Monday, September 26, 2022

Can Cancer Cells Escape During A Prostate Biopsy

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Medical History And Physical Exam

Targeted Prostate Biopsy using MR-Ultrasound Fusion

If your doctor suspects you might have prostate cancer, he or she will ask you about any symptoms you are having, such as any urinary or sexual problems, and how long you have had them. You might also be asked about possible risk factors, including your family history.

Your doctor will also examine you. This might include a digital rectal exam , during which the doctor inserts a gloved, lubricated finger into your rectum to feel for any bumps or hard areas on the prostate that might be cancer. If you do have cancer, the DRE can sometimes help tell if its only on one side of the prostate, if its on both sides, or if its likely to have spread beyond the prostate to nearby tissues. Your doctor may also examine other areas of your body.

After the exam, your doctor might then order some tests.

What Screening Tests Are Used For Prostate Cancer

There are two tests used for prostate cancer screening:

The American Cancer Society recommends that men make an informed decision on whether or not they should be screened after talking about the risks and benefits of screening with their healthcare provider. Screening is not recommended in men without symptoms of prostate cancer if they have a life expectancy of less than ten years. Men at average risk of developing prostate cancer should begin this conversation at age 50. African American men and men with one relative with prostate cancer should talk with their healthcare provider about screening beginning at age 45. Men at the highest risk, those with more than one first degree relative with prostate cancer at an early age should begin talking about screening at age 40. Repeat screening is based on baseline PSA results, but typically occurs every 1-2 years.

Two Important Questions Difficult To Answer

Has the cancer already spread elsewhere in the body?

If cancer has already spread , then there is no need to consider treatment of the prostate gland itself, because the horse is out of the barn. Instead, we need to treat the whole body. There are three main tests available, but none is infallible.

  • Since prostate cancer, if it travels at all, usually travels to bones, a bone scan is the most common test. Unfortunately, a bone scan is both too sensitive, and not sensitive enough, to be a decisive test. It can show any area of bone injury, old or new, including simple arthritis. And it can NOT show a few prostate cancer cells in the bones, unless they are causing enough bone injury to detect. For this reason, when the PSA and Gleason score are low, a bone scan is more likely to show false results than true results. The American Urologic Association recommends that we NOT do a bone scan unless the PSA is over 20. Although this is based on excellent statistical evidence, many doctors feel that this is too conservative, and they ask for a bone scan when the PSA is over 10.
  • Another place prostate cancer can go is to the pelvic lymph nodes, which are best investigated by CT scan or MRI scan. Because of poor ability to show very early spread, the AUA again says that this testing is unnecessary for men whose PSA is under 25.
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    Cancer Risk Depends On Family History

    Most types of cancer are not caused by genetics. Cancer Research UK said that most cancers are developed due to gene faults that become apparent during a persons lifetime, probably due to aging or exposure to certain factors, such as sunlight or cigarette smoke. These genes, however, are not inherited and cannot be inherited by your children. There are a few cases where family history may show that some people have a faulty gene, which increases their risk of developing cancer, more than most people. If your family history shows that members were afflicted with specific types of cancer, early detection is important.

    Biopsies Do Not Cause Metastasis

    PCA3: a gene

    What weve been talking about up until now is local spread of cancer, along the needle tract. Some folks also worry that fine needle aspirate or needle biopsies can also cause metastasis or distant spread.

    At this time, we dont have enough data to suggest that doing surgical biopsies in dogs causes distant spread of cancers.

    This could change over time as more information comes in. There are a couple of tumors in other species where biopsy does increase the odds of spread.

    All that said, in general, fine needle aspirates, needle biopsies, and biopsies are very safe.

    For more general information about this topic, this abstract has some good data.

    In the end, the scale tips most definitely in the direction of the biopsy.

    Best,

    Dr D

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    Spread Through The Lymphatic System

    The lymphatic system is a network of tubes and glands in the body that filters body fluid and fights infection. It also traps damaged or harmful cells such as cancer cells.

