How Curable Is Prostate Cancer

Psa And Gleason Score

Two other important factors that doctors and specialists use to assess cancer cells are the prostate specific antigen and the Gleason score.

PSA levels: PSA is a protein that appears in higher levels in the bloodstream when there is a problem with the prostate. Normally, PSA levels in the blood are very low, and a test cannot detect them. However, in some circumstance, such as prostate cancer, PSA levels start to rise.

Screening for prostate cancer uses a blood test for PSA. If PSA levels are high, the doctor may recommend further tests to see if prostate cancer is present.

There are various other reasons why PSA levels may rise, including sexual stimulation or an infection.

The grade and Gleason score: Different types of cancer cell act differently. Some types, or grades, are more aggressive and can spread more easily. The Gleason score and grade are different measures, but they both reflect how likely it is that a tumor will spread, and how quickly it will do so. Either a biopsy or surgery can determine the types of cancer cells present in the prostate tissues.

Nearly 50% of males have a condition known as prostatic intraepithelial neoplasia by the time they are 50 years old. PIN is when there are changes in the cells that line the prostate gland.

High grade PIN is not cancer, but the cells can become cancerous in the future. For this reason, a doctor may recommend treatment to remove the cells.

Where Do These Numbers Come From

The American Cancer Society relies on information from the SEER database, maintained by the National Cancer Institute , to provide survival statistics for different types of cancer.

The SEER database tracks 5-year relative survival rates for prostate cancer in the United States, based on how far the cancer has spread. The SEER database, however, does not group cancers by AJCC TNM stages . Instead it groups cancers into localized, regional, and distant stages.

• Localized: There is no sign that the cancer has spread outside the prostate.
• Regional: The cancer has spread outside the prostate to nearby structures or lymph nodes.
• Distant: The cancer has spread to parts of the body farther from the prostate, such as the lungs, liver, or bones.

What Causes Prostate Cancer

Experts arent sure why some cells in the prostate gland become cancerous . Genetics appear to play a role. For example:

• Youre two to three times more likely to get prostate cancer if your father, brother or son has the disease.
• Inherited mutated breast cancer genes and other gene mutations contribute to a small number of prostate cancers.

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Questions To Ask Your Doctor Or Nurse

• What is my Gleason score?
• What is the stage of my cancer?
• What treatments are suitable for me?
• Could my cancer be monitored instead?
• How quickly do I need to make a decision?
• What are the advantages and disadvantages of each treatment?
• What are the side effects?
• How effective is my treatment likely to be?
• What is the risk of my cancer coming back after treatment?
• Can I see the results of treatments youve carried out?
• Can I get copies of all my test results and letters about my treatment?
• Are all of the treatments available at my local hospital?
• If not, how could I have them?
• Can I join any clinical trials?
• If I have any questions or get any new symptoms, who should I contact?

What Are The Different Stages Of Uterine Cancer

1 Stage I: Cancer that is confined to the uterus 2 Stage II: Cancer that has spread to the cervix 3 Stage III: Cancer that has spread to the vagina, ovaries, and/or lymph nodes 4 Stage IV: Cancer that has spread to the urinary bladder, rectum, or organs located far from the uterus, such as the lungs or bones

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What Will This Summary Tell Me

This summary will tell you about:

• What localized prostate cancer is
• Common treatment options for localized prostate cancer
• What researchers found about how the treatments compare
• Possible side effects of the treatments
• Things to talk about with your doctor

This summary does not cover:

• How to prevent prostate cancer
• Less common treatments for localized prostate cancer, such as high-intensity focused ultrasound , cryotherapy , proton-beam radiation therapy , and stereotactic body radiation therapy
• Herbal products or vitamins and minerals
• Treatments for cancer that has spread outside the prostate gland

*In this summary, the term doctor refers to your health care professional, including your primary care physician, urologist, oncologist, nurse practitioner, or physician assistant.

Side Effects And Nutrition

Cancer treatment often causes side effects, such as nausea, mouth sores, and taste changes that may make it difficult to eat or drink. Follow these tips to help you get the nutrition you need:

• If water tastes unpleasant to you, take in more liquid though items such as soup, tea, milk or milk substitutes such as almond milk, or a sports drink. Or, flavor your water by adding fresh cut fruit.
• If food tastes bland, try seasoning it with flavorful spices such as garlic, cayenne, dill, and rosemary.
• Eat several small meals throughout the day instead of trying to eat large amounts of food at one time.
• Enhance your protein intake with protein from foods such as fish, egg whites, cheese, beans, or high protein smoothies.
• Suck on mints, chew on gum, or try fresh citrus fruits if you have a metallic taste in your mouth. Brushing your teeth before eating, using plastic utensils, and cooking in glassware can also help.
• If you have mouth sores or a gum infection, use a blender to make vegetables and meats smooth. Try juicing or making smoothies.Some side effects are often treated with medication, so talk with your doctor or another member of your health care team for more information.

