CONTENTS. What is Cancer? What Should I Know About Prostate Cancer? Who's at Risk?... 3 Diagnosis & Staging Tests... 3

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1 CONTENTS Introduction What is Cancer? What Should I Know About Prostate Cancer? Who's at Risk? Diagnosis & Staging Tests Staging Prostate Cancer Stage (T) 1, 2, 3, Stage NX, MX The Gleason System How is Prostate Cancer Treated? Watchful Waiting Surgery Radiation Brachytherapy Hormonal Therapy Chemotherapy What Happens After I Receive Treatment? Personal Stories Cancer Support Services & Resources Glossary of Medical Terms

2 1 INTRODUCTION The diagnosis of prostate cancer brings with it many questions and a need for clear, understandable answers. It is natural for anyone facing cancer to be concerned about what the future holds. Many people with cancer want to learn all they can about their disease, their treatment choices, and possible side effects of treatment, so they can take an active part in decisions about their medical care. Learning more about the prognosis of cancer and understanding cancer statistics may help some men with prostate cancer and reduce the stress and fear associated with the diagnosis. There are a number of available treatments for men with prostate cancer (surgery, radiation therapy, and hormone therapy). Not all men require treatment. The physician who is most familiar with the patient's medical condition is in the best position to discuss a patient's prognosis and to help the patient understand the meaning of the diagnosis. We hope this booklet will help in providing useful resources and valuable information for you and those close to you. It is designed to help you understand and cope with your diagnosis. It explains prostate cancer, how it develops, and what its effects are. It describes symptoms, diagnosis, treatment, and follow-up care. It also describes what doctors and other health care professionals know about treating this disease. After you read this booklet, you and your doctor will probably want to talk further about your illness and treatment. By working together, you will plan the treatment that is best for you.

3 WHAT IS CANCER? 2 Cancer is a group of many related diseases that begin in cells, the body's basic unit of life. Although cancer is often referred to as a single condition, it actually consists of more than 100 different diseases, all characterized by the uncontrolled growth and spread of abnormal cells. Cancer can arise in many sites and behaves differently depending on its organ of origin. To understand cancer, it is helpful to know what happens when normal cells become cancerous. The body is made up of many types of cells. Normally, cells grow and divide to produce more cells only when the body needs them. This orderly process helps keep the body healthy. Sometimes, however, cells keep dividing when new cells are not needed. These extra cells form a mass of tissue, called a growth or tumor. TUMORS CAN BE BENIGN OR MALIGNANT: Benign tumors are not cancer. They can often be removed and, in most cases, they do not come back. Cells from benign tumors do not spread to other parts of the body. Most important, benign tumors are rarely a threat to life. Malignant tumors are cancer. Cells in these tumors are abnormal and divide without control or order. They can invade and damage nearby tissues and organs. Also, cancer cells can break away from a malignant tumor and enter the bloodstream or the lymphatic system. That is how cancer spreads from the original cancer site to form new tumors in other organs. The spread of cancer is called metastasis. Most cancers are named for the organ or type of cell in which they begin. For example, cancer that begins in the lung is lung cancer, and cancer that begins in cells in the skin known as melanocytes is called melanoma. When cancer spreads (metastasizes), cancer cells are often found in nearby or regional lymph nodes (sometimes called lymph glands). If the cancer has reached these nodes, it means that cancer cells may have spread to other organs, such as the liver, bones, or brain. When cancer spreads from its original location to another part of the body, the new tumor has the same kind of abnormal cells and the same name as the primary tumor.

