Two Reasons Women Should Get Tested For The Prostate Cancer Gene
While its true that women cant develop prostate cancer, they can still carry the gene. And learning whether you have the gene matters.
Dr. Caroline Peterson, OB-GYN and Director of Cancer Screening and Prevention for Kettering Health, says it matters for two reasons:
A woman can pass a gene for prostate cancer to a son and not realize it, says Dr. Peterson. You can carry a gene and pass a gene for a cancer that you may not get, but you can still pass it to children.
Ladies: Check Your Prostates
Okayyou may not have one physically, but if you are married to a man or care about other males in your life, you might as well resign yourself to becoming an advocate for this small and mysterious part of the male anatomy. Men are often their own worst enemy when it comes to their healthcare, making a strong dose of feminine persistence just what the doctor ordered. Heres an introduction to the number one mens health issue that might be affecting someone you love.
What Types Of Treatment Are Recommended
The stage of the tumor and ones age at diagnosis may significantly guide treatment options. Because many forms of prostate cancer are slow growing, very early-stage tumors may warrant careful observation, known as active surveillance, rather than aggressive treatment.
When treatment is required, the urologist may recommend either radiation therapy or the surgical removal of the prostate, known as a radical prostatectomy. Radiation therapy can take several forms, with the most common being an external beam of radiation to target the prostate and kill cancer cells. The most common form of external radiation is image modulated radiation therapy . IMRT generally involves five treatments per week for eight weeks.
A small number of cancer centers offer another form of external radiation known as proton therapy. Proton therapy is controversial4 because its cost greatly exceeds that of IMRT, and numerous experts have argued that there is insufficient data to prove that it is more effective or less toxic.
For patients who do not want to undergo repeated treatments, referred to as fractions, brachytherapy provides a highly effective option. Brachytherapy involves a single, surgical insertion of radioactive seeds into the cancerous portions of the prostate.
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Can Women Have Prostate Cancer
Most people are aware that men can develop prostate cancer, but can women have prostate cancer? The answer is, Yes, sort of.
While women dont have a prostate gland, they have what are called the Skene glands . This group of glands and ducts is at the front of the vagina and is similar in some ways to the prostate, including that it contains prostate-specific antigen and PSA phosphatase , two enzymes that doctors use to assess the condition of the prostate in men.
Women can develop cancer in the Skene glands and, given the structures similarity to the prostate, the condition is sometimes referred to as female prostate cancer. Its extremely rare, but it can occur. One older study found that prostate cancer in women accounted for just 0.003% of all genital cancers.
What Is The Prostate Cancer Survival Rate
Prostate cancer can be successfully treated when caught early on. The survival rate for this cancer depends on the stage of cancer.
According to the American Cancer Society, men with localized and regional prostate cancer have a nearly 100% 5-year relative survival rate. This means that men with prostate cancer are nearly 100% as likely as men without cancer to live for at least five years following their diagnosis. Localized cancer is cancer confined to the prostate, while regional cancer is cancer that has spread outside the prostate to nearby tissues or lymph nodes.
The 5-year relative survival rate for distant prostate cancer is 30%. Distant prostate cancer is aggressive cancer that has spread to other parts of the body far from the prostate, such as the liver or lungs.
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What Causes Prostate Cancer
Researchers do not know exactly what causes prostate cancer. But they have found some risk factors and are trying to learn just how these factors might cause prostate cells to become cancer cells.
On a basic level, prostate cancer is caused by changes in the DNA of a normal prostate cell. DNA is the chemical in our cells that makes up our genes, which control how our cells function. We usually look like our parents because they are the source of our DNA. But DNA affects more than just how we look.
Some genes control when our cells grow, divide into new cells, and die:
- Certain genes that help cells grow, divide, and stay alive are called oncogenes.
- Genes that normally keep cell growth under control, repair mistakes in DNA, or cause cells to die at the right time are called tumor suppressor genes.
Cancer can be caused by DNA mutations that keep oncogenes turned on, or that turn off tumor suppressor genes. These types of gene changes can lead to cells growing out of control.
DNA changes can either be inherited from a parent or can be acquired during a persons lifetime.
Diagnosis And Treatment Of Female Prostate Cancer
Due to the challenges of diagnosis, the signs of female prostate cancer are often mistakenly attributed to underlying conditions in the urinary tract or reproductive system.
Unfortunately, the initial stage of cancer in the Skene glands is asymptomatic. Once your menstrual cycle is disrupted, sex becomes painful, or youre always feeling sick, the disease is quite advanced.
Treatment of female prostate cancer follows a similar strategy to that of other reproductive cancers. If chemical and radiation therapies arent successful in eradicating tumors, then surgery will likely be required to excise them. Frequently, the surgical removal of larger tumors and the chemical destruction of smaller tumors happen simultaneously.