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Ets Gene Fusions Are Linked To Cell Migration And Lipid Metabolism

One of the strongest effects on the proteome was the presence of ETS gene fusions. These fusions are the most frequent somatic aberration in prostate cancer, and are not associated with clinical outcome . We focused on 245 mRNAs and 68 proteins significantly associated with ETS gene fusion status . To be conservative we excluded 22 genes with a high proportion of missing protein abundance measurements. Overall changes in mRNA and protein abundances were well correlated , but protein abundances showed larger dynamic range than mRNA abundances. The median differentially abundant mRNA differed 1.50-fold between ETS fusion-positive and ETS fusion-negative tumors, while the median protein differed 1.66-fold . The many genes showing only mRNA or protein abundances associations with ETS fusions, but not both, may be attributed to biological factors like translational and post-translational regulation, as well as to technical factors.

Transcriptomic and Proteomic Consequences of ETS fusions

Comparison of the difference in protein and mRNA abundance observed between samples with an ETS gene fusion and those without. Analysis includes 55 samples with matched RNA-Seq and protein data in 255 genes as 22 genes were removed due to a high proportion of missing protein data. Color indicates which protein abundance decile the gene is in, where purple indicates the most abundant.

See also .

What Is Localised Prostate Cancer

Localised prostate cancer is cancer thats inside the prostate and hasnt spread to other parts of the body. You may also hear it called early or organ-confined prostate cancer, or stage T1 or T2 prostate cancer.

Most localised prostate cancer grows slowly or doesnt grow at all and has a low risk of spreading. So it may never cause you any problems or affect how long you live. Because of this, localised prostate cancer might not need treatment. You might be able to have your cancer monitored with regular check-ups instead. This is to make sure the cancer isnt growing more quickly than expected.

But some men will have cancer that grows quickly and has a high risk of spreading. This is more likely to cause problems and needs treatment to stop it spreading outside the prostate.

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Genetic Testing For Prostate Cancer

You may hear a lot about genetics or genomics. Both terms are related to genes and cell DNA, but they are different. These tests are being used to learn more about the DNA of cancer cells, and link DNA mutations with treatments. In the future, genetic testing may be the first step doctors take when diagnosing prostate cancer.

Diagnostic Tests Are Limited

We always knew that prostate cancer is common and that, until recently, it often went undiagnosed: Autopsies of men who died of other causes have shown that about one-third of men over age 50 have some cancerous cells in their prostate, while 90% of men over age 90 have such cells.

As PSA screening has grown more widespread, we are finding more tumors that otherwise would have escaped detection. Yet current diagnostic technology does not always enable urologists to determine which tumors will lie dormant and which will become active, spreading elsewhere in the body.

Studies estimate that anywhere from 16%56% of men diagnosed with prostate cancer, generally because of an abnormal PSA test, have tumors that might never have caused problems had they not been found. And the landmark Prostate Cancer Prevention Trial unexpectedly yielded data that early-stage prostate tumors are incredibly common, even at PSA levels considered normal.

The PCPT was a randomized controlled study the type considered to be the gold standard in research . The study, which involved almost 19,000 healthy men, was designed to evaluate whether the drug finasteride could prevent prostate cancer from developing. Finasteride is a hormonal medication originally approved to treat benign prostatic hyperplasia , but which has also been investigated as a potential treatment for prostate cancer.

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Table 1 Why A Low Psa Does Not Mean You Are Cancer

The Prostate Cancer Prevention Trial included a provision that men randomized to receive placebo undergo a prostate biopsy at the end of the study, even if they had normal PSA levels and digital rectal exams. To their surprise, investigators found that many of these men had prostate cancer in some cases, high-grade prostate cancer.

PSA level 13 *Note: A PSA level over 4.0 ng/ml traditionally triggers a biopsy. Adapted with permission from I.M. Thompson, et al. Prevalence of Prostate Cancer Among Men with a Prostate-Specific Antigen Level 4.0 ng per Milliliter. New England Journal of Medicine, May 27, 2004, Table 2.

This study inadvertently provided evidence not only that prostate cancer occurs more often than once believed, but also that PSA levels may not be a reliable indicator of which cancers are most aggressive. Both findings add weight to the growing consensus that many prostate tumors currently being detected may not need to have been diagnosed or treated in the first place.

Cancer May Spread From Where It Began To Other Parts Of The Body

When cancer spreads to another part of the body, it is called metastasis. Cancer cells break away from where they began and travel through the lymph system or blood.

• Lymph system. The cancer gets into the lymph system, travels through the lymph vessels, and forms a tumor in another part of the body.
• Blood. The cancer gets into the blood, travels through the blood vessels, and forms a tumor in another part of the body.

