After Diagnosis: Prostate Cancer. Understanding Your Treatment Options

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1 After Diagnosis: Prostate Cancer Understanding Your Treatment Options

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3 What s inside How will this booklet help me?... 3 What is the prostate?... 4 What is prostate cancer?... 4 Who gets prostate cancer?... 5 Surviving prostate cancer... 5 How is prostate cancer diagnosed?... 5 What tests are used for prostate cancer?... 6 What is grading?... 6 What is staging?... 7 What are my treatment options?... 9 What is recurrent disease? Treating cancer pain Living with cancer...22 Questions to ask your doctor...24 To learn more

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5 How will this booklet help me? You ve been told you have prostate cancer. You may be feeling confused, scared, lonely, angry, or sad. These feelings are normal, especially when you re trying to learn about prostate cancer and your treatment options. Keep in mind that prostate cancer often can be treated, especially when it s still small and hasn t spread to other parts of your body. It s also possible that it might not need treatment or ever become a major problem, because some prostate cancers grow very slowly. This booklet gives you information about prostate cancer, treatment options, common treatment side effects, and other places you can go to learn more. But you ll want to talk with your doctor about your cancer and how to best treat it. Think about your health, how much prostate cancer you have, your age and expected lifespan, and possible treatment side effects as you make decisions about treatment. Prostate cancer often can be treated successfully, especially when it s still small and has not spread to other parts of your body. 3

6 What is the prostate? The prostate is a gland found only in males. It makes some of the fluid that helps keep sperm alive and healthy. It sits just below the bladder and in front of the rectum. The tube that carries urine runs through the prostate. The prostate gland is about the size of a walnut in young men, but it tends to get bigger as men get older. This is called benign prostatic hyperplasia, or BPH. BPH is not cancer, and it does not lead to cancer. But sometimes the enlarged prostate can squeeze the tube that carries urine and cause problems passing urine. What is prostate cancer? There are many types of cancer. All cancers start when a group of cells in the body change and grow out of control. In prostate cancer this uncontrolled growth starts inside the prostate. Over time, it may take over the entire gland and spread outside the gland. As the cancer grows, it may also spread to other parts of the body. Some prostate cancers grow slowly. Others can be very fast-growing and spread quickly to other parts of the body, like the lymph nodes and the bones. This spread is called metastasis. Bladder Urethra Penis Seminal Vesicle Prostate Scrotum 4

7 Who gets prostate cancer? Prostate cancer is the most common type of cancer found in American men (other than skin cancer). It s less common in younger men, and more common with age. African American men and men with close family members who had prostate cancer are more likely to develop this cancer than other men. The cause of prostate cancer is unknown. Surviving prostate cancer When someone is told they have cancer, a common question is How long will I live? Today, nearly all men with prostate cancer can expect to live at least 5 years from the time the cancer is diagnosed. About 9 out of 10 men can expect to live at least 15 years after diagnosis. Most prostate cancers are found in men 65 and older. Many men with prostate cancer, especially those whose cancer is only in the prostate gland itself, die of other illnesses or old age not prostate cancer. How is prostate cancer diagnosed? Prostate cancer can be found by a blood test that checks the amount of prostate-specific antigen (PSA) in the blood. Another way to find prostate cancer is the digital rectal exam or DRE. (For this test, the doctor puts a gloved finger into the man s rectum to feel the prostate gland.) Changes in these tests may be signs of prostate cancer and you may need a biopsy. This means one or more small pieces of tissue will be taken out of the prostate using a very thin needle. A biopsy is the only way to know for sure if you have prostate cancer. 5

8 A biopsy is done in the doctor s office. The tissue is then looked at under a microscope to see if there are cancer cells in it. Biopsies are often done during a procedure called transrectal ultrasound (TRUS). TRUS makes pictures of the prostate that the doctor can use to make sure the needle is in the right place for the biopsy. Once prostate cancer has been found, you will need more tests to figure out the extent or stage of the cancer. The PSA blood test, ultrasound, and DRE are used to help find prostate cancer at its earliest and most treatable stage. What tests are used for prostate cancer? After finding out you have prostate cancer, your doctor will do tests to help find out how much cancer is present. This is called the stage of the cancer. Some of the tests that helped find your cancer in the first place (for example, the PSA blood test) are also used in staging. You may need other tests, like a bone scan, a CT or CAT scan, MRI, ultrasound, and/or blood tests. You might also need more biopsies. 6 What is grading? The tissue taken during your biopsy is studied in a lab to help decide the grade. The grade tells how likely the cancer is to grow and spread. The Gleason score is a measure of the grade of a prostate cancer. The Gleason score can be between 2 and 10, but most biopsies are at least a 6. The higher your Gleason score, the more likely it is that the cancer will grow and spread quickly.

