|Also Listed As:
Prostate cancer is a malignant tumor that originates in the prostate gland
and can eventually spread to other organs, bones, and tissues. The prostate is a
cluster of small glands located beneath the bladder that surrounds the urethra,
the tube that carries urine from the bladder out through the penis. Its
principle function is to manufacture fluid that constitutes a portion of the
Prostate cancer is the most common cancer in men in the United States and it
is the second most common cause of cancer death in men over age 55. The
incidence of prostate cancer increases dramatically with each decade after 50,
and disease rates appear to vary by population. For example, North Americans
(particularly African Americans) develop prostate cancer at one of the highest
rates in the world, while Japan and Africa have low rates of the disease.
Fortunately, prostate cancer tends to be slow-growing compared to many other
cancers—the majority of prostate cancers either do not
spread or cause harm for decades.
|Signs and Symptoms|
Many people with prostate cancer experience no symptoms at all.
Some symptoms that may indicate prostate cancer include:
- Difficult and painful urination
- Frequent urination and a feeling that one has to urinate even when the
bladder is empty
- Incomplete emptying of the bladder, which may lead to dribbling of
- Awakening frequently in the night to urinate
- Decreased force of urine stream
- Blood in the urine
- Hip and back pain
When the cancer has spread to other parts of the body, symptoms can
- Bone pain
- Weakness or paralysis caused by compression of the spinal
- Weight loss
- Kidney failure
The causes of prostate cancer are unknown, but are thought to include
environmental, nutritional, hormonal, and genetic factors. The influence of
genes on the development of prostate cancer is suggested by the fact that
prostate cancer tends to occur in men who are related to one another (see
Risk Factors below); plus, a gene has
been identified that is associated with 30% of family-related prostate cancers.
Reports also indicate that farmers as well as men who work in tire, rubber, and
sheet metal factories tend to have high rates of prostate cancer or more
aggressive forms of the cancer. Some researchers speculate that environmental
exposure to cadmium (present in commercial fungicides) and other harmful
substances may be responsible for the high rates of prostate cancer in these
men. Nutrition has been implicated in the development of prostate cancer because
disease rates among men from countries with low prostate cancer rates (such as
Japan) increase when they immigrate to the United States; this rise in incidence
is thought to be due to the switch to a typical American diet, which is high in
saturated fat. Elevated levels of
male sex hormones, such as testosterone, may also play a role in the development
of prostate cancer.
The following factors may increase an individual's risk for prostate
- Older age—prostate cancer is most common
among men who are older than 55
- Race—African Americans have a greater risk of
developing prostate cancer than European Americans who, in turn, have a greater
risk than Native and Hispanic Americans
- Family history of prostate cancer—having a
brother with prostate cancer makes an individual 4.5 times more likely of
developing the disease; having a father with prostate cancer makes an individual
2.3 times more likely of developing prostate cancer; having a sister or mother
with ovarian or breast cancer is also considered a risk
- High-fat diet—foods rich in saturated fat may
increase testosterone levels
- Lack of exercise may increase the risk in those who eat a high-fat
- Occupation—people who are regularly exposed
to the chemicals dimethyl formamide and acrylonitrate, and the metal cadmium
(such as metal workers and farmers) have high rates of prostate
Two standard tests are used for early detection of prostate
- Digital rectal exam (DRE)—in this test, the
physician inserts a gloved, lubricated finger into the patient's rectum in order
to feel the prostate for bumps or other abnormalities. Many malignant tumors
originate in the outer part of the prostate where they may be detected by this
exam. Some men find this test embarrassing, but the DRE is quick and relatively
painless, and helps detect 40% of all prostate cancers. Although as many as 40%
of tumors identified using DRE have already spread outside of the prostate
gland, studies indicate that regular DREs still save lives.
- PSA test—blood test measuring the level of
prostate-specific antigen (PSA), a protein produced in the prostate gland that
keeps semen in liquid form. Prostate cancer cells produce elevated quantities of
PSA, so measuring PSA levels allows physicians to detect cancer while it is
still microscopic. Unfortunately, the test is not accurate enough to
definitively rule out or confirm cancer. For example, advancing age and benign
conditions such as enlarged prostate can also elevate PSA levels. In general,
PSA tests help detect up to 75% of all tumors.
