Prostate Cancer Treatment

Prostate cancer is a type of cancer that forms in the tissues of the prostate.

La próstata es una glándula del sistema reproductor masculino. Se encuentra justo debajo de la vejiga (el órgano que recoge y vacía la orina) y delante del recto (la parte inferior del intestino). Tiene aproximadamente el tamaño de una nuez y rodea parte de la uretra (el conducto que vacía la orina de la vejiga). La glándula prostática produce un líquido que forma parte del semen.

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Anatomía de los sistemas reproductivo y urinario masculino que muestra los uréteres, la vejiga, la próstata, la uretra, el pene, los testículos y otros órganos.

Prostate cancer is most common in older men. In the United States, about one out of eight men will be diagnosed with prostate cancer.

Signs of prostate cancer include a weak flow of urine or frequent urination.

These and other signs and symptoms may be caused by prostate cancer or by other conditions. Check with your doctor if you have:

• Dificultad para iniciar el flujo de orina
• Frequent urination (especially at night).
• Trouble emptying the bladder completely.
• Flujo de orina débil o interrumpido (intermitente)

When prostate cancer is detected in an advanced stage, symptoms may include:

• Pain in the back, hips, or pelvis that doesn't go away.
• Shortness of breath, feeling very tired, fast heartbeat, dizziness, or pale skin caused by anemia.

Other conditions may cause the same symptoms. As men age, the prostate may get bigger and block the urethra or bladder. This may cause trouble urinating or sexual problems. The condition is called benign prostatic hyperplasia (BPH), and although it is not cancer, surgery may be needed. The symptoms of benign prostatic hyperplasia or of other problems in the prostate may be like symptoms of prostate cancer.

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Próstata normal e hiperplasia prostática benigna (HPB). Una próstata normal no bloquea el flujo de orina desde la vejiga. Una próstata agrandada presiona la vejiga y la uretra y bloquea el flujo de orina.

Tests that examine the prostate and blood are used to diagnose prostate cancer.

Además de preguntarle sobre su historial de salud personal y familiar y de hacerle un reconocimiento físico, es posible que el médico realice las siguientes pruebas y procedimientos:

• Digital rectal exam (DRE): An exam of the rectum. The doctor or nurse inserts a lubricated, gloved finger into the rectum and feels the prostate through the rectal wall for lumps or anómalas zonas.
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  Digital rectal exam (DRE). The doctor inserts a gloved, lubricated finger into the rectum and feels the rectum, anus, and prostate (in males) to check for anything abnormal.
  

• Prostate-specific antigen (PSA) test: A test that measures the level of PSA in the blood. PSA is a substance made by the prostate that may be found in higher than normal amounts in the blood of men who have prostate cancer. PSA levels may also be high in men who have an infection or inflammation of the prostate or BPH (an enlarged, but noncancerous, prostate).
• PSMA PET scan: An imaging procedure that is used to help find prostate cancer cells that have spread outside of the prostate, into bone, lymph nodes, or other organs. For this procedure, a cell-targeting molecule linked to a radioactive substance is injected into the body and travels through the blood. It attaches to a protein called prostate-specific membrane antigen (PSMA) that is found on the surface of prostate cancer cells. A PET scanner detects high concentrations of the radioactive molecule and shows where the prostate cancer cells are in the body. A PSMA PET scan may be used to help diagnose prostate cancer that may have come back or spread to other parts of the body. It may also be used to help plan treatment.
• Transrectal ultrasound: A procedure in which a probe that is about the size of a finger is inserted into the rectum to check the prostate. The probe is used to bounce high-energy sound waves (ecografía) off internal tejidos or organs and make echoes. The echoes form a picture of body tissues called a ecograma. Transrectal ultrasound may be used during a biopsia procedure. This is called transrectal ultrasound guided biopsy.
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  Transrectal ultrasound. An ultrasound probe is inserted into the rectum to check the prostate. The probe bounces sound waves off body tissues to make echoes that form a sonogram (computer picture) of the prostate.
  

