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Prostate Cancer

To many men the prostate remains "invisible." They may not even know its location or function until they have the tangible symptoms of prostate disease.
This information is provided to help men maintain and improve their prostate health.


What is a prostate gland, and why is your prostate health important?

http://www.abbottdiagnostics.com/your_health/Cancer-Oncology/images/cancer_prostate_04.jpgThe prostate gland, found only in men, is about the size of a small walnut. The gland is located beneath the bladder in front of the rectum (see Figure 1). The prostate surrounds the urethra, the canal through which urine passes as it moves from the bladder and exits the body.
Having a healthy prostate is therefore important to ensure the proper function of the male reproductive and urinary system. The gland’s primary function is to produce fluid that nourishes and transports semen during ejaculation. The gland also gives you the ability to maintain urination. If there is a problem with the health of your prostate, your ability to
experience normal sexual activity or maintain bladder control may become impaired.

Figure 1: The prostate and nearby organs
U.S. National Cancer Institute

What diseases is your prostate susceptible to?

Some of the prostate disorders that you might develop include benign conditions such as Benign Prostatic Hyperplasia (BPH), prostatitis and, a more serious condition, prostate cancer.
BPH is an enlargement of the prostate gland that can make urination difficult. BPH is very common in  men over 50 with four out of five men likely to develop the condition. It is important to note that BPH is not prostate cancer.
Prostatitis is an infection or inflammation of the prostate that can occur in men who are middle-aged or older. Symptoms of the condition include frequent urination, painful ejaculation and pain in the back or rectum.
Treatment options exist that can reduce symptoms of BPH and prostatitis without the risk and potential side effects of surgery. Additionally, BPH and prostatitis have not been shown to cause cancer and should not be confused with prostate cancer.
FACT: Prostate Cancer is the most common cancer in American men.


What is the chance you may develop prostate cancer?

There are both age-related and genetic reasons why you might develop prostate cancer. Prostate cancer is characterized by the malignant growth of tumors in the prostate gland. With this in mind, it is a good idea to have regular prostate examinations and PSA tests if you…

  • Have family members who have been diagnosed with prostate cancer
  • Are a 40+ year old African-American
  • Are age 50 or older

The following chart underscores the fact that the risk of having prostate cancer increases as you grow older.

http://www.abbottdiagnostics.com/your_health/Cancer-Oncology/images/cancer_prostate_03.gif

Additionally, prostate cancer is the most commonly diagnosed cancer among American men. One out of six men in the U.S. will develop this form of cancer during their lifetime. In the United States, every 18 minutes someone dies of prostate cancer. Prostate cancer also accounts for 33% of all new cancer cases in American men.
FACT: Lifetime risk of developing prostate cancer is 1 in 6 in the U.S.
Globally speaking, there are 700,000 cases of prostate cancer diagnosed each year, resulting in 221,000 deaths. This is the equivalent to 1 death from prostate cancer every 2.5 minutes worldwide.


Understanding cancer


Cancer is a serious health reality that all of us should be aware of. However, having a good understanding about the effects of cancer is the first step for you to know how to stay healthy and prevent this disease from causing serious complications.
FACT: 96% of prostate cancer deaths occur in men over 60.

http://www.hiltonheadmedctr.com/images/What-Is-Cancer.jpgWhat is cancer?


Your body’s cells normally grow and divide in an orderly manner, permitting you to replace lost cells and remain healthy. Sometimes genetic imbalances cause cells to reproduce in an un  controlled way and spread abnormal cells throughout the body; when this happens cancer develops. These abnormal cells can produce a mass, or tumor. Tumors are responsible for destroying normal, healthy body tissue. When these cancer cells spread, tumors may grow throughout the body, this is called metastasis. When prostate cancer metastasizes, it typically spreads first to the lymph nodes and bones.
With genetics playing a key role in developing cancer, prostate or otherwise, you should find out if there has ever been a family member of yours who has had cancer. And while genetics are an important factor in determining the possibility of you developing cancer, other factors such as the environment and your diet may also play a part in developing the disease.
FACT: If one close relative, say a father or brother, has prostate cancer, your chance of getting prostate cancer doubles.
Since you can never be certain how fast or slow cancer grows and spreads, the earlier cancer is detected by your doctor and treatment for the disease begins, the better your chance for survival.