9 What is staging? A staging system is a standard way your doctor describes how much cancer there is and whether it has spread. Your treatment and expected outcome depend on the stage of the cancer. The system used most often is the TNM system. The TNM system describes: The extent of the primary tumor (T) Whether the cancer is in nearby lymph nodes (N) The absence or presence of distant metastasis (M) or spread to other parts of your body Lymph nodes or lymph glands are small, bean-shaped collections of immune system tissue found throughout the body along lymph vessels. They remove cell waste, germs, and other harmful substances from the body. Cancers often spread to nearby lymph nodes before reaching other parts of the body. There are 2 types of staging for prostate cancer: The clinical stage is your doctor s best guess of how much cancer is there, based on the physical exam, lab tests, biopsy, and imaging tests. 7

10 If you have surgery, you will also have a pathologic stage. This is based on what the doctor sees in the removed tissue, which may include the prostate gland, both seminal vesicles (2 small sacs next to the prostate that store semen), and, in some cases, nearby lymph nodes. The clinical stage is used to make treatment decisions, such as whether surgery to remove the prostate is an option. The pathologic stage, which is only known after surgery, is more accurate in predicting your outlook. Stages of prostate cancer Once your doctor has your T, N, and M information, this, along with your Gleason score and PSA level, are used to give you a stage. The stages for prostate cancer are stages I, II, III, and IV. A lower stage means less prostate cancer and it s only in the prostate gland. A higher stage means more cancer, and it has spread beyond the prostate gland. Your doctor will suggest treatments based on your stage. Your treatment and expected outcome, or prognosis, depend on the stage of the cancer. You should know the stage of your disease. 8

11 What are my treatment options? There s a lot to think about when deciding the best way to treat prostate cancer. You may feel like you need to make a decision right away, but try to give yourself time. You are learning new information and need time to take it all in. It can be hard to remember what the doctor tells you. So, ask questions. It may even help to write down your questions before meeting with your doctor so you don t forget any of them. You may want to take a friend or family member with you or ask your doctor if it s OK to record your talks so you can remember what s said. There are many ways to treat prostate cancer. Your treatment decisions should take into account how much cancer there is and how likely it is to grow and spread. You also need to know the goal of treatment is the plan to cure the cancer or control it? You ll want to weigh the benefits of treatment with the possible side effects and what you want for yourself. Talk to your doctor about what s important to you. It may take more than one visit to go over all of your concerns. You also may want to think about getting a second opinion. Make sure that all your concerns and questions, no matter how minor, have been answered before you decide on a treatment. Your treatment plan might involve more than one kind of treatment. The most common treatments for prostate cancer are: Watching closely with no treatment Surgery Radiation Hormone therapy 9

12 Less common treatments include chemotherapy and vaccine therapy. We ll briefly describe these treatments here. Call us or visit our website if you d like more details on any of these treatments. When making treatment decisions, be sure to talk to you doctor about the goal. Is treatment being used to cure the cancer or keep it under control? Watching closely with no treatment Because prostate cancer often grows very slowly, some men may never need treatment. Instead, their doctors may recommend watching them closely without starting treatment right away. This is called different things such as watchful waiting or active surveillance. During this time, tests like PSA blood tests, rectal exams, and ultrasounds are done to see if the cancer is growing. This approach is only an option for early stage cancers (small tumors without spread) that are likely to be slow growing (low Gleason score) and aren t causing any symptoms. If tests show the cancer is growing, treatment can be started at any time. Men who can t tolerate other treatments because they are frail or have other serious health problems are also often watched without treatment. Questions to ask about watchful waiting How often will I need to see the doctor? Which tests will be done and how often? 10