    Cancer cells can go into the small lymph vessels close to the primary tumour and travel into nearby lymph glands . In the lymph glands, the cancer cells might die. But some may survive and grow to form tumours in one or more lymph nodes. This is called lymph node spread.

    This 2 minute video is about the lymphatic system.

    I Am 59 And In An Advanced Stage Of Prostate Cancer When The Psa Starts To Rise At What Level Does It Metastasize

    Generally, not before the PSA reaches 50 ng/ml however, some high grade tumors that do not produce much PSA might produce metastases at lower PSA levels. The best way to be sure is to have a bone scan, at least yearly, if the PSA is rising. An abdominal and pelvic CT scan is also helpful to determine whether there are metastases in lymph nodes or other internal organs.

    The important point is that with intermittent hormonal therapy, if the PSA level is maintained between zero and four, there is a very low likelihood that the cancer will have spread.

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    Treatment Of Oligometastatic Pca

    The SoC for newly-diagnosed, low-volume metastatic disease is hormone therapy. However, emerging data from retrospective studies suggest that local treatment can provide a survival benefit in oligometastatic patients. These findings have given rise to randomized controlled trials such as the STAMPEDE trial , which was conducted to compare SoC with or without external beam radiotherapy to the prostate. In unselected patients, SoC plus radiotherapy improved failure-free survival compared to SoC alone 0.76, 95% CI, 0.680.84 p< 0.0001] but did not improve OS. However, in the subgroup of patients with low metastatic burden EBRT improved 3-year OS and FFS . In another trial ADT + EBRT was compared to ADT alone, with some improvement in OS for the EBRT arm in the subgroup of patients with low metastatic volume. Despite the limitations of these studies, such as the relatively low total radiation dose in both STAMPEDE schemes /4 weeks and 36Gy/6 fxs/6 weeks], the results support the recommendation to consider radical radiotherapy to the prostate in well-selected, newly-diagnosed oligometastatic patients. Numerous similar studies are currently underway. For example, the four-arm PEACE-1 trial was designed to compare ADT+ docetaxel ± local radiotherapy ± abiraterone . That study is important due to the known benefit of adding abiraterone to conventional ADT for hormone-sensitive stage IV patients .

    Exosome Bioactive Molecules As Biomarkers For Pca Detection

    What Happens After a Prostate Biopsy?

    Recent studies have demonstrated that exosomes isolated from the TME are important factors that affect the progression of PCa . As carriers of proteins, RNAs, and lipids, PCa-derived exosomes have been reported to affect cancer cell proliferation, angiogenesis, survival, and immune escape . Cancer cells communicate with each other or CAFs through substances carried by exosomes, which include signaling complexes, receptors, functional proteins, and genetic information that regulates signaling networks involved in cancer growth and invasiveness. In terms of recent studies on protein and miRNA biomarkers, this section focuses on exosomal proteins and miRNAs in PCa monitoring.

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    Where Does Prostate Cancer Spread

    The most common place for prostate cancer to spread to is the bones. It can also spread to the lymph nodes, liver and lungs and other organs.

    A large tumour in the prostate gland can spread into or press on areas around the prostate, such as the back passage or urethra. The urethra is the tube which carries urine from the bladder to the outside of the body.

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    Seeding Local Tumors By Track Implantation

    Instances in which sarcomas were seeded along needle biopsy tracks are easier to document as iatrogenic because the tumors are obviously growing in an artificial path.

    Viable tumour spread in FNA biopsy tracks has been histologically confirmed. Although this complication is not common and is of unknown clinical significance, it is one that all clinicians who undertake FNA of malignant neoplasms should be aware of.

    There are documented instances in which sarcomas were seeded along needle biopsy tracks. At least one cancer so frequently implants along the needle track that fine needle biopsies of its suspected lesions are no longer routinely recommended.

    It is also possible to track and implant tumor deposits with other devices than needles, including gastrostomy tubes, stereotactic cannulas, and postoperative drains. Implantation also can occur after percutaneous ethanol injection into the tumors and thoracoscopic or laparoscopic or other surgical intervention.