In more severe cases, the organ or organs containing the cancerous growths must be removed as well. This could include your Skene glands, uterus, ovaries, or your entire reproductive system . Whenever cancer in the Skene glands goes undiagnosed and untreated, bladder cancer may follow.
Medical experts have theorized that female prostate cancer could be linked to a history of sexually transmitted infections. The Skene glands, like the male prostate, act as guardians against infections that travel throughout the reproductive system.
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Pain Or Burning Sensation When Urinating
Painful urination is also known as dysuria. This symptom tends to be more common in older men than in younger men. Dysuria is characterized by feelings of discomfort, pain, and/or burning when urinating. Dysuria may also be a sign of other medical conditions, including a urinary tract infection or sexually transmitted infection, which is why its important to see your doctor for a proper diagnosis.
What Are The Stages Of Prostate Cancer
Your healthcare provider uses the Gleason score and Grade Groups to stage prostate cancer based on its projected aggressiveness. To get this information, the pathologist:
- Assigns a grade to each type of cell in your sample. Cells are graded on a scale of three to five . Samples that test in the one to two range are considered normal tissue.
- Adds together the two most common grades to get your Gleason score .
- Uses the Gleason score to place you into a Grade Group ranging from one to five. A Gleason score of six puts you in Grade Group 1 . A score of nine or higher puts you in Grade Group five . Samples with a higher portion of more aggressive cells receive a higher Grade Group.
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Can Prostate Cancer Be Prevented
You may be able to prevent prostate cancer by practicing a series of healthy lifestyle behaviors that reduce your risk of developing this condition. For example, a high-fat diet is a known risk factor for prostate cancer, therefore, consuming less fat may help you avoid prostate cancer.
There is not a fool proof method to prevent prostate cancer. Keeping any chronic illness you might have such as diabetes, hypertension, high cholesterol, high salt diet, or high sugar diet under control. Maintain a healthy exercise program. Make sure to do a self-exam and include scrotum and pelvic lymph node exam. You should report any abnormal findings, says Maslow.
Heres how to prevent prostate cancer using healthy lifestyle behaviors:
- Maintain a healthy weight, as being overweight or obese can increase your risk for prostate cancer.
- Eat healthy, whole foods such as fruits, vegetables, nuts, seeds, and fish, as foods such as these are loaded with vitamins and other nutrients that help you maintain good overall health.
- Exercise regularly, as exercise can help you maintain a healthy weight, regulate hormones, and prevent obesity.
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The Paradox Of Being Male
Throughout the ages men have been taught that they must be strong, virile hunters, gatherers, and defenders of their families. Over time this societal mandate has ingrained a false sense of invincibilityone that seemingly exempts men from having to pay attention to their physical ills or see their doctors for annual checkups. The same pressure often leads them to feel extremely vulnerable and reluctant to discuss their self-perceived weaknesses when diagnosed with health problemsespecially those that lie below the belt.
When women are diagnosed with breast cancer, they go on the offensive, explains Jonathan Simons, MD, president and CEO of the Prostate Cancer Foundation , the worlds leading philanthropic supporter of advanced research for finding a cure. They open lines of communication with family and friends, they conduct extensive research, and they mobilize with pink ribbons and races. In contrast, too many men shut down and shut up. They are convinced that they can fight the battle alone. Its ironic. By doing so they are actually shirking their roles as protectors and contributing providers for their families and partners.
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How Is Prostate Cancer Diagnosed
Preliminary diagnosis generally relies on screening, which consists of a blood test, known as a PSA , accompanied by a digital rectal exam. Because the prostate is located directly in front of the rectum, a physician is able to palpate the gland with his or her finger to see if there are any obvious abnormalities. Neither test is definitive, which means that suspected cases of cancer must be biopsied.
When a mans PSA reaches a certain threshold or there is perceived abnormality upon physical examination, the physician may recommend a biopsy. It should be noted that some physicians also recommend biopsies based on the rate of change in PSA levels, referred to as PSA velocity. Recent research suggests, however, that PSA velocity, by itself, is not a reliable measure on which to recommend biopsies.2
When performing a biopsy, a surgeonmost frequently a urologistrelies on ultrasound-guided imaging to insert needles into various sites on the prostate. The hollow needles extract tissue cores that can then be examined to determine the extent of the disease. Twelve samples are most commonly collected.
The cores are then examined by a pathologist, who rates them based on what is known as the Gleason score,3 which ranges from 2 to 10 higher numbers signify a more serious expression of the disease.
Psa Testing: One Step At A Time
The PSA test is a diagnostic beginning, not an end. Its biggest limitation is that it is not cancer-specific. I have heard it best explained as a smoke alarm that can alert us to potential problems in the prostate, but it cannot distinguish between a full-blown fire fueled by cancer or one of several other medical conditions, such as an enlarged prostate or prostatitis, that can be creating smoke. This data, combined with the DRE that provides a tactile assessment for the presence of tumor growth, gives physicians information that may lead them to recommend a needle biopsy to determine if cancer cells are present in the prostate.