• Transrectal magnetic resonance imaging (MRI): A procedure that uses a strong magnet, radio waves, and a computer to make a series of detailed pictures of areas inside the body. A probe that gives off radio waves is inserted into the rectum near the prostate. This helps the MRI machine make clearer pictures of the prostate and nearby tissue. A transrectal MRI is done to find out if the cancer has spread outside the prostate into nearby tissues. This procedure is also called nuclear magnetic resonance imaging (NMRI). Transrectal MRI may be used during a biopsy procedure. This is called transrectal MRI guided biopsy.

A biopsy is done to diagnose prostate cancer and find out the grade of the cancer (Gleason score).

A transrectal biopsy is used to diagnose prostate cancer. A transrectal biopsy is the removal of tissue from the prostate by inserting a thin needle through the rectum and into the prostate. This procedure may be done using transrectal ultrasound or transrectal MRI to help guide where samples of tissue are taken from. A pathologist views the tissue under a microscope to look for cancer cells.

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Transrectal biopsy. An ultrasound probe is inserted into the rectum to show where the tumor is. Then a needle is inserted through the rectum into the prostate to remove tissue from the prostate.

Sometimes a biopsy is done using a sample of tissue that was removed during a transurethral resection of the prostate (TURP) to treat benign prostatic hyperplasia.

If cancer is found, the pathologist will give the cancer a grade. The grade of the cancer describes how abnormal the cancer cells look under a microscope and how quickly the cancer is likely to grow and spread. The grade of the cancer is called the Gleason score.

To give the cancer a grade, the pathologist checks the prostate tissue samples to see how much the tumor tissue is like the normal prostate tissue and to find the two main cell patterns. The primary pattern describes the most common tissue pattern, and the secondary pattern describes the next most common pattern. Each pattern is given a grade from 3 to 5, with grade 3 looking the most like normal prostate tissue and grade 5 looking the most abnormal. The two grades are then added to get a Gleason score.

The Gleason score can range from 6 to 10. The higher the Gleason score, the more likely the cancer will grow and spread quickly. A Gleason score of 6 is a low-grade cancer; a score of 7 is a medium-grade cancer; and a score of 8, 9, or 10 is a high-grade cancer. For example, if the most common tissue pattern is grade 3 and the secondary pattern is grade 4, it means that most of the cancer is grade 3 and less of the cancer is grade 4. The grades are added for a Gleason score of 7, and it is a medium-grade cancer. The Gleason score may be written as 3+4=7, Gleason 7/10, or combined Gleason score of 7.

Hay ciertos factores que afectan al pronóstico (probabilidad de recuperación) y a las opciones de tratamiento.

El pronóstico y las opciones de tratamiento dependen de los siguientes factores:

• The stage of the cancer (level of PSA, Gleason score, Grade Group, how much of the prostate is affected by the cancer, and whether the cancer has spread to other places in the body).
• La edad del paciente
• Si el cáncer acaba de ser diagnosticado o ha recidivado (regresado)

Treatment options also may depend on:

• Whether the patient has other health problems.
• The expected side effects of treatment.
• Past treatment for prostate cancer.
• Los deseos de cada paciente

Most men diagnosed with prostate cancer do not die of it.

After prostate cancer has been diagnosed, tests are done to find out if cancer cells have spread within the prostate or to other parts of the body.

The process used to find out if cancer has spread within the prostate or to other parts of the body is called staging. The information gathered from the staging process determines the stage of the disease. It is important to know the stage in order to plan treatment. The results of the tests used to diagnose prostate cancer are often also used to stage the disease. (See the General Information section.) In prostate cancer, staging tests may not be done unless the patient has symptoms or signs that the cancer has spread, such as bone pain, a high PSA level, or a high Gleason score.

También se pueden utilizar las siguientes pruebas y procedimientos en el proceso de estadificación:

• Gammagrafía ósea: procedimiento para comprobar si hay divisiones rápidas de células, como las células cancerosas, en el hueso. Una cantidad muy pequeña de material de origen radioactivo se inyecta en una vena y viaja por el torrente sanguíneo. El material radiactivo se acumula en los huesos con cáncer y es detectado por un escáner.
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  Bone scan. A small amount of radioactive material is injected into the patient's bloodstream and collects in abnormal cells in the bones. As the patient lies on a table that slides under the scanner, the radioactive material is detected and images are made on a computer screen or film.
  