4 3 WHAT SHOULD I KNOW ABOUT PROSTATE CANCER? WHO'S AT RISK? The only well-established risk factors for prostate cancer are age, ethnicity, and family history of prostate cancer. Most prostate cancer is diagnosed in men over age 65. The highest incidence rates in the world are in African-American men. Genetic studies suggest that a strong familial predisposition may be responsible for 5 % - 10% of prostate cancers. HOW IS PROSTATE CANCER DIAGNOSED? DRE: The American Cancer Society recommends a digital rectal exam (DRE) be offered annually beginning at age 50. Men at high risk (African Americans and men who have a first-degree relative diagnosed with prostate cancer at a young age) should begin testing at age 45. PSA: A routine prostate-specific antigen (PSA) blood test, used to detect a substance made by the prostate, should be drawn annually beginning at age 50. A normal PSA level is between 0-4 ng/ml. Levels which range between 4 and 10 ng/ml are associated with prostate cancer in 25% of patients. The PSA levels can also rise in men who have benign prostatic hypertrophy (BPH), or infection in the prostate. TRUS: A transrectal ultrasound would be recommended if the PSA test results are borderline high, but the DRE results were normal. This will allow the urologist to view an ultrasonic image of the prostate, and to guide the biopsy needle into the area of the prostate that will be biopsied. Several samples are obtained from different areas of the prostate. ADDITIONAL TESTS: Additional tests may be ordered to make sure the cancer has not spread. A computerized tomography (CT) scan, magnetic resonance imaging (MRI), a radionuclide bone scan or other blood tests may be ordered by your physician. A bone scan may be done if the PSA is greater than 20 or at the discretion of your physician. DIAGNOSIS & STAGING TESTS It is important for your doctor to determine the stage of your prostate cancer, because only by knowing how the cancer is growing and exactly where it is located in the body can you and your physician choose the best treatment for you. Digital Rectal Examination (DRE): A procedure in which a physician inserts a gloved, lubricated finger into the rectum to feel some areas of the prostate. Transrectal Ultrasonography (TRUS): A procedure in which an instrument is inserted into the rectum and produces sound waves directed at the prostate; from these sound waves, a picture is created. Bone Scan: A picture that is taken using radioactive material that can show whether cancer has spread to the bone. This is done if the PSA test result is higher than 20. T refers to the size of the primary tumor N will describe the extent of the regional lymph node involvement M refers to the presence of absence of metastases

5 T - STAGING PROSTATE CANCER 4 Stage TX, TO, T1 Common Treatment Choices: Prostatectomy or radiation therapy may be chosen for Stage T1. In addition, hormonal therapy may be used before, during, or after prostatectomy or radiation. In other cases, watchful waiting may be an option. TX TO T1 (A) T1a (A1) T1b (A2) T1c Primary tumor cannot be assessed. No evidence of primary tumor. Tumor not clinically apparent. Tumor incidentally found in < 5% of prostate sample. Tumor incidentally found in > 5% of prostate sample. Tumor identified at needle biopsy performed to investigate PSA elevation. Stage T2 Common Treatment Choices: Treatment options for this state often include prostatectomy and radiation therapy. In addition, hormonal therapy may be used before, during, or after prostatectomy or radiation. In other cases, watchful waiting may be an option. T2 (B) T2a (B1) T2b (B2) Tumor palpable and confined to prostate. Tumor involves one prostate lobe. Tumor involves both prostate lobes. T2b (B2) Stage T3 Common Treatment Choices: Prostatectomy, radiation therapy, or both are common choices during this stage. In addition, hormonal therapy may be used before, during, or after prostatectomy or radiation. In other cases, watchful waiting may be an option. T3 (C1 < 6 cm) Tumor palpable and extends beyond prostate capsule. T3a (C1) Tumor extends beyond prostate capsule, either on one side (unilaterally) or both sides (bilaterally). T3b (C1) Tumor invades seminal vesicles. T3b (C1) Stage T4 Common Treatment Choices: The treatment options available during Stage T4 are generally the same as those in Stage T3. However, prostatectomy is used less frequently. T4 (C2) Tumor is fixed or invades adjacent anatomy other than seminal vesicles; bladder neck, external sphincter, rectum, levator muscles, and/or pelvic wall.