If either the DRE or PSA test suggests the possible presence of cancer, the
following tests will be performed to make a definite diagnosis:
- Transrectal Ultrasound—a visual image of the
prostate is obtained by using ultrasound
- Biopsy of the prostate—a tissue sample is
obtained through the rectum and examined for cancerous cells under the
If the biopsy confirms the presence of cancer, several tests will be
performed to detect any spread of the disease. This information gauges how
serious the prostate cancer is at the time of diagnosis. Likely tests include
- Imaging tests (CT and MRI)—computerized
tomography (CT) or magnetic resonance imaging (MRI) scans may pinpoint the
location of cancer that has spread beyond the prostate
- Bone scans and X rays—these look for spread
of cancer to the bones
- Lymph node dissection—this is part of a
surgical procedure to determine if the cancer has spread to the lymphatic
As described in the
Diagnosis section, regular screening with
the DRE and PSA exams by the doctor helps to detect prostate cancer in the early
stages, before it has spread. Both the American Cancer Society and the American
Urological Association recommend that men between the ages of 50 and 70 should
have DRE or PSA tests performed annually. African American men or those with a
family history of prostate cancer should begin screening at age 40.
Studies also suggest that the following lifestyle modifications may minimize
the risk of prostate cancer:
- Consuming a
low-fat diet, rich in
fruits and vegetables
- Eating foods rich in
selenium (such as brewer's yeast,
wheat germ, chicken liver, nuts and seeds, tuna, herring, and oysters) and
vitamin E (such as wheat germ, organ
meats, sweet potatoes, leafy vegetables including spinach, nuts and seeds, eggs,
soybeans, and lima beans)
- Exercising regularly, because exercise temporarily lowers
Treatment for prostate cancer depends on the stage of the disease, the age of
the individual, the presence of other medical conditions, and the individual's
preferences in conjunction with the physician's recommendations. If prostate
cancer is detected early, treatment usually involves either
surgical removal of the prostate or
radiation therapy. For more advanced cases
of prostate cancer, or if cancer spreads beyond the prostate, hormone
medications are the preferred
treatment. If the individual is older than 70 and has only a slow-growing tumor,
the physician may adopt a strategy called "watchful waiting," in which the man
returns frequently for check-ups and treatment only occurs if his condition
worsens. During the time of watchful waiting (and also as a possible adjunct to
surgery, medication, or radiation),
dietary modifications may slow the
growth of the cancer. For example, eating a low-fat diet, rich in fruits,
vegetables, soy, selenium, and fiber has been associated with a decreased risk
of prostate cancer.
PC-SPES, an herbal mixture
originating in Traditional Chinese Medicine, appears to significantly reduce PSA
levels in people with prostate cancer.
Acupuncture can relieve pain and the
side effects of surgery while
massage may reduce stress and anxiety
associated with having prostate cancer.
Medications are considered the best therapy for people with advanced stages
of prostate cancer or when cancer spreads from the prostate to other parts of
the body. Drugs may also be prescribed prior to radiation therapy or when
surgical procedures fail to lower PSA levels. Most medications for prostate
cancer lower levels of male sex hormones (such as testosterone). Lowering
testosterone levels can cause tumors to shrink or slow their growth.
Some commonly prescribed medications include:
- Luteinizing Hormone-Releasing Hormone (LH-RH) agonists (such as
leuprolid, goserelin, and buserelin)—LH-RH is natural
hormone, released by the hypothalmus in the brain, that lowers the production of
testosterone; the medication encourages the release of this natural hormone.
Side effects can include hot flashes, weight gain, development of male breast
tissue, breast pain, and nausea.
- Hormones including antiandrogens (such as flutamide, bicalutamide, and
nilutamide) and estrogens (such as diethylstilbestrol and ethinyl
estradiol)—these medications reduce testosterone
levels; side effects can include reduced sex drive, fatigue, nausea, impotence,
diarrhea, and hot flashes
- Chemotherapeutic medications (such as vinblastine, mitoxantrone, and
estramustine)—improve symptoms in advanced cancer but
do not increase life expectancy
- Glucocorticoids—may be used along with
chemotherapy to suppress production of male
|Surgery and Other Procedures|
- Removal of the prostate
(prostatectomy)—offers an excellent cure for men with
prostate cancer that is completely confined to the prostate, and is performed if
life expectancy is at least 10 years and cancer is confined to the prostate.