What symptoms indicate that you may have a prostate problem?

Through regular Digital Rectal Examinations (DRE) and Prostate Specific Antigen (PSA) testing, prostate problems are more likely to be detected early and you are less likely to experience serious prostate-related health issues. Some men, however, may experience the following symptoms indicating prostate problems:

  • A need to frequently urinate, especially at  night
  • Weak, interrupted or uncontrolled urine flow, or incontinence
  • Painful urination or a burning sensation during urination
  • Difficulty in achieving an erection, or impotence
  • Painful ejaculation
  • Blood or pus in urine or semen
  • Weight loss
  • Pelvic discomfort
  • Persistent back, hip and spine pain

If you are experiencing any of these symptoms, make an appointment to see your doctor immediately. Your doctor can perform additional examinations and tests to determine the underlying cause of these symptoms. Keep in mind that these symptoms may indicate diseases or disorders other than prostate cancer.
FACT: African-American men are more likely to be diagnosed with advanced prostate cancer and their death rate is 2.5 times greater than Caucasian men.


How do you find out if your prostate is healthy?


The two most common early testing procedures that doctors perform to assess prostate health are the Digital Rectal Examination (DRE) and the Prostate Specific Antigen Blood Test (PSA or Total PSA Blood Test).


Digital Rectal Examination


The first of these prostate-testing procedures is called the Digital Rectal Examination or DRE (see Figure 2). The DRE is a simple examination your doctor can give you during
an annual physical. Using this examination technique your doctor will insert a lubricated, gloved finger into your rectum and feel the surface of your prostate in order to see if the
size and shape of the prostate is normal and free of abnormalities such as hard nodules or lumps. An abnormal DRE, it should be remembered, is not a definitive indicator of prostate cancer. An abnormal DRE can be caused by infections, the presence of stones or other non-cancerous conditions.

Figure 2: Digital Rectal Examination (DRE)
Even if your prostate shows all signs of being normal, for a more complete and accurate diagnosis the DRE should be combined with the Prostate Specific Antigen Blood http://www.nlm.nih.gov/MEDLINEPLUS/ency/images/ency/fullsize/18039.jpgTest.

 

 

 

Total PSA Blood Test


Performing a Total PSA test significantly increases your doctor’s ability to detect prostate cancer early, and early cancer detection always translates to a better prognosis. Available worldwide, the PSA test measures the level of a protein produced by the prostate called prostate specific antigen, or PSA, that is in your blood.
Some health conditions and drug substances can affect PSA levels, so be sure to discuss your current health status and all medical treatments with your doctor at the time you have a PSA test. When certain abnormal prostate conditions arise — such as BPH, prostatitis, infection or cancer — an increased amount of the PSA protein is released into your bloodstream.


Measuring PSA


PSA levels are measured in nanograms per milliliter (ng/mL). As your doctor will explain to you, PSA levels under 4 ng/mL are usually considered normal. If your PSA levels are greater than 10 ng/mL it is considered abnormal. With levels between 4 and 10 ng/mL your status may be borderline abnormal. Increased PSA levels can indicate inflammation, infection or simple enlargement of the prostate, stones within the prostate, urinary tract infection, other non-cancerous disorders or possibly prostate cancer.
“Normal” PSA levels can also vary due to your age or race. It should also be noted that cancer has been detected in cases where PSA levels were less than 4 ng/mL, so a thorough examination and discussion with your doctor should occur before reaching any conclusions. (see Table 1)
Table 1: General PSA Guidelines


PS Level ng/mL

Condition

<4

Normal

4 to 10

Borderline

>10

Abnormally High

Recent studies have also found that the year after year rate of increase in your Total PSA has predictive value in detecting life-threatening forms of prostate cancer. This concept, called Total PSA velocity, underscores the benefit of tracking your annual Total PSA result, which is easy to do with the tear-out PSA tracking card located on this booklet’s back cover, and regular consultation with your doctor.