13 What changes do I need to tell the doctor about right away? Surgery Surgery may be done to remove the prostate in order to take out all the cancer. But there s no way to know for sure whether the cancer cells are only in the prostate. Knowing how much cancer is present, its grade, and your PSA level will help figure out the chances of removing all the cancer. It will also help you and your doctor decide what type of surgery is best for you. Types of prostate surgery Many types of operations are used to treat prostate cancer. Radical prostatectomy is used to treat cancer that s only in the prostate. During this operation, the entire prostate gland, along with some tissue around it, is removed. Other surgeries may be used to ease the symptoms of prostate cancer or treat it without removing the prostate. The different types of prostate surgeries are: Radical retropubic prostatectomy. In this surgery, the doctor removes the entire prostate through a cut in your lower belly. Lymph nodes near the prostate may be taken out first to find out if cancer has spread to them. If the lymph nodes do contain cancer, it s likely in other places, too. In this case, the doctor might not remove the prostate and will talk to you about other treatment options. During this surgery, the surgeon closely checks the small bundles of nerves on either side of the prostate gland. If it looks like the cancer has not spread to these nerves, they will not be removed (this is called nerve sparing). These are the nerves that are needed for erections, so leaving them unharmed means that you might not lose erections. Radical perineal prostatectomy. The doctor removes the prostate by making a cut in the space between the scrotum and anus (this area is called the perineum). This approach is 11

14 used less often because the nerves cannot easily be spared and lymph nodes can t be removed. But it s often a shorter operation and might be an option if you don t want the nerve-sparing procedure and you don t need to have lymph nodes removed. Laparoscopic radical prostatectomy (LRP). This surgery is done through several small cuts, through which special long, thin instruments are used to remove the prostate. One of the instruments has a small camera on the end, which allows the surgeon to see inside. Robotic-assisted laparoscopic radical prostatectomy. A newer way to do this surgery is to use a robotic device called the da Vinci system. The surgeon sits at a panel near the operating table and controls robotic arms to do the operation through the small cuts. For the patient, there is little difference between the robotic and standard LRP. Transurethral resection of the prostate (TURP). This operation is not done to treat the cancer. It s used to ease symptoms caused by the tumor blocking the urethra (the tube urine flows through to leave the bladder). The part of the prostate blocking the urethra is removed using a tool with a small wire loop on the end. The tool is put in the end of the penis and passed through the urethra up to the prostate gland. TURP is used for men who can t have a radical prostatectomy, because of age or other medical illnesses, but need to have some of the tumor removed because it s blocking the urethra and urine cannot pass through. Cryosurgery. In this surgery, long, thin metal needles are put into the tumor through the skin between the anus and scrotum (the perineum). The needles are then filled with very cold gasses, which kill the tumor by freezing it. The doctor guides the needles into the prostate using transrectal ultrasound (TRUS). 12

15 Discuss your surgery with your doctor. Ask what kind of procedure is planned and how long you will be in the hospital. Side effects of prostate surgery The most common and most troublesome side effects of prostate surgery are incontinence and impotence. Incontinence is the complete or partial loss of control of urine. Control often returns over time. Your doctor can teach you exercises that can help make your bladder muscles stronger and give you better control. Many men are able to hold urine soon after surgery but may leak when their bladder gets too full or when they cough or sneeze. Getting back full control can take as long as 6 months to a year. Some men may never regain full bladder control and may benefit from medicine or certain procedures that can help with this. Talk to your doctor about how likely you are to be incontinent. Find out what can be done to help lessen the risks or help you cope with incontinence. You might feel embarrassed about talking about this, but remember that you re not alone. Call the American Cancer Society at or visit for more information. Impotence is not being able to get or keep an erection. It s also called ED or erectile dysfunction. It happens when the nerves that control erections are removed or damaged. Doctors try to spare these nerves during surgery, and this may help some men. But even if some nerves are spared, it can take up to 2 years for erections to return. 13

16 Being able to have an erection after surgery depends on your age, how well you could have an erection before surgery, and whether the nerves were damaged. Most men who have a radical prostatectomy should expect some decrease in being able to have an erection, but younger men may keep more of their function. Most men older than 70 have trouble with erections after prostate surgery, even if nerves on both sides aren t removed. Impotence is more common after cryosurgery than radical prostatectomy. Most doctors believe that if a man tries to get an erection as soon as possible once his body has healed, this may help him get his erections back. A man can try about 6 weeks after surgery, or even sooner. Some doctors call this penile rehabilitation. Talk to your doctor about what you can expect after surgery and what you may be able to do to keep as much function as possible. Keep in mind that sexual pleasure and orgasms are still possible after your prostate is removed, but your orgasm will be dry. You can have an orgasm even without having an erection. There are many ways to help get an erection, such as the use of drugs, vacuum devices, injections, or penile implants. Talk to your doctor about what option might be best for you. Talking with your sexual partner, both before and after surgery, will also help you keep a satisfying sex life. Some men feel embarrassed talking about this. Remember: This is a common medical problem and there are many treatments to help. The American Cancer Society has books on sexuality that may help you understand impotence better and 14