• Resonancia magnética (RM): se utilizan un imán, ondas de radio y una computadora para generar imágenes detalladas de las estructuras internas del cuerpo. Este procedimiento también se denomina resonancia magnética nuclear (RMN).
• CT scan (CAT scan): A procedure that makes a series of detailed pictures of areas inside the body, taken from different angles. The pictures are made by a computer linked to an x-ray machine. A dye may be injected into a vein or swallowed to help the organs or tissues show up more clearly. This procedure is also called computed tomography, computerized tomography, or computerized axial tomography.
• Pelvic lymphadenectomy: A surgical procedure to remove the lymph nodes in the pelvis. A pathologist views the tissue under a microscope to look for cancer cells.
• Seminal vesicle biopsy: The removal of fluid from the seminal vesicles (glands that make semen) using a needle. A pathologist views the fluid under a microscope to look for cancer cells.
• ProstaScint scan: A procedure to check for cancer that has spread from the prostate to other parts of the body, such as the lymph nodes. A very small amount of radioactive material is injected into a vein and travels through the bloodstream. The radioactive material attaches to prostate cancer cells and is detected by a scanner. The radioactive material shows up as a bright spot on the picture in areas where there are a lot of prostate cancer cells.

El cáncer se propaga por el cuerpo de tres maneras.

El cáncer puede extenderse a través de los tejidos circundantes, el sistema linfático y la sangre:

• Tejidos: el cáncer se extiende desde el lugar donde comenzó y crece hacia las zonas circundantes.
• Sistema linfático: el cáncer se extiende desde el lugar donde comenzó hacia el sistema linfático. El cáncer viaja a través de los vasos linfáticos a otras partes del cuerpo.
• Sangre: el cáncer se extiende desde el lugar donde comenzó hacia la sangre. El cáncer viaja a través de los vasos sanguíneos a otras partes del cuerpo.

El cáncer puede extenderse desde donde comenzó a otras partes del cuerpo.

Cuando el cáncer se extiende a otra parte del cuerpo se denomina metástasis. Las células cancerosas se desprenden de donde comenzaron (tumor primario) y viajan a través del sistema linfático o la sangre.

• Sistema linfático: el cáncer entra en el sistema linfático, viaja a través de los vasos linfáticos y forma un tumor (tumor metastásico) en otra parte del cuerpo.
• Sangre: el cáncer llega a la sangre, viaja a través de los vasos sanguíneos y forma un tumor (tumor metastásico) en otra parte del cuerpo.

The metastatic tumor is the same type of cancer as the primary tumor. For example, if prostate cancer spreads to the bone, the cancer cells in the bone are actually prostate cancer cells. The disease is metastatic prostate cancer, not bone cancer.

Denosumab, a monoclonal antibody, may be used to prevent bone metastases.

The Grade Group and PSA level are used to stage prostate cancer.

The stage of the cancer is based on the results of the staging and diagnostic tests, including the prostate-specific antigen (PSA) test and the Grade Group. The tissue samples removed during the biopsy are used to find out the Gleason score. The Gleason score ranges from 2 to 10 and describes how different the cancer cells look from normal cells under a microscope and how likely it is that the tumor will spread. The lower the number, the more cancer cells look like normal cells and are likely to grow and spread slowly.

The Grade Group depends on the Gleason score. See the General Information section for more information about the Gleason score.

• Grade Group 1 is a Gleason score of 6 or less.
• Grade Group 2 or 3 is a Gleason score of 7.
• Grade Group 4 is a Gleason score 8.
• Grade Group 5 is a Gleason score of 9 or 10.

The PSA test measures the level of PSA in the blood. PSA is a substance made by the prostate that may be found in an increased amount in the blood of men who have prostate cancer.

The following stages are used for prostate cancer:

Estadio I

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Stage I prostate cancer. Cancer is found in the prostate only. The cancer is not felt during a digital rectal exam and is found by needle biopsy done for high prostate-specific antigen (PSA) level or in a sample of tissue removed during surgery for other reasons. The PSA level is less than 10 and the Grade Group is 1; OR the cancer is felt during a digital rectal exam and is found in one-half or less of one side of the prostate. The PSA level is less than 10 and the Grade Group is 1.

