Prostate cancer is cancer that starts in the prostate gland. It can spread outside the prostate into nearby tissue, or through the lymph or blood systems.
The stage of the cancer can be determined with the help of:
The stage describes how aggressive the cancer is and how far it has spread.
If you’ve been told you have stage 2 prostate cancer, it’s still localized. It hasn’t spread outside the prostate gland, but it’s more likely than stage 1 to grow and metastasize.
Often there are no symptoms in the early stages of prostate cancer. Stage 2 symptoms can still be quite mild, but may include:
- trouble urinating
- blood in your semen
- pelvic discomfort
Your doctor will recommend treatment based on several factors, including your age, overall health, and whether or not you’re having symptoms.
Your doctor might consider active surveillance if you have a slow-growing cancer and no symptoms. That means you won’t actually be treating the cancer, but you will be monitoring it carefully with your doctor. This might involve visiting your doctor every six months, which would include a digital rectal exam and PSA testing. You might also need an annual prostate biopsy.
Active surveillance is only an option if you can commit to following up as advised by your doctor. Treatment will be considered if there are any changes.
Treatment may involve a combination of therapies, some of which are:
Radical prostatectomy is surgical removal of the prostate. This is done through an abdominal incision. You’ll have either general anesthesia or an epidural. Nearby lymph nodes may be biopsied at the same time.
You’ll need a catheter, but it’s only temporary. You’ll be in the hospital for a night or two, and you’ll have to limit your activities for several weeks.
Sometimes the surgeon can make the incision between the anus and scrotum (perinea) instead of through the abdomen. This method isn’t used as much because it doesn’t allow access to the lymph nodes.
The surgery may also be done laparoscopically, which involves a few small abdominal incisions and a somewhat easier recovery.
Potential side effects of prostate surgery include:
- bad reaction to anesthesia
- bleeding, infection, or blood clots
- damage to nearby organs
- urinary incontinence
- erectile dysfunction
- lymphedema, a collection of fluid due to lymph node removal
Radiation therapy is used to destroy cancer cells. In external beam radiation therapy (EBRT), radiation beams come from a machine outside the body. Treatment is usually given five days a week for several weeks. Types of EBRT include:
- three-dimensional conformal radiation therapy (3D-CRT)
- intensity modulated radiation therapy (IMRT)
- stereotactic body radiation therapy (SBRT)
- proton beam radiation therapy
Possible side effects include:
- skin irritation
- urinary problems
- bowel problems
- erection problems
Brachytherapy is internal radiation therapy, which involves a lot less time on your part. A surgeon inserts radioactive pellets directly into your prostate. A permanent low-dose rate (LDR) gives off radiation for up to a few months. Alternatively, there’s a temporary high-dose rate (HDR) that only lasts a few days.
Potential side effects include:
- movement of the seeds
- urinary problems
- bowel problems
- erection problems
Hormone therapy is used to lower male hormone levels or block them from fueling cancer cells. It’s not a cure for prostate cancer, but it does a good job of shrinking tumors and slowing growth.
One way to accomplish this is through surgical castration (orchiectomy), since most male hormones are produced in the testicles. The surgery can be done on an outpatient basis.
Another way to reduce testosterone is with luteinizing hormone-releasing hormone (LHRH) agonists. These drugs are injected or implanted under the skin. Some LHRH antagonists are:
- goserelin (Zoladex)
- histrelin (Vantas)
- leuprolide (Eligard, Lupron)
- triptorelin (Trelstar)
These antiandrogens are taken orally:
- bicalutamide (Casodex)
- enzalutamide (Xtandi)
- flutamide (Eulexin)
- nilutamide (Nilandron)
Some potential side effects of hormone therapy are:
- loss of sex drive or erectile dysfunction
- shrinkage of testicles and penis
- hot flashes
- breast tenderness
- osteoporosis, anemia, or increased cholesterol levels
- loss of muscle mass or weight gain
- fatigue or depression
Enzalutamide can also cause diarrhea or dizziness.
Antiandrogens tend to have fewer sexual side effects than LHRH agonists or surgical castration. Many side effects of hormone therapy are treatable.
Prostate cancer and treatment can lead to problems with urination as well as erectile dysfunction.
If stage 2 prostate cancer spreads outside the prostate, it can reach nearby tissues, the lymph system, or bloodstream. From there, it can metastasize to distant sites. Later-stage prostate cancer is difficult to treat and can be life-threatening.
Once your main treatment ends and there’s no sign of cancer, you’re in a state of remission. Your doctor can still help you with short- and long-term side effects of treatment.
Any cancer can recur. So you’ll need to return for routine physical exams and PSA testing per your doctor’s recommendations. A rise in your PSA level doesn’t necessarily mean cancer has returned. Additional procedures, such as imaging tests, can help determine if it has. Learn more about why your PSA levels may be high.
Prostate cancer is treatable and survivable. According to the American Cancer Society, the following are the survival rates for all stages of prostate cancer:
- 5-year relative survival rate: 99 percent
- 10-year relative survival rate: 98 percent
- 15-year relative survival rate: 96 percent
Most prostate cancer is localized, or stages 1 and 2, when found. The relative 5-year survival rate for localized prostate cancer is almost 100 percent.