6 5 N & M - STAGING PROSTATE CANCER Stage NX, NO, N1 Common Treatment Choices: Hormonal therapy is generally used. Prostatectomy or radiation may be used with hormonal therapy. Chemotherapy may be used later if hormonal therapy is no longer working. In other cases, watchful waiting may be an option. NX NO N1 (D1) Regional lymph nodes cannot be assessed. No regional lymph node metastasis. Metastasis in regional lymph node or nodes. Stage MX, MO, M1 Common Treatment Choices: Hormonal therapy is generally used. Chemotherapy may be used later if hormonal therapy is no longer working. In some cases, watchful waiting may be an option. MX MO M1 (D2) M1a (D2) M1b (D2) M1c (D2) Presence of distant metastasis cannot be assessed. No distant metastasis. Distant metastasis. Metastasis to non-regional lymph nodes. Metastasis to bone. (Seen in photo to right) Metastasis to other distant sites. THE GLEASON SYSTEM If your diagnostic tests and other examinations reveal a malignant tumor, your physician may use the Gleason grading system to help describe the appearance of the cancerous prostate tissue. If the cancerous cells appear to resemble the normal prostate tissue very closely, they are said to be very well differentiated and are considered to be Gleason grade 1. This means that the tumor is not expected to be fast growing. On the other hand, if the cells in question look fairly irregular and very different from the normal prostate cells, then they are very poorly differentiated and are assigned a Gleason grade 5. Grades 2-4 are used for tumors that fall between grades 1 and 5, with higher numbers corresponding to a faster-growing tumor. Because prostate cancer tissue is often made up of areas that have different grades, the pathologist will closely examine the areas that make up the largest portion of the tissue. Gleason grades are then given to the two most commonly occurring patterns of cells. Once the two grades have been assigned, a Gleason score can be determined. This is done by adding together the two Gleason grades. The Gleason score that results will be a number from 2 to 10. Because Gleason scores on their own can be confusing, you will most likely want to discuss your results with your physician. Your doctor can explain what your Gleason score, along with your other test reports, mean for you as an individual. Although scores on the higher end of the Gleason scale (7 through 10) usually indicate a more serious prognosis, your age, emotional well-being, family support system, and physical health status are all individual factors that can influence the outcome of your disease. In addition, the treatment options that you and your physician choose will be important determinants to the outcome of your disease.

7 HOW IS PROSTATE CANCER TREATED? 6 UNDERSTANDING YOUR OPTIONS The method selected to treat prostate cancer depends on its stage, speed of growth, and the general health of the patient. Before making a decision, you may want to review the diagnosis and treatment options. A short delay will not reduce the chance that treatment will be successful. Some insurance companies require a second opinion; many others will cover a second opinion if the patient requests it. WATCHFUL WAITING Careful observation without immediate active treatment ("watchful waiting") may be appropriate, particularly for older individuals with low-grade and/or early stage tumors, or who may not be expected to tolerate other therapy due to adverse health conditions. Your doctor will monitor you by performing routine DRE and PSA tests. Watchful waiting has been found most appropriate for men older than 75 years of age with a slower growing cancer. SURGERY Radical Prostatectomy removes the entire prostate gland, attached seminal vesicles, and some nearby tissue. Advantage: The radical prostatectomy is a one time procedure that can obtain a cure in most patients when the cancer is confined to the prostate gland and may help extend life in later stages. Disadvantage: Possible side effects include impotence, urinary incontinence, rectal injury and stricture (scar tissue) formation. Although impotency can occur in a large number of patients, the chance of impotence is lower with the newer nerve-sparing technique. Urinary incontinence occurs in only a small percentage of patients. Lymphadenectomy is performed to remove nearby pelvic lymph nodes. Lymph is a nearly clear fluid that drains waste from cells. This fluid travels through vessels and into small bean-shaped structures called lymph nodes. Lymph can carry cancer cells from the primary tumor to other parts of the body. One function of lymph nodes is to filter unwanted substances, such as cancer cells, of the lymph fluid. Sometimes the doctor removes the lymph nodes before doing a prostatectomy. If the prostate cancer has not spread to the lymph nodes, the doctor then removes the prostate. But, if cancer has spread to the nodes, the doctor usually does not remove the prostate, but may suggest other treatment. Nerve-sparing Radical Prostatectomy is similar to the radical prostatectomy, but the nerves on each side of the prostate are left behind. This type of surgery can be done when the size and location of the tumor are right. This reduces the risk of impotence. But it also increases the risk that some cancer cells may be left behind. RADIATION THERAPY Radiation therapy uses high-energy rays to kill prostate cancer cells, shrink tumors, or prevent cancer cells from dividing and spreading. Radiation beams are directed at the prostate. It is possible to damage healthy cells nearby. Radiation doses are usually small and spread out over time. This allows the healthy cells to recover and survive while the cancer cells eventually die. Radiation therapy may be used when prostate cancer has not spread beyond the prostate (Stage T1-T2). A radiation session lasts about 15 minutes. Patients usually get 1 session a day, 5 days a week for 6-8 weeks.