17 give you ideas for new ways to be intimate. Call us to find out more. Questions to ask about prostate surgery What kind of surgery is best for me? Is surgery the only treatment I ll need? How long will I be in the hospital? What are the possible risks of surgery? What can I expect right after surgery? What are the short- and long-term problems I may have? Radiation therapy Radiation therapy uses high-energy x-rays or particles to kill or shrink cancer cells. It s used to treat prostate cancer that s only in the prostate gland or has spread only to nearby tissue. The goal of radiation is to kill all the cancer cells. If the cancer can t be removed or comes back after surgery, radiation may be used to shrink the tumor and relieve the symptoms. It might also be used to treat prostate cancer that has spread to other parts of the body, like the bones. Types of radiation therapy Two types of radiation therapy are used to treat prostate cancer: external beam radiation and brachytherapy (internal radiation). Both are good ways to treat prostate cancer, but more is known about the long-term results of external beam radiation treatment. External beam radiation. The radiation is focused on the cancer from a source outside the body. Before treatment, imaging tests will be done to find out exactly where the cancer is. You may get some ink marks on your skin that will be used as a guide to direct the radiation to the right area. Treatment is given 5 days a week for about 7 to 9 weeks. Each treatment lasts only a few minutes, and it doesn t hurt. It s a lot like getting an x-ray. 15

18 Most often, external beam radiation is given using more advanced techniques that better target the prostate and lower damage to nearby tissues. These techniques are called threedimensional conformal therapy (3D-CRT) and intensity modulated radiation therapy (IMRT). Proton beam radiation therapy is a form of external beam radiation that uses beams of protons instead of x-rays. Protons are the positive parts of atoms. In theory, proton beam radiation therapy can deliver more radiation to the prostate while doing less damage to nearby normal tissues. So far, though, there doesn t seem to be much advantage, if any, over IMRT. Brachytherapy (it s said like this: BRAY-kee-THAIR-uh-pee) is also called internal radiation therapy. This radiation treatment uses radioactive materials that are put right into the prostate. A transrectal ultrasound (TRUS), CT scan, or MRI is used to guide placement of the materials. For short-term brachytherapy, thin needles are used to put soft tubes through the skin of the perineum (area between the scrotum and anus) and into the prostate. The needles are taken out, but the tubes stay in place. Radioactive material is put inside these tubes for 5 to 15 minutes, usually 3 times a day for 2 days. After treatment, the tubes are removed. In permanent brachytherapy, or seed implants, long, thin needles are used to put pellets or seeds (each about the size of a grain of rice) into the prostate. Up to 100 seeds may be used. The seeds are left in the tumor, where they give off low doses of radiation for weeks or months. Because they are so small, they cause little discomfort. They are left in place, and, over time, the radioactive material is used up. 16

19 Side effects of radiation therapy In radiation therapy, the high-energy rays are aimed at the cancer, but healthy cells in the area being treated will also be damaged. This causes side effects. Because the rectum is near the prostate, external beam radiation therapy can cause diarrhea, blood in the stool, and stool leakage. Rarely, bowel function doesn t go back to normal after treatment. The bladder is also near the prostate, so during radiation treatment, and sometimes for a while after, you may find that you pass urine more often or feel an urgent need to pass urine. You also may have burning or bleeding when you pass urine. These problems usually don t last long. Many of these side effects can be treated with medicines, and they often get better over time. In radiation therapy, the high-energy rays are aimed at the cancer, but nearby healthy cells will also be affected. Radiation can also make you feel very tired, which should get better a month or 2 after treatment. Some men treated with radiation will have problems getting erections. This is because radiation can damage the nerves around the prostate or the arteries that carry blood to the penis. Erection problems usually don t happen right away, but may slowly develop over months or years after treatment. The older you are, the more likely it is that you will have erection problems. But there are treatments that can help. 17

20 Brachytherapy may also cause erection problems, problems passing urine, and bowel problems. If seeds were put in your prostate, you may need to stay away from small children, pregnant women, and pets for the first few weeks. Long-term rectal problems (burning, pain, and diarrhea) are rare. Questions to ask about radiation therapy What kind of radiation is best for me? Where will I get radiation treatments? Will I need to be in the hospital for treatment? What are the possible risks of radiation? What can I expect to feel like during treatment? Are there any precautions I need to take during or after treatment? What side effects can I expect? What can we do about them? What are the short- and long-term problems I may have? Hormone therapy Hormone therapy is often used when prostate cancer has spread to other parts of the body or has come back after treatment. It s also used along with radiation therapy if you re at high risk for the cancer coming back. It may be used before surgery or radiation to shrink the cancer to help other treatments work better. The goal of hormone therapy is to lower levels of male hormones, which cause prostate cancer cells to grow, or keep them from reaching prostate cancer cells. Several types of hormone therapy can be used. Hormone therapy can make prostate cancer shrink or grow more slowly, but it does not cure the cancer. Types of hormone therapy There are 2 ways to lower testosterone in the body: 18