In stage I, cancer is found in the prostate only. The cancer:

• is not felt during a digital rectal exam and is found by needle biopsy (done for a high PSA level) or in a sample of tissue removed during surgery for other reasons (such as benign prostatic hyperplasia). The PSA level is lower than 10 and the Grade Group is 1; or
• is felt during a digital rectal exam and is found in one-half or less of one side of the prostate. The PSA level is lower than 10 and the Grade Group is 1.

Estadio II

In stage II, cancer is more advanced than in stage I, but has not spread outside the prostate. Stage II is divided into stages IIA, IIB, and IIC.

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Stage IIA prostate cancer. Cancer is found in the prostate only. Cancer is found in one-half or less of one side of the prostate. The prostate-specific antigen (PSA) level is at least 10 but less than 20 and the Grade Group is 1; OR cancer is found in more than one-half of one side of the prostate or in both sides of the prostate. The PSA level is less than 20 and the Grade Group is 1.

In stage IIA, cancer:

• is found in one-half or less of one side of the prostate. The PSA level is at least 10 but lower than 20 and the Grade Group is 1; or
• is found in more than one-half of one side of the prostate or in both sides of the prostate. The PSA level is lower than 20 and the Grade Group is 1.

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Stage IIB prostate cancer. Cancer is found in the prostate only. Cancer is found in one or both sides of the prostate. The prostate-specific antigen level is less than 20 and the Grade Group is 2.

In stage IIB, cancer:

• is found in one or both sides of the prostate. The PSA level is lower than 20 and the Grade Group is 2.

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Stage IIC prostate cancer. Cancer is found in the prostate only. Cancer is found in one or both sides of the prostate. The prostate-specific antigen level is less than 20 and the Grade Group is 3 or 4.

In stage IIC, cancer:

• is found in one or both sides of the prostate. The PSA level is lower than 20 and the Grade Group is 3 or 4.

Estadio III

El estadio III se divide en los estadios IIIA, IIIB y IIIC.

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Stage IIIA prostate cancer. Cancer is found in the prostate only. Cancer is found in one or both sides of the prostate. The prostate-specific antigen level is at least 20 and the Grade Group is 1, 2, 3, or 4.

In stage IIIA, cancer:

• is found in one or both sides of the prostate. The PSA level is at least 20 and the Grade Group is 1, 2, 3, or 4.

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Stage IIIB prostate cancer. Cancer has spread from the prostate to the seminal vesicles or to nearby tissue or organs, such as the rectum, bladder, or pelvic wall. The prostate-specific antigen can be any level and the Grade Group is 1, 2, 3, or 4.

In stage IIIB, cancer:

• has spread from the prostate to the seminal vesicles or to nearby tissue or organs, such as the rectum, bladder, or pelvic wall. The PSA can be any level and the Grade Group is 1, 2, 3, or 4.

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Stage IIIC prostate cancer. Cancer is found in one or both sides of the prostate and may have spread to the seminal vesicles or to nearby tissue or organs, such as the rectum, bladder, or pelvic wall. The prostate-specific antigen can be any level and the Grade Group is 5.

In stage IIIC, cancer:

• is found in one or both sides of the prostate and may have spread to the seminal vesicles or to nearby tissue or organs, such as the rectum, bladder, or pelvic wall. The PSA can be any level and the Grade Group is 5.

Estadio IV

El estadio IV se divide en los estadios IVA y IVB.

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Stage IVA prostate cancer. Cancer is found in one or both sides of the prostate and may have spread to the seminal vesicles or to nearby tissue or organs, such as the rectum, bladder, or pelvic wall. Cancer has spread to nearby lymph nodes. The prostate-specific antigen can be any level and the Grade Group is 1, 2, 3, 4, or 5.

In stage IVA, cancer:

• is found in one or both sides of the prostate and may have spread to the seminal vesicles or to nearby tissue or organs, such as the rectum, bladder, or pelvic wall. Cancer has spread to nearby lymph nodes. The PSA can be any level and the Grade Group is 1, 2, 3, 4, or 5.

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Stage IVB prostate cancer. Cancer has spread to other parts of the body, such as the bones or distant lymph nodes.

In stage IVB, cancer:

• has spread to other parts of the body, such as the bones or distant lymph nodes. Prostate cancer often spreads to the bones.

Prostate cancer may recur (come back) after it has been treated.

The cancer may come back in the prostate or in other parts of the body.

There are different types of treatment for people with prostate cancer.