8 7 TREATMENT METHODS Radiation therapy may be used:! Alone.! In combination with hormonal therapy when cancer cells have spread beyond the prostate, into the pelvic area (Stages T3 - T4).! For relief of pain in prostate cancer that has spread to the bones (Stage M+).! When the cancer no longer responds to hormonal therapy. When radiation therapy begins, a CT simulation is done. It is important for the planning and set-up. It allows the radiation oncologist to visualize important structures including the prostate in a three dimensional manner. The prostate, bladder and rectum are digitized into a computerized system. In order to visualize the bladder, a contrast dye may be given intravenously prior to scanning. Also, a small rectal tube is inserted and a small amount of rectal contrast is injected at the same time. Temporary marks will be drawn on your abdomen and sides that you may not wash off. It is important to avoid hot showers, baths, hot tubs, creams or anything that may take these marks off. This is only until permanent marks can be made with a very small needle and ink. This "tattoo" will be the size of a pen point. Once these permanent tattoos are on the skin, you may shower as usual. These markings ensure that the exact area is being treated consistently each day. Surrounding critical organs, such as the bladder and the rectum, will be shielded by lead blocks to protect these normal tissues and organs from unnecessary exposure to radiation, further minimizing potential adverse effects. Side Effects: There are potential side effects that may occur with radiation therapy. It is important that that you communicate to the nurse and the doctor how you are feeling. Side effects don't usually occur until after the second week of treatment and may last several weeks after the radiation is complete. EXTERNAL BEAM RADIATION THERAPY External beam radiation therapy is delivered by a machine in a painless procedure. Intensity Modulated Radiation Therapy (IMRT) In this form, patients lie in a partial box and the air is drawn out of a vacuum bag that surrounds the patient in order to immobilize him so he remains still. Computed tomography (CT) is used to create a 3-D picture of the prostate and surrounding organs. The high dose radiation rays can be delivered only to the prostate gland, while the surrounding healthy tissue receives a lower dose. IMRT is more precise than other forms of external beam radiation. IMRT is delivered in short sessions - 5 times a week for approximately 7 weeks. The advantages of IMRT are:! Can treat tumors with a higher dose of radiation.! Can re-treat cancers previously treated with radiation therapy.! Can safely treat tumors located close to other organs. 3-Dimensional Conformal Radiation Therapy (3D-CRT) High-tech computers locate the cancer inside the prostate gland. A special device or body mold, made out of styrofoam, is created for the patient to wear during the treatments.! It keeps the patients still while the radiation beams are aimed more accurately to target the entire prostate gland. This enables a high dose of radiation to be delivered only toward the prostate, while reducing the amount of radiation that the surrounding healthy areas receive.! If healthy tissue can be spared from the effects of radiation, side effects should be lower and therapy success rates higher.