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.

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Treatments For Prostate Cancer

If you have prostate cancer, your healthcare team willcreate a treatment plan just for you. It will be based on your health andspecific information about the cancer. When deciding which treatments to offerfor prostate cancer, your healthcare team will consider:

• the type and stage of the cancer
• the grade or Gleason score
• prostate-specific antigen levels
• the risk group
• possible side effects of treatments
• your personal preferences
• your overall healthand any existing medical conditions
• your age and life expectancy
• whether you have symptoms

Prostate cancer treatments can seriously affect your qualityof life and cause side effects such as erectile dysfunction and incontinence . Manyprostate cancers grow slowly and cause no symptoms or problems.

Risk Factors For Prostate Cancer

Factors that can increase your risk of prostate cancer include the following.

• Older age: Your risk of prostate cancer increases as you age.
• Race: Black men have a greater risk of prostate cancer than do men of other races. In black men, prostate cancer is also more likely to be aggressive or advanced. Its not clear why this is.
• Family history of prostate or breast cancer: If men in your family have had prostate cancer, your risk may be increased. Also, if you have a family history of genes that increase the risk of breast cancer or a very strong family history of breast cancer, your risk of prostate cancer may be higher.
• Obesity: Obese men diagnosed with prostate cancer may be more likely to have advanced disease thats more difficult to treat.

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Selenium Vitamin E And Other Antioxidants

The concept that antioxidants can prevent malignant transformation or treat established malignancy has been reported for many years and previously reviewed . Briefly, this concept is based on the idea that free radicals are able to induce DNA damage that may ultimately lead to mutations that predispose cells to malignant transformation . In humans, the most common free radical is the hydroxyl radical and the term reactive oxygen species is commonly used to encompass all oxygen-containing free radicals.

There are multiple preclinical models in prostate and other malignancies to suggest that antioxidants can prevent malignant transformation and/or delay progression . Antioxidants such as selenium and vitamin E have long been touted, and until quite recently, commonly used by PCa patients with both preventive and therapeutic intent.

Watchful Waiting And Active Surveillance

Prostate cancer often grows very slowly. You might not need to treat it right away — or at all — especially if you’re older or have other health issues.

For some men, the treatments themselves have risks that are greater than the benefit of getting rid of the cancer. Watchful waiting may be an option in this case. It means you and your doctor will look out for symptoms and treat them if they start. The doctor may do tests from time to time to see if the cancer is growing.

Active surveillance might be a choice if the cancer is likely to grow very slowly, if at all, but you would still want to cure it if it does get worse. Your doctor will do tests, including PSA blood tests and rectal exams, usually about every 3-6 months to check on the cancer. You might also have a biopsy, where your doctor takes a small piece of tissue from your prostate and checks it under a microscope.

These options donât mean that you ignore your cancer. Your doctor will keep a close eye on your health to be sure the disease doesnât cause any problems for you. If it does, your doctor will talk to you about starting treatment.

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How Common Is Prostate Cancer

About one in nine men will receive a prostate cancer diagnosis during his lifetime. Prostate cancer is second only to skin cancer as the most common cancer affecting males. Close to 200,000 American men receive a diagnosis of prostate cancer every year. There are many successful treatments and some men dont need treatment at all. Still, approximately 33,000 men die from the disease every year.

Watchful Waiting Or Active Surveillance

Many prostate cancer cases tend to be slow-growing, Dr. Howard Adler, medical director of the prostate care program at Stony Brook Medicine, explains to MensHealth.com. This means that the tumors grow so slowly that theyre unlikely to be life-threatening or impact quality of life. In fact, it might take 30 years for a prostate tumor to grow large enough to cause symptoms, according to the National Cancer Institute.

For these men, doctors recommend whats known as watchful waiting or active surveillance. That’s because surgery and radiation therapy come with their own set of risks, such as post-treatment incontinence. It is recommended for early stage I and II prostate cancers.

Using this method, doctors

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Treatments May Have Side Effects

The treatment options for early-stage prostate cancer fall into three broad categories: surgery, radiation therapy, and active surveillance. Your doctor will make a treatment recommendation based on your numbers as well as a mathematical tool known as a nomogram, which can help you and your doctor better assess how extensive your cancer is likely to be and whether it is likely to become active in the future.

Yet clinical studies have not provided any evidence that one treatment is better than another or that any treatment at all actually prolongs life: The average 5-, 10-, and 15-year survival rates are virtually the same for all treatment options in early-stage prostate cancer, including active surveillance. Its also important to understand that no mathematical model is foolproof, and some men diagnosed with early-stage, locally confined disease will later find out that their cancer was more extensive than originally believed.

If you are diagnosed with early-stage prostate cancer, you have a number of treatments to choose from. A brief comparison is listed in Table 2.