Different types of treatment are available for patients with prostate cancer. Some treatments are standard (the currently used treatment), and some are being tested in clinical trials. A treatment clinical trial is a research study meant to help improve current treatments or obtain information on new treatments for patients with cancer. When clinical trials show that a new treatment is better than the standard treatment, the new treatment may become the standard treatment. Patients may want to think about taking part in a clinical trial. Some clinical trials are open only to patients who have not started treatment.

Se utilizan los siguientes tipos de tratamiento:

There are treatments for bone pain caused by bone metastases or hormone therapy.

Prostate cancer that has spread to the bone and certain types of hormone therapy can weaken bones and lead to bone pain. Treatments for bone pain include:

• Pain medicine.
• External radiation therapy.
• Estroncio-89 (un radioisótopo ).
• Targeted therapy with a monoclonal antibody, such as denosumab.
• Bisphosphonate therapy.
• Corticosteroids.

For more information, see Cancer Pain.

Se están probando nuevos tipos de tratamiento en ensayos clínicos.

En esta sección se resumen los tratamientos que se están estudiando en ensayos clínicos. Es posible que no se mencionen todos los tratamientos nuevos que se están estudiando. La información sobre los ensayos clínicos está disponible en el sitio web del NCI.

Treatment for prostate cancer may cause side effects.

Para obtener información sobre los efectos secundarios causados por el tratamiento para el cáncer, visite la página de efectos secundarios.

Los pacientes pueden evaluar la posibilidad de participar en un ensayo clínico.

Para algunos pacientes, participar en un ensayo clínico puede ser la mejor opción de tratamiento. Los ensayos clínicos son parte del proceso de investigación del cáncer y se realizan para determinar si los nuevos tratamientos para el cáncer son seguros y eficaces o mejores que el tratamiento estándar.

Muchos de los tratamientos estándar actuales para el cáncer se basan en ensayos clínicos anteriores. Los pacientes que participan en un ensayo clínico pueden recibir el tratamiento estándar o ser de los primeros en recibir uno nuevo.

Los pacientes que participan en ensayos clínicos también ayudan a mejorar la forma en que se tratará el cáncer en el futuro. Incluso cuando los ensayos clínicos no conducen a nuevos tratamientos efectivos, suelen responder a preguntas clave y contribuir de forma significativa al avance de la investigación.

Los pacientes pueden participar en ensayos clínicos antes, durante o después de comenzar el tratamiento contra el cáncer.

Algunos ensayos clínicos solo incluyen a pacientes que aún no han recibido tratamiento. Otros ensayos prueban tratamientos para pacientes cuyo cáncer no ha mejorado. También hay ensayos clínicos que prueban nuevas formas de evitar que el cáncer recidive (regrese) o de reducir los efectos secundarios del tratamiento del cáncer.

Se están realizando ensayos clínicos en muchas partes del país. Puede encontrar información sobre los ensayos clínicos respaldados por el NCI en el sitio web de búsqueda de ensayos clínicos del NCI. Puede encontrar ensayos clínicos respaldados por otras organizaciones en el sitio web ClinicalTrials.gov.

Es posible que se necesiten cuidados de seguimiento.

A medida que avanza el tratamiento, se le realizarán pruebas o controles de seguimiento. Es posible que se repitan algunas pruebas para diagnosticar o estadificar el cáncer con el fin de evaluar cómo está funcionando el tratamiento. Las decisiones sobre si continuar, modificar o suspender el tratamiento pueden basarse en los resultados de estas pruebas.

Algunas pruebas seguirán realizándose de manera periódica después de terminar el tratamiento. Los resultados pueden indicar si su afección ha cambiado o si el cáncer ha redicivado (regresado).

Acerca del PDQ

El Physician Data Query (PDQ) es la base de datos integral sobre el cáncer del National Cancer Institute (NCI). La base de datos del PDQ contiene resúmenes con la última información publicada sobre prevención, detección, genética, tratamiento, atención médica de apoyo y medicina complementaria y alternativa relacionada con el cáncer. La mayoría de los resúmenes se presentan en dos versiones. Las versiones para profesionales de la salud contienen información detallada escrita en lenguaje técnico. Las versiones para pacientes están escritas en un lenguaje fácil de entender y no tan técnico. Ambas versiones contienen información precisa y actualizada sobre el cáncer. La mayoría de las versiones también están disponibles en español.