Side effects include incontinence and impotence, but new procedures that spare
nerves near the prostate preserve sexual function in 25% to 90% of
- Surgical exploration of lymph nodes—may be
performed to evaluate whether prostate cancer has spread to the lymphatic
- Resection of the prostate (called TURP or transurethral resection of
the prostate)—removal of all or part of the prostate
gland to eliminate cancer and to relieve obstruction of urine
- Removal of the testes (orchiectomy)—lowers
testosterone levels; side effects can include impotence and hot
In addition to these surgical procedures, radiation therapy may be effective
for cancer confined to the prostate, particularly for older men. Radiation can
be administered through an external source, or irradiated seeds can be placed
internally near the prostate. Using irradiated seeds actually lowers the risk of
damage to organs surrounding the prostate from radiation because administration
can be more precise in both amount and location. Side effects can include
proctitis (inflammation of the lining of the rectum), urinary tract infections,
|Nutrition and Dietary Supplements|
Population-based studies suggest that dietary fat may influence the risk of
prostate cancer. In one study of 384 men with prostate cancer, those who
consumed the most saturated fat (from, for example, meat, dairy, and butter) in
the previous year were significantly more likely to develop advanced prostate
cancer. Diets particularly high in animal fats have also been linked to an
increased risk of prostate cancer among African Americans and to advanced stages
of the disease in European Americans. While an association between high-fat
diets and prostate cancer is not definitive, it is probably wise for people at
risk for prostate cancer to avoid foods high in saturated fat and trans fatty
acids (such as margarine).
Fruits and Vegetables
People who consume higher amounts of fruits and vegetables, especially
cruciferous vegetables (such as broccoli, cauliflower and Brussels sprouts) may
have a reduced risk of developing prostate cancer. One study of more than 1,200
men (half with prostate cancer and half free of the disease) found that those
who consumed 28 or more servings of vegetables per week were 35% less likely to
develop prostate cancer than those who had less than 14 servings per week.
Although this type of study cannot be considered definitive, eating at least
four servings of vegetables per day to help prevent or slow the progression of
the disease is reasonable and may be healthy for a variety of reasons.
Fructose, or fruit sugar, seems to stimulate the production of a certain form
of vitamin D (see below) which, in turn, has been associated with a decreased
risk of advanced prostate cancer. As with vegetables, therefore, including fruit
in the diet also appears to be safe and potentially beneficial.
Omega-3 Fatty Acids
Laboratory and animal studies indicate that omega-3 fatty acids
(specifically, docosahexaenoic acid [DHA] and eicosapentaenoic acid [EPA]) may
inhibit the growth of prostate cancer. Similarly, population based studies of
groups of men suggest that a low-fat diet with the addition of omega-3 fatty
acids from fish or fish oil help prevent the development of prostate cancer. A
healthy balance of omega-3 to omega-6 fatty acids appears to be particularly
important for reducing the risk of this condition. Alpha linolenic acid (ALA;
another omega-3 fatty acid) may not offer the same benefits as EPA and DHA. In
fact, one recent study evaluating 67 men with prostate cancer found that they
had higher levels of ALA compared to men without prostate cancer. More research
in this area is needed.
While some studies suggest that lycopene, the primary ingredient in tomatoes,
may protect against prostate cancer, this relationship is not entirely clear.
Lycopene is a carotenoid that acts as an antioxidant, protecting cells from
damage that may become cancerous over a long period of time. In a large study,
lycopene levels were significantly lower in those with prostate cancer compared
to those without. However, tomato consumption in another study did not reduce
the risk of prostate cancer. Although levels of this carotenoid in the blood may
be lower in those with prostate cancer, eating more tomatoes in order to raise
lycopene levels may not make a difference in the risk of development or
treatment of prostate cancer. Like other vegetables, however, it seems safe and
reasonable to include tomatoes in the diet.
People who live in cultures in which soy is a large part of the diet are at
less risk for developing hormone-related cancers, such as prostate cancer. For
example, men living in Japan have a significantly lower risk of developing
prostate cancer than men in the United States—notably,
the Asian diet contains significantly more soy than the typical American diet.
Laboratory and animal studies also suggest that genistein, a plant based hormone
(phytoestrogen) which comes from soy, may suppress the growth of prostate cancer
cells. Such studies are promising, but the role of soy in preventing or treating
prostate cancer in people remains unclear.
Several studies indicate that selenium, an antioxidant, may protect against
prostate cancer. In one large study, 1,312 people with skin
cancer—three quarters of them
men—received either 200 micrograms of selenium (in the
form of brewer's yeast) or a placebo for approximately 4 years. Study
participants were followed for over 6 years. Men who received selenium were
significantly less likely to develop prostate cancer by the end of the study
than men who received placebo. Laboratory studies also suggest that selenium may
suppress the growth of prostate cancer cells. Selenium supplementation may be
worth considering as part of a regimen to treat or prevent progression of
Beta-carotene is an antioxidant that occurs naturally in the body. In a
well-respected long-term study, supplementing with beta-carotene appeared to
reduce the risk of developing prostate cancer by 32% in men who had low levels
at the beginning of the study. However, because other large trials have not
shown it to be useful in preventing prostate cancer, the benefits of
beta-carotene are still unclear. More information is needed before
recommendations for beta-carotene can be made, particularly because
supplementation with these antioxidants has been associated with increased risk
of certain types of cancer.