    “The incidence of implantation metastases after fine-needle procedures is probably underestimated. There is a slight but definite risk that the procedure may render an otherwise curative resection palliative. Implantation metastases cause local complaints of varying severity and seem to have a tendency to recur locally. We recommend that fine-needle biopsy should be restricted to patients who will truly benefit from a more accurate preoperative diagnosis.”

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    Solid Tumors: Low Likelihood

    For solid tumors within the body, there is very little risk of spread along the needle tract.

    So, if a mass looks solid on imaging, its almost always smart to get a specimen for fine needle aspirate or a needle biopsy if warranted.

    Note: There is one report of a lung tumor that spread along the needle tract in the dog, but this is only a single report, and thus we need more data before suggesting we avoid fine needle aspirate for lung tumors or solid tumors in the chest cavity.

    Thats why, at this time, I am comfortable suggesting that all solid tumors are good candidates for fine needle aspirate or needle biopsy.

    The only exception to this rule is if the mass is in the urinary tract.

    Genetic Testing For Some Men With Prostate Cancer

    What to Expect During Prostate Cancer Biopsy

    Some doctors now recommend that some men with prostate cancer be tested to look for certain inherited gene changes. This includes men in whom a family cancer syndrome is suspected, as well as men with prostate cancer that has certain high-risk features or that has spread to other parts of the body. Talk to your doctor about the possible pros, cons, and limitations of such testing.

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    Liquid Biopsya New Diagnostic Tool For Patients With Metastatic Disease

    Generally, accurate diagnosis of oligometastatic disease constitutes a problematic procedure because all radiological modalities are strongly limited by certain thresholds for the detection of size-limited metastases. Nieder et al. performed a retrospective study that involves 34 patients with a limited number of distant metastases. They proved that elevated level of LDH and reduced hemoglobin is associated with shorter survival, whereas in multivariate analysis, hemoglobin outperformed LDH. This work shows that serum biomarkers may reflect the total burden of malignant disease . Thus, the biomarkers that will allow to objectively and unequivocally identify oligometastatic patients are needed .

    What Kind Of Follow

    With any cancer, not only prostate cancer, theres always a possibility that the cancer can come back and thats why patients need to have follow up visits. I recommend a PSA test every six months for 15 years after the operation.

    That said, in the category of men who have a prostate cancer removed that is very small and totally contained within the prostate and all the margins are clear and it has not spread to any lymph nodes, the life expectancy is virtually equal to that of the normal population who have never had prostate cancer.

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    My Pathology Report After A Radical Prostatectomy Stated: Focally Involved Right Posterior Inferior Third Prostate What Does Focal Involvement Mean And What Does That Report Mean

    Focal in this context usually means microscopic amounts of cancer, usually about the size of a pencil dot. The report means that the pathologist found a small region of prostate cancer in the right lobe of the prostate toward the back and lowest regions of the gland. This low-volume of cancer would be a very favorable finding.

    Identification Of Mrna Transcripts That Can Detect Prostate Cancer In A Majority Of Patients By Using Ade

    When should You Have a Prostate Biopsy?

    To more efficiently increase the odds of identifying transcript differences common to a majority of tumornontumor pairs, DD was carried out by using RNA pooled from multiple patients . We use the term ADE to refer to DD of RNA pooled from multiple patients. ADE analysis of RNA pooled from 10 different patient specimens led to the identification of an mRNA transcript that was overexpressed in the pooled tumor RNA as well as in 7 of the 10 individual tumor RNAs that comprised the pool . The sequence of this mRNA transcript showed 100% identity to a 285-nucleotide sequence in KB208E9 . Based on another ADE analysis of RNA pooled from five patient specimens , we identified the down-regulation of an mRNA transcript in pooled, as well as in three of the five individual, tumor RNAs . The sequence of this mRNA transcript showed 100% identity to a 343-nucleotide sequence in rp11-442e11 . These two were the only differentially expressed transcripts that were identified by ADE with the one primer pair used.