9 TREATMENT METHODS 8 BRACHYTHERAPY In brachytherapy, also known as interstitial radiation therapy or "seeds," the radiation rays come from tiny, radioactive seeds inserted directly into the prostate. These seeds are inserted into the tumor during a minor surgical procedure, so brachytherapy is usually performed as an outpatient procedure. The seeds are too small to be felt by the patient and do not cause any discomfort. Brachytherapy allows the physician to use a higher dose of radiation than is possible with external beam radiation. The seeds give off rays continually for hours, weeks, months, up to a year, and can remain safely in place for the rest of a person's life. The amount of time that the seeds remain radioactive depends on the dose and what type of radioactive material is used. Brachytherapy does not make the patient radioactive. Because it is designed to target the cancerous cells and not harm the surrounding area, brachytherapy is rarely recommended when the cancer has spread beyond the prostate gland. Brachytherapy may be used alone or can be combined with hormonal therapy or external beam radiation therapy. High-dose rate brachytherapy is a new form of brachytherapy that involves the temporary placement of seeds.! Seeds stay in for less than a day and contain more radioactive material.! May be performed in a clinic without hospitalization. Advantages:! Fewer surgery-related complications than with more extensive surgeries.! Procedure is generally painless.! Requires fewer visits to the hospital or physician's office than other treatments.! Very little discomfort with high-dose rate brachytherapy. Disadvantages:! Brachytherapy has been associated with impotence, urinary incontinence, and bowel problems.! Diarrhea, rectal pain, and burning may also be experienced in some patients; in addition, these side effects may not be easy to treat.! Usually not an option for treatment of prostate cancer that has spread beyond the prostate gland. After it has been established that you are a candidate for the procedure, the doctor will do a volume study. This study provides information that will determine the number of seeds necessary for optimal implantation, the strength of each seed and the exact placement of the seeds. Radioactive seed implant procedure provides men with the advantage of preserving their erections more than does radical surgery or full-course external beam radiation therapy. However, the degree of potency preservation depends upon the patient's age, underlying medical conditions, medications, and the level of erections prior to the procedure. Literature reports the probability of maintaining erections in approximately 80% (Memorial Sloan Kettering data). Side Effects:! Blood in your urine. Notify your physician of any excess bleeding or large blood clots, or if you are unable to urinate.! Frequency, urgency, and burning are normal and may last several weeks up to several months after surgery.! Discomfort and swelling in the scrotal area, which can be treated with Tylenol.

10 9 TREATMENT METHODS! You are radioactive for approximately two months. Small children should not sit on your lap. Pregnant women and anyone under the age of 45 needs to maintain a distance of approximately six feet. Providing your significant other is over the age of 45, you may sleep in the same bed.! Sperm may be discolored for the first few ejaculations. If you pass a seed it is usually within the first 24 to 48 hours. Should you pass a seed, flush the toilet twice and notify the radiation oncologist. HORMONAL THERAPY The goal of hormonal therapy is to decrease the production of testosterone by the testes or block the actions that testosterone has on the prostate cells. Hormonal therapy cannot cure prostate cancer. It slows the cancer's growth and reduces the size of the tumor(s). Hormonal therapy is most commonly used when the cancer has spread outside of the prostate. It can be used to shrink the prostate and the cancer prior to surgery or radiation therapy. SURGERY ~ ORCHIECTOMY An orchiectomy is the surgical removal of the testes, which are the organs that produce 95% of the body's testosterone. By doing so, it "starves" the cancer cells of the fuel they need to multiply. Advantages: Relatively simple; the patient may go home the same day. Disadvantages: The surgery is permanent, thus the effect cannot be reversed. Side Effects:! Decreased sexual desire.! Possible breast tenderness and/or growth.! Temporary hot flashes.! Impotence. LHRH ANALOG THERAPY Hormonal therapy given through injections uses a drug called a luteinizing hormone-releasing hormone analog (LHRH-A). A dose can be given every 1, 3, 4, or 12 months. It acts to shut off the production of testosterone from the testes. LHRH analogs are commonly used to help relieve the symptoms when the cancer has spread (metastasized) to other parts of the body. In patients with early-stage cancer (Stage T1 - T2), hormonal therapy may be used in combination with radiation therapy or prostatectomy. It may also be combined with radiation therapy or prostatectomy in locally advanced stages of cancer when the disease has spread locally beyond the prostate (Stages T3 - T4). Advantages: Simple injection, usually once a month. Disadvantages: Need to visit physician on a regular basis. Hot flashes, decreased bone mineral density, general body pain, decrease in sexual desire and/or ability to have erections. ANTIANDROGEN THERAPY Antiandrogens do not prevent testosterone production, but they block the action of male hormones at the prostate. Antiandrogens may be used alone, but they are usually used in combination with an LHRH analog or orchiectomy. Advantages: May result in less impotence, less of a decrease in libido, and fewer hot flashes compared to LHRH analogs. Antiandrogens do not cause loss of bone mineral density. Disadvantage: The cancer may become resistant to the treatment.