One recent study found that a form of vitamin E found in soybean oil, known
as gamma-tocopherol, may significantly decrease the risk of prostate cancer.
Researchers measured levels of gamma tocopherol, selenium, and alpha-tocopherol
(another form of vitamin E), in the blood and toenails of 117 men with prostate
cancer and 233 healthy men. Men with the highest levels of gamma tocopherol were
significantly less likely to develop prostate cancer compared to those with the
Laboratory and animal studies have suggested that a certain form of vitamin
D, known as 1, 25 dihydroxy vitamin D, inhibits growth of prostate cancer cells.
What this means for people with or at high risk for prostate cancer is unclear.
Some experts suggest eating several servings of fruit daily, which helps
stimulate production of this form of vitamin D, and avoiding dairy, which may
inhibit production of this type of vitamin D. This latter suggestion, however,
is somewhat controversial and not scientifically proven at this time.
In one 4-month, randomized, controlled trial studying men with high
cholesterol, researchers happened to note that PSA levels were lowered after the
men consumed meals high in soluble fiber (such as barley, peas, beans, oat bran,
and cereal with psyllium) but not with meals rich in insoluble fiber (such as
wheat bran cereal as well as high-fiber crackers and bread). However, these
findings do not necessarily indicate that a diet high in fiber will lower PSA
readings, or guarantee a decreased risk for prostate cancer.
Studies suggest that melatonin levels are lower in people with prostate
cancer than those without cancer. In addition, men with prostate cancer also
tend to have lower than normal nighttime levels of this hormone. In one study,
melatonin (when used in conjunction with conventional medical treatment)
improved survival rates in 9 out of 14 patients with metastatic prostate cancer.
Laboratory studies have also found that melatonin inhibits the growth of
prostate cancer cells in test tubes. Interestingly, meditation is thought to be
a valuable addition to the treatment of prostate cancer as it has been shown to
increase levels of melatonin in the body. Although these early results are
intriguing, more research is needed.
Preliminary laboratory studies suggest that the flavonoid quercetin inhibits
prostate cancer cells in test tubes. How this will ultimately translate to
prevention or treatment of prostate cancer in men is unknown at this time.
Red Clover (Trifolium pratense)
In one report, a 66 year old man who took red clover every day for a week
prior to having a prostatectomy for prostate cancer showed reduced signs of
cancer in the diseased prostate tissue. While making any assumptions from one
case report is highly speculative, the authors of the report hypothesize that
plant estrogens (phytoestrogens) in the red clover may have been responsible for
the observed improvement. It may be worthwhile to test this theory in a large
number of people with prostate cancer over an extended period of time.
St. John's wort (Hypericum perforatum) and kava kava (Piper
At least 25% of people with advanced prostate cancer are depressed, and many
are anxious. Some experts recommend St. John's wort to help alleviate depression
or kava kava to soothe anxiety. Use of these herbs should be discussed with your
healthcare provider, who can also describe the potential for interactions
between the herbs and prescription medications. For example, St. John's wort
should not be taken with other antidepressants or with a class of drugs called
protease inhibitors (used for HIV).
Ginkgo (Ginkgo biloba)
While ginkgo has become a popular remedy for men who are unable to have an
erection (a side effect of many prostate cancer treatments), the herb has not
been specifically studied for this use in men with prostate
Acupuncture may provide relief from side effects of orchiectomy (removal of
the testes). In one small trial, 4 out of 6 men who were given acupuncture twice
weekly for 2 weeks and then once a week for 10 weeks reported a decreased number
of hot flashes. Studies also support the use of acupuncture for the pain that
often occurs when cancer has spread beyond the prostate (particularly to the
bones). A National Institutes of Health statement released in 1997 also supports
the use of acupuncture to alleviate nausea associated with chemotherapy.
While acupuncture is not used as a treatment for cancer itself, evidence
suggests it can be a valuable therapy for cancer-related symptoms (particularly
nausea and vomiting that often accompanies chemotherapy treatment). There have
also been studies indicating that acupuncture may help reduce pain and shortness
of breath. Acupressure (pressing on rather than needling acupuncture points) has
also proved useful in controlling breathlessness; this is a technique that
patients can learn and then use to treat themselves.