21 Orchiectomy is surgery to remove the testicles (where most of the male hormones are made). The testicles are taken out through a small cut in the scrotum. The scrotum is left in place. This surgery is a low-risk, outpatient procedure. Still, it can be hard for men to accept. Many men have hot flashes afterward. They usually don t last very long, but men can have them for a long time. After orchiectomy, most men have little sexual desire and are not able to get or keep an erection. More often, drugs are used to reduce hormone levels. They work by keeping the body from making hormones. Some are given as a shot or as small implants under the skin. They can be given monthly or every 3, 4, 6, or 12 months at the doctor s office. Others are taken every day as pills. Drugs can also be used to block the action of testosterone. They are taken every day as pills. Side effects of hormone therapy Each hormone treatment has its own side effects and benefits. Common side effects due to changes in hormone levels include hot flashes, loss of sex drive, not being able to get or keep an erection, shrinking of the penis and testicles, breast tenderness, growth of breast tissue, osteoporosis (bone thinning), weight gain, loss of muscle mass, and risks of heart and circulation problems. Questions to ask about hormone therapy How will I get hormone therapy? What can I expect to feel like while getting hormone therapy? What side effects can I expect? What can we do about them? What are the short- and long-term problems I may have? 19

22 Less common prostate cancer treatments Chemotherapy Chemotherapy, or chemo, is the use of drugs to kill cancer cells. Chemo may be an option if prostate cancer has spread outside the prostate gland. It s most often used when hormone therapy isn t working. Chemo isn t expected to kill all of the cancer cells, but it may slow tumor growth, reduce symptoms, and help the man live longer. Chemo may be given through a needle in the vein (IV) or taken as a pill. The drugs flow through the bloodstream and kill cancer cells throughout the body. But they also damage some normal cells. The doctor must balance the chemo doses, making them strong enough to kill the cancer cells but not strong enough to destroy many healthy cells. Side effects of chemo depend on which drugs are used, the dose, and how often it s given. More common side effects are nausea and vomiting, hair loss, mouth sores, appetite changes, low blood counts, and tiredness. Vaccine treatment A prostate cancer vaccine, sipuleucel-t (Provenge ), has been approved by the FDA to treat advanced prostate cancer that s not responding to hormone therapy, but causing few or no symptoms. The vaccine is specially made for each man who gets it it s not mass-produced. Common side effects include fever, chills, fatigue, back and joint pain, nausea, and headache. These most often start while getting the vaccine and last no more than a day or 2. Rarely, men have more severe symptoms, including problems breathing and high blood pressure. 20

23 What is recurrent disease? If you have already been treated for prostate cancer and it has come back, you have recurrent disease. It may come back (recur) in the prostate or other parts of the body. Depending on how much cancer there is, where it is, and what treatments you have already had, more treatment may be possible. Treating cancer pain Most of this information is about ways to remove, kill, or slow the growth of prostate cancer cells. But having a good quality of life is important, too. Quality of life includes things like being able to do what you want and need to do, being able to maintain relationships, feeling good about yourself, and meeting your spiritual needs. Don t be afraid to talk to your doctor or nurse about symptoms, problems, or any other concerns you might have. Many men are concerned about pain. And pain can change your quality of life. It may help to keep these facts in mind: Having cancer does not always mean having pain. If you do have pain, there are many good ways to control and relieve it. The key to pain relief is to tell your doctor or nurse about your pain. Controlling pain is part of your cancer treatment. Asking for help with pain does not make you a complainer. And people taking medicine for cancer pain don t need to worry about addiction. Please 21

24 call us at if you would like to learn more about managing cancer pain. When used as prescribed, medicine can relieve pain without the risk of addiction or dependence and without making you too drowsy to do most of your usual activities. Living with cancer Deciding on a course of treatment may be one of the hardest decisions you ever make. You may be feeling angry, depressed, or overwhelmed you may not feel like you can make a lot of big decisions right now. Learning more about the prostate cancer can help you feel better. Talking with someone in your family, a close friend, or even other men with the disease may help, too. There are also support programs for men with prostate cancer (see Other sources of information on page 26). 22