11 TREATMENT METHODS 10 Side Effects: Depends on what Antiandrogen is being used. There have been reports of severe liver injury with the use of Antiandrogens. Therefore, liver functions should be measured at regular intervals. Nausea, vomiting, diarrhea, or breast growth or tenderness. Any method of hormonal therapy that lowers androgen levels can contribute to weakening of the bones in older men. DO NOT stop taking hormonal therapy unless your physician advises you to do so. CHEMOTHERAPY Chemotherapy is the use of powerful and toxic drugs to attack cancer cells. The drugs circulate throughout the body in the bloodstream and may kill any rapidly growing cells including healthy ones. Chemotherapy drugs are carefully controlled in both dosage and frequency so that cancer cells are destroyed while minimizing the risk to healthy cells. Chemotherapy is usually reserved for patients with advanced stage prostate cancer (Stage M+) that no longer responds to hormonal therapy. Advantages: It provides an additional means of relieving the symptoms of advanced prostate cancer that no longer responds to hormonal therapy. It can reduce pain and may slow tumor growth. Disadvantages: Because the drugs circulate throughout the whole body, they can affect both healthy and cancerous cells. This can lead to many side effects. Side Effects:! The specific side effects will depend upon which drugs and regimens are used.! Common adverse reactions included: hair loss, nausea, vomiting, diarrhea, lowered blood counts, reduced ability of the blood to clot, and increased risk of infection.! Some side effects occur only temporarily or are more noticeable when treatment is first started.! Most of the side effects disappear when the drugs are stopped. WHAT HAPPENS AFTER I RECEIVE TREATMENT? After you receive treatment for your prostate cancer, you ll have routine checkups with your doctor for the rest of your life. You will be evaluated to determine if the prostate cancer has recurred or progressed. In addition, your doctor will evaluate any side effects you may be experiencing for your treatment(s). The PSA is the best way to make sure the cancer hasn t come back after your treatment. You will be required to have follow-up PSA tests to evaluate the effectiveness of your treatment. The PSA should remain stable at a low level. If the PSA is rising after a few follow-up visits, this may mean that the cancer has come back or is progressing, and further testing is needed. Prostate cancer can trigger many different, often confusing emotions in a patient. To best cope with these feelings, patients with prostate cancer should share them with family members and close friends, or contact cancer support services to find out what resources are available to you. SEXUAL CHANGES The effects of prostate cancer and its treatment are a natural concern for a man and his partner on their sexual relationship. You should speak with your physician about the possible side effects. He can tell what they might be and whether they are likely to be temporary or permanent. There are booklets and other useful information available from Cancer Support Services, the American Cancer Society, and several organizations that are listed in the Support Services and Resources section.