A valuable early detection tool


The Total PSA test is not considered conclusive to detect the presence of prostate cancer. It does provide a valuable early detection tool to assist you and your doctor in assessing your risk of having the disease. The PSA test combined with the DRE is considered the most effective method to determine your cancer risk and the possible need for further
investigation.
FACT: 21% of all cancer deaths in men over 80 are from prostate cancer.


http://www.pca3.org/public/images/prostate-biopsy.jpgWhat other tests let you know if you are at risk for prostate cancer?

There are other tests to help determine if you may have prostate cancer, including Free PSA (to allow for calculation of % Free PSA) and Biopsy.
% Free PSA
Your doctor will calculate your % Free PSA using your Total PSA and Free PSA values. As mentioned earlier, Prostate Specific Antigen, or PSA, is a protein found in your blood and produced by the prostate gland. PSA appears in two major forms, bound to other proteins and unbound from other proteins. Unbound PSA is called Free PSA. Comparing your amounts of bound and unbound PSA can help doctors differentiate between prostate cancer and other prostate health issues (see Table 2).The comparison can also assist
your doctor in evaluating the aggressiveness of cancer if it has been identified.
When you have borderline Total PSA test results (4 - 10 ng/mL) the use of % Free PSA aids in distinguishing between benign conditions and prostate cancer. These test results therefore assist you and your doctor in determining if a biopsy is appropriate.
By helping doctors get a clearer picture of your prostate health, the % Free PSA test may eliminate up to 40% of unnecessary biopsies and enables the accurate identification of 90% of patients with cancer.
FACT: Lower % Free PSA = Higher Probability of prostate cancer.
Higher % Free PSA = higher probability of BPH or another benign condition.
Table 2: Percent Free PSA and Cancer Probability


% Free PSA

Probability of Prostate Cancer*

0-10%

59%

>10-15%

40%

>15-20%

24%

>20-26%

13%

>26%

7%

http://www.keyholeurology.co.uk/images/transrectalbiopsy.jpg*Based on prevalence rate of 25% for prostate cancer (screening population)

Biopsy

When prostate abnormalities are suspected (as a result of abnormal DRE, a high total PSA and a low % Free PSA value) your doctor may request a prostate biopsy. Biopsy is the surgical removal of small amounts of tissue from your body for diagnostic examination.
Urologists usually perform this procedure. Urologists are doctors who specialize in the treatment of urinary disorders and problems with the male reproductive system. Your urologist will perform a biopsy when he believes the risk of cancer is high.
During a biopsy, your urologist uses a device to provide a video image that helps him guide an instrument called the biopsy gun into the prostate gland. The procedure to surgically remove tissue from your prostate gland takes about 15 minutes and is usually performed in your urologist’s office. The sample is then sent to a laboratory to be studied under a microscope.
Although a biopsy sounds painful, it usually only causes brief discomfort. In the event you require a biopsy, you may want to ask your doctor about numbing the area with a harmless anesthetic.


http://www.cancerline.com/gUserFiles/pc_Classification_Fig1.10.gifFollow-up to biopsy
While biopsy is regarded as the only conclusive method for detecting prostate cancer, it is not accurate 100% of the time. This means that even if prostate cancer is present, it is not always detected in an initial biopsy. In the event an initial biopsy is negative, % Free PSA can help determine if an increased risk of prostate cancer still exists, and whether a second biopsy is appropriate to ensure that cancer is not present.


If your test results are positive for Prostate Cancer, what is the next step?

If your biopsy results confirm that you have prostate cancer, the extent of the cancer is determined through a process called Staging. Staging provides your doctor with information regarding the severity of the cancer and your prognosis. Staging separates cancer into four stages (T-1 to T-4) based on how far cancer cells have spread throughout your body and can also indicate the treatments that are most appropriate for you. % Free PSA may also indicate how far the disease has progressed.