Some acupuncturists prefer to work with a patient only after the completion
of conventional medical cancer therapy. Others will provide acupuncture and/or
herbal therapy during active chemotherapy or radiation. Acupuncturists treat
cancer patients based on an individualized assessment of the excesses and
deficiencies of qi located in various meridians. In many cases of cancer-related
symptoms, a qi deficiency is usually detected in the spleen or kidney
|Massage and Physical Therapy|
Studies suggest that massage reduces stress and boosts immune function, so it
may help relieve anxiety for men undergoing treatment for prostate cancer.
Pelvic floor exercises—the repetitive use of muscles
that start and stop the flow of urine—may help decrease
incontinence caused by prostatectomy (removal of the prostate). This therapeutic
approach is often combined with biofeedback.
Meditation may benefit men with prostate cancer by helping them to reduce
stress, ease anxiety, and regain a sense of self-control.
Biofeedback and Pelvic Muscle Training (PMT)
Several studies have found that learning to start and stop the flow of urine
by repeatedly using the muscles of the pelvis (PMT) in combination with
biofeedback can reduce the duration of incontinence after prostate cancer
surgery. Other studies suggest however, that PMT alone, with or without
biofeedback, is responsible for the beneficial effects. Either way, both PMT and
biofeedback are safe, noninvasive therapies that may benefit men who suffer from
incontinence following either surgical removal of the prostate or other
treatments for prostate cancer.
|Traditional Chinese Medicine|
Several studies suggest that the traditional Chinese herbal mixture, PC-SPES,
appears to be a promising treatment for prostate cancer. As suggested by a
recent study of 67 men with prostate cancer at the Memorial Sloan-Kettering
Cancer Center, PC-SPES, a combination formula containing the following herbs may
reduce PSA levels in men with prostate cancer:
- Chrysanthemum (Dendrantherma morifolium)
- Reishi mushroom (Ganoderma lucidium)
- Licorice (Glycyrrhiza glabra)
- Da Qing Ye (Isatis indigotica)
- San-qi ginseng (Panax pseudo-ginseng, Wall)
- Chinese skullcap (Sculletaria baicalensis, Georgi)
- Saw palmetto berry (Serenoa repens)
While these results are promising, further studies are needed to determine
whether PC-SPES is safe and effective for men with prostate cancer. In fact, a
well-designed long-term study is currently underway by researchers at the
University of California, San Francisco in collaboration with scientists at the
Dana Farber Cancer Institute in Boston. Research regarding possible use of
PC-SPES is of particular interest for men who do not respond to surgery,
radiation, or medication. Commonly reported side effects of PC-SPES include loss
of libido, impotence, leg cramps, diarrhea, and hot flashes. More serious side
effects have included blood clots, allergic reactions, and heart and kidney
|Prognosis and Complications|
Most complications from prostate cancer result from specific treatments.
- Prostatectomy—can cause incontinence and/or
- Radiation therapy—can cause proctitis
(inflammation of the lining of the rectum), bladder infections, and/or
- Hormone medications—can cause loss of libido,
impotence, hot flashes, excessive development of male breasts, and tenderness in
male breast tissue
- Removal of testes—can cause impotence and hot
The outlook for a man with prostate cancer depends on his age, the stage of
tumor growth, whether he has any underlying medical illnesses, and his PSA
levels. The prognosis for men with cancer that has not spread beyond the
prostate is quite good. Most of these cancers are curable with appropriate
treatment, and after 15 years the same number of these men will be alive as
those who never had prostate cancer. If the cancer spreads beyond the prostate
and does not respond to hormone medications, however, there is little hope for a
cure. Still, prostate tumors are slow-growing, and even men with advanced
prostate cancer can survive for 5 years or more.
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|Review Date: March 2001|
|Reviewed By: Participants in the review process include: Richard Glickman-Simon, MD,
Department of Family Medicine, New England Medical Center, Tufts University,
Boston, MA; Jacqueline A. Hart, MD, Department of Internal Medicine,
Newton-Wellesley Hospital, Harvard University and Senior Medical Editor
Integrative Medicine, Boston, MA; Jane Hart, MD, Clinical Instructor, Case
Western Reserve University School of Medicine and Director for Preventive
Medicine Consultations and Medical Director for the Institute for Total Health
at the Cleveland YMCA, Cleveland, OH; Lonnie Lee, MD, Internal Medicine, Silver
Springs, MD; Richard A. Lippin, MD, President, The Lippin Group, Southampton,
PA; Anne McClenon, ND, Compass Family Health Center, Plymouth, MA; Marcellus
Walker, MD, LAc, (Acupuncture section October 2001) St. Vincent's Catholic
Medical Center, New York, NY; Ira Zunin, MD, MPH, MBA, (Acupuncture section
October 2001) President and Chairman, Hawaii State Consortium for Integrative
Medicine, Honolulu, HI.|
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