12 11 PERSONAL STORIES HUGH PHILLIPS When Hugh Phillips, then 80 years old, learned he had prostate cancer in 1994, his doctor told him he had three options - invasive surgery, radiation treatment or simply ignore it. Phillips chose to go with radiation treatment at Northern Illinois Cancer Treatment Center - a cooperative venture between CGH Medical Center and KSB Hospital - and is glad he did. They found my cancer in its early stages, so my treatment went very smoothly, said Phillips. I was able to drive to the treatment center and make it back to work in a little over an hour. I had very few side effects and was able to go about my business normally. Phillips says he has regular PSA screenings, and all have been in the normal range since his initial treatment regimen. His only lasting side effect is slightly reduced bladder control. "I just have to be a little more careful and plan ahead," he said. "It hasn't slowed me down at all." Phillips knows he's fortunate, because his cancer was found early. "Men need to pay attention to their bodies and see their doctor on regular basis, especially as we get older," he said. "I know if I had waited to go to the doctor, things might not have turned our so well." LYNN VON HOLTEN At age 47 in 2002, Lynn Von Holten had no idea he already was stricken with advanced prostate cancer. "I had no family history," he said. "I had no reason to worry." After experiencing difficulty in urinating for a couple of years, and at the urging of his wife, Lynn took a routine PSA screening in February of The result came back at was the upper limit for his age. After taking antibiotic medication for three months, his next PSA reading was even higher at 5.9. A biopsy confirmed Lynn had advanced prostate cancer. "The day after I found out, my father passed away, so I was caught up in a lot of emotions," Lynn said. "The fear of the unknown. The 'C-Word.' I was scared." On August 1, 2003 Lynn underwent a nerve sparing, radical prostatectomy at the Mayo Clinic in Rochester, Minnesota. After surgery, the cancer was diagnosed at stage 3b. It had also spread from the prostate to seminal vesicles with lymph-node involvement. Since the surgery, Lynn's PSA levels have been well within normal ranges. To help ensure the cancer will not return, he will be on hormone therapy indefinitely. "I prefer to say forever," says Lynn. As result of the surgery and the hormone therapy, Lynn does experience some side effects including fatigue, hot flashes and weight gain. "I certainly don't like the side effects, but I can live with them because the alternative is much worse," he says. Lynn's advice to all men is simple: "See your doctor regularly, get your PSA screenings every year after you turn 40 and sooner if you have a family history, eat right and exercise. Prostate cancer is very treatable if diagnosed early on. Don't procrastinate, start early!"

13 SUPPORT SERVICES 12 Cancer Information Service CANCER American Foundation for Urologic Disease 1128 North Charles Street Baltimore, MD American Prostate Society 7188 Ridge Road Hanover, MD Cancer Care, Inc. 275 Seventh Ave New York, NY HOPE CAP CURE (The Association for the Cure of Cancer of The Prostate) th Street Santa Monica, CA CURE or CGH Cancer Support Services 100 E. LeFevre Road Sterling, IL , ext Prostate Cancer AstraZeneca Pharmaceuticals LP International Cancer Alliance (I CARE) 4853 Cordell Avenue Suite 206 Bethesda, MD ICARE Prostate Cancer Research and Education Foundation (PC-REF) 6699 Alvaro Road Suite 2301 San Diego, CA Prostate Cancer Resource Network P.O. Box 966 New Port Richey, FL Prostate Health Council C/O American Foundation for Urologic Disease 1128 North Charles Street Baltimore, MD Us Too! International, Inc Fairview Avenue Downers Grove, IL Fax:

14 13 GLOSSARY Acute side effect - a side effect that occurs within days or weeks of a treatment. Adenocarcinoma - cancerous cells in the lining of the prostate gland; prostate cancer. Adrenal gland - a gland located near the kidneys that produces a small amount of testosterone. Benign tumors - cells or tumors that are not cancerous or malignant. Benign prostatic hyperplasia - a benign (noncancerous) condition in which an overgrowth of the prostate tissue pushes against the urethra and bladder blocking the flow of urine. Also called benign prostatic hypertrophy or BPH. Biopsy - the removal of bits of tissue from the body for diagnostic examination. Brachytherapy - a cancer treatment, also known as internal radiation therapy and prostate seed implant therapy. Brachytherapy - radioactive materials sealed in needles, seed, wires, or catheters is placed directly into or near the tumor. Also called internal radiation, or interstitial radiation therapy. Core needle biopsy - a means of harvesting small tissue samples to be examined for the presence of cancer cells. Digital rectal examination (DRE) - a common screening procedure for prostate cancer examination whereby a physician inserts a gloved, lubricated finger into the rectum for the purpose of feeling the size and shape of the prostate through the rectal wall. Dosimetry - the science of determining the treatment plan to deliver the prescribed dose of radiation. Erectile dysfunction - impotence; the inability to have an erection. Gleason score - a system for rating the aggressiveness of a cancer. Impotence - the inability to have an erection. Incontinence - the inability to control bladder function. Late side affects - side effects that may not appear for six months or more following treatment. Lymph node - produce white blood cells and filter bacteria and cancer cells that may travel through the system. Also known as a lymphatic gland. Lymph nodes are spread out along lymphatic vessels and they contain many lymphocytes, which filter lymphatic fluid (lymph). Malignant tumors - cells or tumors that are cancerous. Metastasis - the spread of disease from one part of the body to another. Mitosis - cell division. Oncologist - a specialist in the treatment of cancer. Orchiectomy - surgery to remove one or both testicles. Perineum - the area between the anus and the posterior part of the external genitalia. Prostate gland - a gland in the male reproductive system just below the bladder. It surrounds part of the urethra, the canal that empties the bladder. It produces a fluid that forms part of semen. Ejaculation - the sudden release of fluid, especially the semen, from the body. Hormonal therapy - treatment of cancer by removing, blocking, or adding hormones. Also called endocrine therapy. Hormones - chemicals produced by glands in the body and circulated in the bloodstream. Hormones control the action of certain cells or organs.

15 GLOSSARY 14 Prostate-specific antigen (PSA) - a protein that is manufactured only by the prostate and can be measured as an indicator of prostate cancer, benign prostatic hyperplasia, or infection or inflammation of the prostate. Prostatic acid phosphatase (PAP) - an enzyme produced by the prostate. It may be found in increased amounts in men who have prostate cancer. Prostatectomy - surgical removal of the prostate. Radiation therapy - the use of high-energy radiation from x-rays, neutrons, and other sources to kill cancer cells and shrink tumors. Radiation may come from a machine outside the body (external-beam radiation therapy) or from materials called radioisotopes. Radioisotopes produce radiation and are placed in or near the tumor or in the area near cancer cells. This type of radiation treatment is called internal radiation therapy, implant radiation, interstitial radiation, or brachytherapy. Systemic radiation therapy uses a radioactive substance, such as radiolabeled monoclonal antibody, that circulates throughout the body. Also called radiotherapy. Rectum - the last five or six inches of the intestine leading to the outside of the body. Recur - to occur again. Recurrence is the return of cancer, at the same site as the original (primary) tumor or in another location, after it had disappeared. Remission - disappearance of the sign and symptoms of cancer. When this happens, the disease is said to be " in remission." A remission may be temporary or permanent. Testosterone - a male hormone produced by the testicles and adrenal glands that promotes the development and maintenance of male sex characteristics. Tissue - a group of cells organized to perform a specialized function. Transurethral resection of the prostate (TURP) - surgical procedure to remove tissue from the prostate using an instrument inserted through the urethra. Tumor - an abnormal mass of tissue that results from excessive cell division. Tumors perform no useful body function. They may be either benign (non-cancerous) or malignant (cancerous). Urethra - a tube that carries urine from the bladder and semen from the sex glands out of the body through the penis. Ultrasonography - an imaging technique in which sound waves (called ultrasound) are bounced off tissues and the echoes are converted into a picture (sonogram). Urologist - a physician and surgeon who is specially trained in diagnosing and treating diseases of the male genital tract and urinary tract in patients of any age or sex. Watchful Waiting - the person's condition is closely monitored, but treatment does not begin until symptoms appear or change. Also called observation. Seminal fluid - fluid from the prostate and other sex glands that helps transport sperm out of the man's body during orgasm. Seminal fluid contains sugar as an energy source for sperm. Staging - a process of gathering information about cancer using various examinations and diagnostic tests to describe the extent of cancer. Testicles - the two egg-shaped glands found inside the scrotum. They produce sperm and male hormones. Also called testes. 100 E. LeFevre Road Sterling, IL , ext Special thanks to the CGH Health Foundation for their support of this publication.

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