The Clinical Stage
The Clinical Stage is based on all of the available information obtained before a surgery to remove the tumor, and is often the result of physical examination (DRE), radiologic examination (Ultrasound, Computed Tomography [CT] or Magnetic Resonance Imaging [MRI]) and endoscopy. Information from the clinical stage is also used to determine your initial treatment. Biopsy results do not affect the clinical stage.


The Pathological Stage
Since clinical staging by DRE alone can be inaccurate, the Pathological Stage of cancer is determined mostly by biopsy or prostatectomy, or the surgical removal of all or part of the prostate gland. The Pathological stage adds additional information gained by examination of the tumor microscopically by a pathologist. Pathologists are responsible for processing and reporting on all specimens generated during surgery. The pathological stage is used to determine the need for additional treatment after surgery.


http://pro.corbis.com/images/42-16974035.jpg?size=572&uid=%7B1E4FE649-F011-462E-B6EF-EF2A20EC6372%7DOther Staging Procedures


In addition to biopsy, other diagnostic tests for cancer staging include…

  • Computed tomography (CT or CAT scan): A test that makes pictures of the inside of your body using a rotating X-ray beam.
  • Magnetic resonance imaging (MRI): A test that makes pictures of  the inside of your body using magnetic fields.
  • Radionuclide bone scan: A scan that produces images of your bones using a small amount of radioactive material.
  • ProstaScint Scan®: A test to find cancer that has spread beyond your prostate that uses low-level radioactive material.
  • Lymph node biopsy: This procedure involves the removal of small amounts of tissue from the lymph nodes for evaluation.

The last form of staging is called the Gleason Grading System.


Gleason Grading System


Cancer grading estimates how fast the cancer is likely to spread. The Gleason grading system rates the cancer cells on their difference from normal cells on a five-point scale. Because cancers can have different grades in different areas of the same tissue, a grade is assigned to two major areas of the tissue. These two scores are added together to make the Gleason score, which ranges from 2 to 10. Higher scores indicate that cancer may grow and spread rapidly.


If you have Prostate Cancer, what are the available treatments?

If indeed you need to be treated for prostate cancer there are a variety of treatments available. Selecting the best course of treatment for you is a decision that you and your doctor can make together. The surgical and non-surgical treatments for prostate cancer are listed immediately below.


Surgery


The following two common prostate cancer surgical procedures are used to remove your entire prostate gland and any other local area cancer you may have.
http://www.nglam-tr.wales.nhs.uk/procare/images/procare_treatment1.jpg     These procedures are:

  • Radical Prostatectomy: This treatment involves removal of your entire prostate gland and surrounding tissue through open surgery.
  • Laparoscopic Prostatectomy: This treatment involves removal of your entire prostate using a laparoscope and done through a small two-tothree inch incision.

There are also two other surgical procedures for prostate cancer that do not involve the total removal of your prostate gland. These procedures are:

  • Orchiectomy: This treatment involves the surgical removal of your testicles, a man’s main source of testosterone. Prostate cancer usually needs testosterone in order to grow.
  • Transurethral Resection of the Prostate or TURP: This treatment involves removing the part of your prostate gland that surrounds the urethra to restore a normal urine flow out of the bladder.

As you work with your doctor to select the surgical treatment that will best serve your health and lifestyle, discuss what side effects and lifestyle changes you can expect during each of these procedures’ surgical recovery periods.
FACT: 75% of men who undergo surgery never experience a reoccurrence of prostate cancer.

Radiation

Prostate cancer cells can be destroyed by periodic exposure to radiation. The two types of radiation treatment available to you are:

  • Radiation therapy (External beam radiation): Treats your prostate and other selected issues with a targeted beam from a machine outside of the body.
  • Brachytherapy (Internal radiation therapy): In this form of radiation therapy, while under anesthetic, 40 to 120 small radioactive seeds are implanted directly into your prostate to destroy  cancer cells.