25 You may want to talk with members of your health care team your doctor, nurse, or a social worker. Many men also find comfort talking to clergy members or other spiritual helpers. It s important to share your feelings with your family and those close to you, too. Cancer affects your entire family. The best thing you and your loved ones can do is to be honest about what you re feeling. Concerns about sex are often distressing to a man with prostate cancer. Some treatments for prostate cancer can have a huge effect on sexual interest and response. These issues affect you as well as your partner. Partners are usually worried about how to express their love during and after treatment. Things you can do to cope with these changes include seeking the support of others, before surgery if possible; involving your partner as soon as possible after surgery; and sharing your feelings, needs, and wants. Our booklet called Sexuality for the Man With Cancer has a lot more on this. You can also help in your own recovery from cancer by making healthy lifestyle choices. If you use tobacco, stop now. Quitting will improve your health, and the full return of your sense of smell may help you eat better. If you use alcohol, limit how much you drink. Have no more than 2 drinks per day. Good nutrition can help you get better after treatment. Eat a healthy, balanced diet with plenty of fruits, vegetables, and whole-grain foods and less red or processed meat. And talk to your doctor about what kind of exercise might be right for you. Studies have shown that patients who follow an exercise program tailored to their personal needs feel better and cope better. The best thing you and your loved ones can do is be honest about what you are feeling. 23

26 Questions to ask your doctor Have honest, open talks with your doctor or nurse. They want to answer your questions, no matter how minor you might think they are. Think about asking these questions: Is the cancer only in my prostate? What are the chances that the cancer has spread beyond my prostate? If it has, can it be cured? What other tests do I need? Why? What s the stage of the cancer? What does this mean to me? What do you think my outcome will be based on my stage and treatment? What treatment options might be right for me? Why? (See the treatment sections for more specific questions about each type of treatment.) What are the chances that I will have problems with passing urine or having erections after treatment? What are the chances that I will have other urine or bowel problems? What else should I think about when deciding which treatment is right for me? What are the chances of the cancer coming back with the treatments we ve talked about? Should I follow a special diet? What can I do to get ready for treatment? How will I pay for treatment? Will my insurance cover any of it? 24

27 Along with these sample questions, be sure to write down some of your own. Add any other questions you may have here. To learn more The American Cancer Society has information on all aspects of cancer prevention, detection, diagnosis, treatment, and services for people with cancer and their loved ones. We can also help you find a prostate cancer education and support program near you. For more information on prostate cancer and our programs and services, visit us online at or call our tollfree number, From your American Cancer Society Prostate Cancer: Detailed Guide (also in Spanish) Prostate Cancer: Overview (also in Spanish) After Diagnosis: A Guide for Patients and Families (also in Spanish) A Guide to Radiation Therapy (also in Spanish) A Guide to Cancer Surgery (also in Spanish) Nutrition and Physical Activity During and After Cancer Treatment: Answers to Common Questions Nutrition for the Person With Cancer During Treatment: A Guide for Patients and Families (also in Spanish) 25

28 Caring for the Person With Cancer at Home: A Guide for Patients and Families (also in Spanish) Managing Incontinence After Prostate Cancer Treatment (also in Spanish) Sexuality for the Man Wth Cancer (also in Spanish) Sex and Men With Cancer Overview Other sources of information* Urological Care Foundation Toll-free number: Website: Offers webinars and other online education about prostate cancer National Association for Continence Toll-free number: Website: Has information on treatments and tips to manage urinary and fecal incontinence National Cancer Institute Toll-free number: TYY: Website: For information on prostate cancer and current clinical trials for men with prostate cancer Prostate Cancer Foundation Toll-free number: Website: For general information on prostate cancer 26

29 Us TOO International, Inc. Toll-free number: Website: Offers information, counseling, and educational meetings to men with prostate cancer and their families to help them make treatment decisions with confidence and support. Also provides answers to questions about prostate cancer, treatment, and clinical trials, and makes referrals to its network of local and international support groups. *Inclusion on this list does not imply endorsement by the American Cancer Society. 27

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32 When a doctor says you have prostate cancer, it s normal to be upset, angry, and scared. Learning more is a key step to dealing with these feelings and the cancer. Here we share information about prostate cancer, common treatments used, common treatment side effects, and other places you can go to learn more. We can help you deal with prostate cancer. 2005, American Cancer Society, Inc. Models used for illustrative purposes only. No Rev.10/14