Testing Options For Prostate Cancer
There is no one age for prostate cancer testing, but the American Cancer Society makes recommendations about screenings. According to the ACS, patients in any of these groups should consider asking their doctor about testing:
- Men age 50 or older who have an average risk of prostate cancer and a life expectancy of at least 10 more years
- Men age 45 or older with a high risk, including African-American men and those with a first-degree relative who had prostate cancer before age 65
- Men age 40 or older who have a higher risk, such as more than one first-degree relative diagnosed with prostate cancer at an early age
Its Time For Men To Step Up
In a recent campaign, Kaiser Permanente ran a series of print and broadcast ads proclaiming, I have cancer. It doesnt have me.There is both wisdom and inspiration in the statement. While there is still much progress to be made in eliminating prostate cancer, we now know that early detection and treatment can drastically improve outcomesin fact the death rate from prostate cancer is now nearly 40 percent lower than what was once predicted. Moreover, scientific studies are beginning to underscore the importance of nutrition and exercise in preventing certain cancers and improving survivorship. Treatments are now less invasive and better tolerated by patients, and new therapies are close at hand.
The time is long overdue for men to move beyond their traditional behaviors, make prostate cancer something to talk about, and proactively develop their personal programs for protecting their prostate health.
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What Do The Results Mean
PSA levels may be above the baseline for various reasons other than prostate cancer.
Other factors that can raise PSA levels include:
- older age
- an enlarged prostate â because of benign prostatic hyperplasia , for example
- prostatitis, which is inflammation and swelling of the prostate
Also, people with obesity may have lower PSA readings.
In addition, some medications may reduce PSA levels, including:
- 5-alpha reductase inhibitors, which can help treat BPH
- aspirin, which some people take regularly as a blood thinner
- statins, which help manage cholesterol levels
- thiazide diuretics, a kind of water pill that can help reduce high blood pressure
Some herbal medicines and supplements can also lower PSA levels. Tell the doctor about any medications and supplements before undergoing the test.
High PSA levels alone do not indicate cancer. However, if a DRE also reveals changes, a doctor may recommend a biopsy for a more accurate result.
The PCA3 is another test for prostate cancer that doctors use in some circumstances. Find out more.
The Psa Test For Prostate Cancer Is Less Than Perfect
Your doctor will tell you to get a PSA test and a digital rectal exam every year. But this autopsy study suggests thats not nearly enough. All of the men in the study had a normal result on both of these tests. In fact, another study says these tests are not very accurate at all.
In 2004, the New England Journal of Medicine published a study that reveals just how inaccurate a normal PSA reading can be.
The authors of the study wondered how often men with both a normal PSA and a normal rectal examination actually had prostate cancer.
These researchers must have done some fast talking. Somehow, they managed to talk 2,950 men into having their prostates biopsied simply as part of their research. None of the men had any indication at all that they were any more likely to have prostate cancer than the average man with normal tests.
What they found was startling. Of these nearly 3,000 men, 449 men actually had cancer despite their normal test scores. Thats one in seven.
That means that for every seven men who have normal findings, one of them has cancer. And the doctors missed it. Whats more, the actual number of the PSA score doesnt offer much help either.
- 6.6 percent of the 449 had an extremely low PSA that was less than 0.5.
- 10.1 percent had PSAs between 0.6 and 1.0.
- 17.0 percent had PSAs between 1.1 to 2.0.
- 23.9 percent had values of 2.1 to 3.0.
- And 26.9 percent had levels between 3.1 to 4.0.
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All Men Should Talk With Their Doctor About Screening
The key word here is talk. While groups like the American Urological Association used to insist on regular screening for men over age 50, now it’s a maybe. “The recommendation is that at age 50, men discuss with their primary care physician whether or not they should undergo the PSA blood test, which measures levels of a chemical called prostate-specific antigen,” explains , DO, urologist and urologic oncologist at NYU Langone Medical Center. The reason: Although it’s just a simple blood test, it has a high rate of false positives, which can lead to painful, unnecessary biopsies.
Only about 25% of men with a moderately high PSA level actually have prostate cancer, and sometimes even when they do the disease is very slow-growing. That said, there isn’t any better way at the moment to detect prostate cancer. That’s why many experts, including Wexler, say it’s still a good idea for most men to get a PSA test at age 50. If they have risk factors like being African- American or a family history, they may need to start as early as 40.
Anything under a 4 is considered normal, says Wexler. If it’s under 2.5, groups like the American Urological Association say men can wait 2 years to get re-tested, but if it’s between 2.5 and 4, “we like patients to come back a year later, and if it has increased more than 0.7%, we do follow up testing, like a biopsy,” says Wexler.