 

Chemotherapy
This treatment employs the use of powerful drugs to destroy cancer cells in your prostate.

http://www.prostatebrachytherapyinfo.net/i/image001.jpg

Hormone Therapy
Also known as Androgen Deprivation Therapy, this is the use of drugs or surgery to decrease the production of male hormones, or androgens, in order to stop or limit the growth of prostate cancer.

Cryosurgery
This treatment uses extremely low temperatures to freeze your prostate, destroying cancer cells.
All prostate cancer treatments available to you have potential advantages and disadvantages. Your doctor will have the most up-to-date knowledge of the actual treatment and possible side effects. Given this, you should decide the best treatment schedule together. Being an active participant in your treatment selection is important because whatever treatment you end up choosing needs to work well with your lifestyle.

 


 

 

 

Is there a circumstance when you may not need to move quickly with prostate cancer treatment?

There are circumstances when your doctor may suggest Watchful Waiting as your best course of action to deal with your prostate cancer. Watchful Waiting involves careful, active observation without immediate prostate cancer treatment. This may be an appropriate therapeutic course for men who…

  • Are found to have less aggressive tumors, which often tend to grow slowly. Remember, to help determine a tumor’s aggressiveness, doctors can use the Free PSA test.
  • Have a life expectancy less than 10-15 years.
  • Have significant coexisting illnesses.

How do you know if prostate cancer treatment has been successful?

There is a method your doctor can use to determine if prostate cancer treatment has been successful and what the prognosis will be. At an appropriate time following prostate cancer therapy another PSA blood test is performed. Successful treatment may be indicated by a decrease in PSA levels. An increase in PSA levels may indicate a reoccurrence of prostate cancer. If there is an increase, your doctor will do additional testing in order to determine the best course of action.


If you have prostate cancer, what are your chances for survival?

If the disease is detected early, chances for surviving prostate cancer are very good. The five year relative survival rate for those whose tumors are diagnosed at the local and regional stages is 99%. A five-year survival rate refers to the number of men surviving five years after they are diagnosed with cancer.
Over the last 20 years, the five-year survival rate for all stages combined has increased from 67% to 92%. Survival rates beyond five years are also increasing. According to recent data, 67% of men diagnosed with prostate cancer survive 10 years and 52% survive 15 years beyond diagnosis.


Unless you have noticeable symptoms, why should you participate in a prostate cancer screening?

It is important to have regular prostate examinations and tests such as the DRE, Total PSA and Free PSA because roughly half of all men may have some type of prostate abnormality by age 50. Early detection of these abnormalities is critical in both treating and curing the ailment. Talk to your doctor about your prostate health, as physicians
remain the best resource for information regarding early detection and treatment for prostate-related disorders and prostate cancer. 


 What are the best ways for you to take charge of your prostate health?
  • Have regular prostate exams and PSA tests. Because symptoms of prostate cancer may not occur until the disease is advanced, the best prevention against advanced prostate cancer is to detect it early through DRE and PSA tests. To help you remember to be screened for prostate cancer, have the tests done at the same time as other important calendar events such as the date of your annual physical, your birthday, around Father’s Day or during Prostate Cancer Awareness Month which occurs in the United States during September.
  • Listen to the women in your life. As many as 60% of men screened say that their wives, girlfriends or another female encouraged them to have it done.
  • Diet can make a difference. A Harvard study showed that a diet high in dairy and fatty foods, particularly those of animal origin, increased the risk of developing prostate cancer by 80%. Supplements and food sources rich in antioxidants (vitamin E and selenium) have been shown to control cell damage and may prevent prostate cancer.
  • Stay fit and active. A healthy exercise program will increase circulation, lower stress and possibly decrease hormones that can increase the risk of cancer. Several studies also suggest a possible connection between obesity and more aggressive prostate cancer.
  • Learn more. The more you know and the earlier you know it, the more control you have over your outcome. Read, ask others and search the Internet to educate yourself about prostate health.


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