Whether you're one of the growing numbers of prostate cancer survivors, currently in treatment, or just interested in learning more about the disease, the American Cancer Society is here to help. Here, we will try to answer some common questions about prostate cancer. If you have a question that's not addressed here, please call 1-800-ACS-2345. You can also find more information in our Detailed Guide: Prostate Cancer.

Common Questions:

• Question: If you're a man in your 50s, should you being getting screened for prostate cancer? 
• Question: What kinds of issues should I think about when choosing a treatment for my prostate cancer? 
• Question: I have heard that some men don't get treated right away. If I have cancer, shouldn't I get it taken out as soon as possible? Why wait? 
• Question: I've been diagnosed with prostate cancer. What if I lose my job – how will I pay for healthcare? 
• Question: I've heard of prostate cancer vaccines. Are they available yet? 
• Question: Prostate cancer runs in my family. Is there anything I can add to his diet, or supplements I can take, to make it less likely I will get this disease?

Question: If you're a man in your 50s, should you being getting screened for prostate cancer?

Answer: Researchers still don’t know for sure whether prostate cancer screening saves lives. A recent US study showed no real difference in prostate cancer deaths between men who got tested for it and men who didn’t. A recent European study found a small benefit, but it also found overtreatment was a big problem.

A lot of men may be getting treated for prostate cancer when they don't need to be. Some prostate cancers grow very quickly, but many prostate cancers grow so slowly that they would never cause a man any problems at all, so treatment isn't really necessary.

Treatments for prostate cancer can have a lot of unpleasant side effects like incontinence and impotence that can really affect the quality of a man's life.

The American Cancer Society does not recommend routine screening at this time. Instead, men need to talk to their doctors about the pros and cons of screening, and then decide whether they want to be tested or not. Men at average risk should have this talk starting at age 50. Men at higher risk – African-American men and men who have a first-degree relative (father, brother, or son) diagnosed with prostate cancer at an early age (younger than age 65) -- should start earlier, at age 45.

Question: What kinds of issues should I think about when choosing a treatment for my prostate cancer?

Answer: There are several accepted treatments for early or localized prostate cancer. Some of these treatments are better for certain patients given their prostate cancer stage, certain pathology features of the disease, and the general health of the patient. It is important that every patient review all the available treatments and choose the one he is most comfortable with. Patients should ask their doctor what treatment options they have.

Radical prostatectomy, or surgery, is the treatment with the longest history. Radiation therapy, either external beam or by brachytherapy (seed implant), are accepted standard treatment options for many men. Radiation and surgery seem to be about equally effective, although the side effects may be slightly different. Cryotherapy or freezing of the prostate cancer cells is being studied in certain centers. Some men may not need treatment right away (see next question).

Treatment options for more advanced disease are more limited. Radiation and hormonal therapy are the mainstays of treatment for cancer that still hasn’t spread to distant sites. Cancers that have spread are usually treated with hormone therapy. Chemotherapy is used in cases that are non-responsive to hormonal therapy. It is very important that the patient have a good conversation with his doctors about all his treatment options.

Question: I have heard that some men don't get treated right away. If I have cancer, shouldn't I get it taken out as soon as possible? Why wait?

Answer: Some prostate cancers diagnosed through screening will never grow, spread, and cause death. Depending on the stage and pathologic features of a cancer, as well as the age and health of the patient, some men may choose "active surveillance," which is also called "watchful waiting," instead of aggressive initial treatment. This involves actively watching and monitoring the prostate, often with physical exams, blood tests (including PSA), and transrectal ultrasounds. If the tumor appears to be growing, more aggressive therapy may be started. In some studies of men choosing observation therapy, nearly half never had any aggressive prostate cancer treatment in their lifetime. These men died "with prostate cancer" and not "of prostate cancer."

Question: I've been diagnosed with prostate cancer. At a recent company meeting, there was talk of staff reductions. There's a real chance I may get laid off because of redundancies in my department. What if I lose my job – how will I pay for healthcare?

Answer: Even in the best of times, paying for cancer care is difficult. In an economic recession, the financial burden of a cancer diagnosis and treatment can be crippling. There are many possible sources of help for families who need extra financial support in tough times.

COBRA: If you lose your job, you have the right to choose to temporarily keep your group health insurance benefits through the Consolidated Omnibus Budget Reconciliation Act, or COBRA, which became law in 1986. However, under that law, you have to pay the full cost of the insurance premiums yourself. Premiums often cost more than $1000 a month, which can be a problem if you don't have a job.

As of March 2009, you may get extra help if you lost your job involuntarily between September 1, 2008 and December 31, 2009. You may qualify for short-term help paying for COBRA through the American Recovery and Reinvestment Act of 2009 (ARRA). There are some limitations, however. Check with the United States Department of Labor for more information.