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    How Does Cancer Spread From One Tumor To Another

    Cancer cells from the primary tumor can break away and form new tumors nearby. The lymph system. Cancer cells from the tumor can enter nearby lymph nodes. From there, they can travel the entire lymph system and start new tumors in other parts of the body. The bloodstream. Solid tumors need oxygen and other nutrients to grow.

    Resources For More Information

    Prostate Cancer Foundation

    Leading philanthropic organization funding and accelerating prostate cancer research globally. Also provides information about prostate cancer, treatment and resources to help patients and families.

    Us Too

    Offers peer-to-peer support and educational materials to help men and their families/caregivers make informed decisions about prostate cancer detection, treatment options and related side effects.

    http://www.ustoo.org/Home

    MaleCare

    Provides cancer support for men with anal, prostate and breast cancer, with emphasis on African-American and gay males. Provides multiple language support.

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    How To Make Your Prostate Biopsy Go Better

    Before a prostate biopsy, discuss all thesteps you or your doctor can take to makethe experience as comfortable, safe, andinformative as possible.

    Here is what men need to know to minimize discomfort of a prostate biopsy and get the best results.

    Many men choose to have prostate-specific antigen blood tests to check for hidden prostate cancer, despite the uncertain benefits. Having an abnormal PSA test result often leads to a prostate biopsythe only way to confirm the presence of cancer. Biopsies are invasive, but they have become routine.

    To reduce discomfort and get the best results, discuss the procedure in detail with your doctor. Certain practices can improve the overall outcomefor example, make sure you get a shot of anesthetic into the prostate to numb pain during the procedure. “Local anesthesia makes a world of difference between having a tolerable biopsy experience and an unpleasant one,” says Dr. Marc B. Garnick, Gorman Brothers Professor of Medicine and a prostate cancer expert at Harvard-affiliated Beth Israel Deaconess Medical Center.

    What Are Biopsies And Why Do I Need One

    prostate biopsy anesthesia

    Biopsies are the most common way that doctors diagnose cancer. During a biopsy, a doctor takes a small piece of tissue, called a sample, from a suspected tumor or area of concern. Then, a pathologist looks at it under a microscope to make a diagnosis. A pathologist is a doctor who specializes in interpreting laboratory tests and evaluating cells, tissues, and organs to diagnose disease, including cancer.

    There are many different techniques for collecting a biopsy. For example, in a fine needle aspiration biopsy, the doctor inserts a needle attached to a syringe into the suspicious area to collect a small amount of tissue for diagnosis. In an excisional biopsy, the doctor removes the entire suspicious mass for examination.

    Properly performed, biopsies often provide essential information to help diagnose, stage, and inform clinical decision-making for patients with suspected or known cancer. Jeffrey E. Gershenwald, MD, FACS, professor in the Department of Surgical Oncology in the Division of Surgery at the University of Texas MD Anderson Cancer Center in Houston, Texas, and Cancer.Net Editorial Board member.

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    Managing Symptoms And Side Effects

    If your doctor prescribed you medicine to treat symptoms or side effects, take it as directed. In addition, a healthy diet and lifestyle can reduce symptoms and side effects.Here are some tips to help:

    • Pain. Many home treatments can relieve pain.
    • Vomiting or nausea. It may be beneficial to eat smaller meals. You can also take ginger tea or ginger candy to help. Be aware of and treat symptoms of dehydration as early as possible.
    • Constipation. Before consulting with a doctor, avoid taking laxatives. You have to drink enough fluids and eat fibre in your diet each day.
    • Diarrhea. You should consult with your doctor before taking any medicines to treat diarrhea. Also, make sure to drink enough liquid to escape dehydration.
    • Sleep problems. Avoiding caffeine in the evening, regular bedtime, and exercise can help deal with sleep problems.
    • Urinary problems. You can overcome urinary incontinence by avoiding caffeinated drinks and setting a urination schedule every 3 to 4 hours. Kegel exercises can also help by strengthening pelvic muscles.

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