
What all of those medical terms mean
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9 Understanding Your Prostate and Prostate
Conditions...
What It Is
What It Is
The prostate is one of the male sex glands. When a man has sex, some fluid from the
prostate mixes with the sperm made in the testes. Then, the fluid (called semen or
ejaculate) gets squeezed out through the penis.
The prostate is thought to do one major thing: add enzymes to the ejaculate to help
increase fertility.
Where It Is
Where It Is
Look at the picture on the next page. The prostate is a walnut-shaped gland in the
male body that sits just below the bladder and in front of the rectum. (That is why the
prostate gland can be felt through the wall of the rectum.) The prostate surrounds the
upper part of the urethra (u-REE-thra) , the tube that carries urine and semen out of
the penis.
What Can Happen to It
What Can Happen to It
Normal Prostate: As you get older, the prostate commonly enlarges.
Enlarged Prostate (Benign Prostatic Hyperplasia or BPH) : If the prostate gets
too large, it can make it hard for a man to pass urine (urinate) because it can press on
the tube that carries urine and semen out of the penis.
Prostatitis (prah-stah-TI-tiss): The prostate can become inflamed, irritated, or
infected.
Prostate Cancer: The prostate can also develop cancer. Prostate cancer is the
uncontrolled growth of cells leading to a malignant tumor in the prostate gland. The
cancer generally grows slowly within the gland, but sometimes the cancer cells
penetrate the outer rim of the gland and spread to tissues and organs near the prostate
(advanced prostate cancer). This includes lymph nodes and seminal vesicles. Where the Prostate Is... PSA, Gleason Grade and Biopsy
If you have been told that you have prostate cancer, you have probably had a
biopsy and possibly other tests that tell you about your condition. These tests give
valuable information, but they are not perfect. Heres what the tests may mean to
you.
PSA Test
PSA Test
The prostate makes an important substance called Prostate Specific Antigen or
PSA. The PSA Test measures the amount of this substance (PSA) in the
bloodstream. Small amounts of PSA are released into the blood normally, but this
amount can be higher in men with cancer as well as other prostate conditions such as
prostate enlargement (BPH) or prostatitis.
The American Urological Association and the American Cancer Society recommend
that prostate screening, including a Digital Rectal Exam (DRE) and PSA blood test,
should be given yearly after age 50. If you are African American or have a family
history, this screening should begin at age 45.
If you have been diagnosed with Prostate Cancer, the PSA test can help tell you
how big your tumor probably is and if it may be spreading:
If your PSA was less than 10, the chances that treatment will work are good
(this includes watchful waiting, surgery and radiation).
If your PSA was between 10 and 20, there is some cause to be concerned.
If your PSA was more than 20, the chances that curative treatment will work are not
so good. Biopsy
Biopsy
A Prostate Specific Antigen or PSA test and/or a Digital Rectal Exam (DRE) may
indicate that a biopsy is necessary. During the biopsy, the doctor removes a sample
of tissue which is looked at closely under a microscope by a pathologist. The
pathologist prepares a report (pathology report) which will grade the tissue
examined in order to understand how aggressive the condition may or may not be.
The biopsy is usually performed as an office procedure using ultrasound guidance.
While only 1 in 200 men may experience an infection following a biopsy, some
blood in the urine or in bowel movements can be common for 2-3 days following the
biopsy. Blood in the semen may last for up to 2-3 weeks.
Gleason Grade or Score
Gleason Grade or Score
The grade of the cancer tells how fast your cancer is likely to grow. The grade
may be called a Gleason Grade or Score, named for the man who invented the test.
To come up with a Gleason grade, a pathologist looks at the cancer tissue removed
during your biopsy and assigns it two numbers between one and five (two numbers
are given because prostate tumors from a single individual will usually show some
variation). A total Gleason grade or score will be between two and ten, the higher
numbers corresponding to more aggressive tumors. By giving your doctor an idea of
how aggressive the cancer appears to be, the Gleason grade helps determine the most
appropriate course of treatment.
What the scores indicate:
What the scores indicate:

If your Gleason Score was 2, 3, 4, or 5, the cancer is likely to grow very slowly.
If your Gleason Score was 6, the cancer is likely to grow at a slow rate.
If your Gleason Score was 7, the cancer is likely to grow at a medium rate.
If your Gleason Score was 8, 9, or 10, the cancer is likely to grow fast. The Stage of the Cancer
The Stage of the Cancer
The stage tells you how big your tumor is and how far it has spread. Your
physician may recommend getting a bone scan, CT scan, MRI or other tests to see
if your cancer has spread to your body. There are two systems of letting you know
what stage the cancer is in. The first system uses letters and numbers, for example
T1, N0, M1. T is for Tumor size, N is Lymph Nodes involvement and M tells that
the cancer has spread (or Metastasized). The second system uses letters from A
through D. The following chart will help you understand what the stages mean.
The Stage
What the Doctors Call It
What It Means
A-D System
TNM System
Early Stage
Stage A
Stage T1
Stage B
Stage T2
Later Stage
Stage C
Stage T3/T4
Stage D
Stage N+/M+
The tumor has probably
not spread outside the
prostate gland.
The tumor is large
enough to feel and has
probably not spread
outside the prostate
gland.
The tumor has spread
outside the prostate
gland.
The tumor has spread to
other parts of the body as
shown by CT or bone
scans.
The tumor cannot be felt. FREQUENTLY ASKED QUESTIONS
FREQUENTLY ASKED QUESTIONS
Q. What are the causes of prostate cancer?
There are several major risk factors associated with prostate can