El PDQ es un servicio del NCI. El NCI es parte de los Institutos Nacionales de Salud (NIH), que son el centro de investigación biomédica del Gobierno federal. Los resúmenes del PDQ se basan en una revisión independiente de la literatura médica. No son declaraciones de políticas del NCI ni de los NIH.

Propósito de este resumen

This PDQ cancer information summary has current information about the treatment of prostate cancer. It is meant to inform and help patients, families, and caregivers. It does not give formal guidelines or recommendations for making decisions about health care.

Revisores y actualizaciones

Los comités editoriales escriben los resúmenes de información sobre el cáncer del PDQ y los mantienen actualizados. Estos comités están formados por equipos de especialistas en el tratamiento del cáncer y otras especialidades relacionadas con esta enfermedad. Los resúmenes se revisan periódicamente y se modifican cuando hay información nueva. La fecha de actualización al pie de cada resumen indica cuándo se realizó el cambio más reciente.

La información de este resumen para pacientes procede de la versión para profesionales de la salud, la cual es revisada y actualizada por el comité editorial del PDQ sobre el tratamiento para adultos.

Información sobre ensayos clínicos

Un ensayo clínico es un estudio para responder a una pregunta científica como, por ejemplo, si un tratamiento es mejor que otro. Los ensayos se basan en estudios anteriores y en lo aprendido en el laboratorio. Cada ensayo responde a determinadas preguntas científicas que permiten encontrar nuevas y mejores formas de ayudar a los pacientes con cáncer. Durante los ensayos clínicos de tratamiento, se recopila información sobre los efectos de un nuevo tratamiento y su eficacia. Si un ensayo clínico demuestra que un nuevo tratamiento es mejor que uno que se utiliza actualmente, el nuevo tratamiento puede convertirse en “estándar”. Los pacientes pueden valorar la posibilidad de participar en un ensayo clínico. Algunos ensayos clínicos solo están abiertos a pacientes que no hayan iniciado el tratamiento.

Los ensayos clínicos se pueden encontrar en línea en el sitio web del NCI. Para obtener más información, llame al Servicio de Información sobre el Cáncer (CIS, por sus siglas en inglés), el centro de contacto del NCI, al 1-800-4-CANCER (1-800-422-6237).

Permiso de uso de este resumen

Physician Data Query (PDQ) es una marca registrada. Se autoriza el libre uso del contenido de los documentos del PDQ como texto. Sin embargo, no se podrá identificar como un resumen de información sobre cáncer del PDQ del NCI, salvo que se reproduzca en su totalidad y se actualice con regularidad. Por otra parte, se permite que los autores incluyan una oración como “en el resumen del PDQ del NCI sobre la prevención del cáncer de mama se describen, de manera concisa, los siguientes riesgos: [incluir fragmento del resumen]”.

La forma recomendada para citar este resumen del PDQ es:

PDQ® Adult Treatment Editorial Board. PDQ Prostate Cancer Treatment. Bethesda, MD: National Cancer Institute. Updated <MM/DD/YYYY>. Available at: https://www.cancer.gov/types/prostate/patient/prostate-treatment-pdq. Accessed <MM/DD/YYYY>. [PMID: 26389353]

Las imágenes de este resumen se utilizan con el permiso del autor, artista y/o editorial para uso exclusivo en los resúmenes del PDQ. Si desea usar una imagen de un resumen del PDQ sin incluir el resumen completo, debe obtener autorización del propietario. El National Cancer Institute no puede otorgar dicho permiso. Para obtener más información sobre el uso de las imágenes de este resumen o de otras ilustraciones relacionadas con el cáncer, consulte Visuals Online, una colección de más de 3,000 imágenes científicas.

Descargo de responsabilidad

La información de estos resúmenes no debe utilizarse para tomar decisiones sobre reembolsos de seguros. Puede encontrar más información sobre la cobertura de seguros en Cancer.gov en el sitio Manejo de la atención del cáncer.

Contáctenos

Puede encontrar más información sobre cómo contactarnos o recibir ayuda en el sitio web Cancer.gov en la página Comuníquese con el NCI. También puede enviar sus preguntas a Cancer.gov en el apartado Escríbanos del sitio web.