Disability Benefits: If you have been working for many years, you probably have contributed to Social Security, and you may qualify for disability benefits.

Under the standard application process for Social Security Disability Insurance (SSDI), it typically takes several months for someone to begin receiving benefits. A recent initiative called the Compassionate Allowances program aims to help people with certain types of cancer and other diseases get their federal disability claims processed faster. The program covers 50 conditions, including 25 cancers that are so serious that they obviously meet the standards required for the Social Security Administration to make a finding that the person is disabled. The program is still very new, however, so there's no data yet on how well it works, and it doesn't help people with certain types of cancer.

Your income has nothing to do with whether or not you qualify for SSDI. To find out how to apply, contact the Social Security Administration. Also keep in mind that after receiving SSDI for 24 months you become eligible for Medicare benefits.

State health insurance risk pools: State health insurance risk pools are designed to help people who can afford to buy health insurance, but are denied health insurance overage by private companies because of a pre-existing medical condition. Contact your state department of insurance to find out if such programs are available in your state, or if there is another way to get coverage.

For easy-to-understand information about eligibility requirements for health coverage in your area, visit the Foundation for Health Coverage Education's (FHCE) Web site. There, you'll find tools and resources that'll help you determine which programs you qualify for.

Question: I've heard of prostate cancer vaccines. Are they available yet?

Answer: Several types of vaccines for boosting the body's immune response to prostate cancer cells are being tested in clinical trials. Unlike vaccines against infections like measles or mumps, these vaccines are designed to help treat, not prevent, prostate cancer. One possible advantage of these types of treatments is that they seem to have very limited side effects. At this time, vaccines are only available in clinical trials.

The furthest along in terms of development is sipuleucel-T (Provenge). For this vaccine, dendritic cells (cells of the immune system) are removed from the patient's blood and exposed to a part of prostate cancer cells. The dendritic cells are then put back into the body where they cause other immune system cells to attack the patient's prostate cancer. One study found that the vaccine seemed to increase survival in men with advanced, hormone-refractory prostate cancer, and further studies are under way.

Another prostate cancer vaccine (PROSTVAC-VF) uses a virus that has been genetically modified to contain prostate-specific antigen (PSA). The patient's immune system should respond to the virus and begin to recognize and destroy cancer cells containing PSA. This vaccine is still in early-stage clinical trials.

Several other prostate cancer vaccines are also in development.

Question: I am a 75-year-old prostate cancer survivor. My brother, who is 65, was recently diagnosed, and my son, who is 48, just had his first prostate exam. He is still waiting on the results but will probably have no signs of anything at this point. Given our family’s history, though, we can’t count on that in the future. My question is, is there anything he can add to his diet, or supplements he can take, to make it less likely he will get this terrible disease?

Answer: Although several studies have looked at the impact of diet and nutrition on prostate cancer prevention, they have produced few clear answers. Until such answers appear, the best advice for your son is to pursue a generally healthful lifestyle, which includes keeping at a healthy weight and making dietary choices known to reduce cancer risk in general.

Such a diet consists of a wide variety of healthful foods, and emphasizes food from plant sources. It includes five or more daily servings of fruits and vegetables and, when available, the whole wheat varieties of bread, cereals, pasta, and beans. This diet limits high-fat dairy and red meat items, as well as processed meats.

Specific foods showing some promise for protecting the prostate are those containing the antioxidant lycopene. This vitamin-like substance helps prevent DNA damage and may help lower prostate cancer risk in men who do not have prostate cancer. Some foods rich in lycopenes are tomatoes (raw, cooked, or in sauces or ketchup), pink grapefruit, and watermelon. Some earlier studies suggested lycopenes may help lower prostate cancer risk, but a more recent study found no link between blood levels of lycopene and risk of prostate cancer. Research in this area continues. Regardless, it won’t hurt to include foods with tomatoes and tomato sauce in your vegetable servings.

Some studies have suggested that daily vitamin E supplements may lower prostate cancer risk, although other studies found no benefit. Some studies have also suggested that selenium, a mineral, might lower the risk of prostate cancer. However, a large clinical trial of about 35,000 men recently reported that after an average of about 5 years of daily use, neither vitamin E nor selenium supplements lowered prostate cancer risk. Some early studies suggested vitamin D may be of benefit, but more study is needed. Soy proteins (called isoflavones) are also being studied.

Taking any supplements can have risks and benefits. Before starting vitamins or other supplements, you should talk with your doctor.

You and your family may be interested in a recent small study that found drinking pomegranate juice daily might help slow the rate at which PSA rises after prostate cancer treatment. Although more studies are needed, there is little risk in drinking pomegranate juice.

If you have a question that's not addressed here, please call 1-800-ACS-2345. You can also find more information in Detailed Guide: Prostate Cancer.

Published: 08/29/2009