About Dr Dan Sperling
Dan Sperling, MD, DABR, is a board certified radiologist who is globally recognized as a leader in multiparametric MRI for the detection and diagnosis of a range of disease conditions. As Medical Director of the Sperling Prostate Center, Sperling Medical Group and Sperling Neurosurgery Associates, he and his team are on the leading edge of significant change in medical practice. He is the co-author of the new patient book Redefining Prostate Cancer, and is a contributing author on over 25 published studies. For more information, contact the Sperling Prostate Center.
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Prostate Cancer In Central America/caribbean
Among the Central American countries, Costa Rica leads with an ASR of 53.8 cases per 100,000 people, followed by Mexico and Cuba with 28.9 and 24.3 cases per 100,000 people respectively . Unfortunately, epidemiological data are scarse for those regions. Trends are available only for Costa Rica which showed an annual increase in incidence of 3.8% per annum over the period 19972008. ASR on mortality put Belize at first place with 28.9 cases per 100,000 people followed by Cuba and Mexico with 24.1 and 17.0 cases per 100,000 people for the period 20032010, respectively. Costa Rica stops at 14.8 cases per 100,000 people . The most recent data on Central America published by GLOBOCAN 2020 shows an ASR incidence of 43.8 and mortality of 11.0 cases per 100,000 people . No active screening program are currently in place in Central America. Between 2004 and 2006, in Monterrey a screening program was run, using PSA and DRE screening of 973 men, 40 years of age, showed that only 44% of the men who had an abnormal result underwent prostate biopsy, and 27% of these were diagnosed with prostate cancer, mostly with high grade lesions .
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Awareness And Early Detection In Africa
Based on the review and analysis of published studies and data, PCa incidence in Africa has been documented to be lower than that of African American men. PCa incidence rates in African men have increased between 1987 and 1992 and continue to increase over time . According to , no data exists on the prevalence of PSA testing in Africa, but it is generally held that early detection testing is not common. Given that PSA testing is relatively rare in several African countries such as Nigeria and The Gambia, PCa incidence rates are projected to increase as early detection, clinical diagnosis protocols, and economies improve. It is likely that improved availability and access to medical care and systems as well as better attainment, reporting, and documentation of cases may contribute to an increasing incidence rate trend .
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Everything You Need For Healthy Aging
Seniors havent reached the end: theyve reached a new beginning. And Aging.com was set up to help youstartthis new phase of your life on the right foot. Our mission is to help you and thousands of other olderadults who want to live independently, plan your finances, and take charge of your health care.
Prostate Cancer In Asia
The incidence of prostate cancer in Asian countries has been historically much lower than their Western counterpart, ranging between 4.5 cases per 100,000 persons for South-Central Asia, 10.5 for Eastern Asia and 11.2 for Southeast Asia . Those values could be explained both by a low susceptibility of Asian men to prostate cancer and the lack of a systematic screening program. However, there is evidence that these figures are increasing in several countries . A review by Ha Chung et al., showed a general increase in prostate cancer incidence across China, India, South Korea, Vietnam, Japan, and Singapore . These figures were supported by data from GLOBOCAN 2008 and 2012 . Sim and Cheng noted that in some centres in Japan, the incidence rate rose from 6.3 to 12.7 between 1978 and 1997, while the incidence rates in Singaporean Chinese men increased to 118% within the same period . The lowest incidence reported in Asia was in Shanghai whereas the highest was in the Rizal Province in the Philippines. shows the differences in incidence and mortality across Asia. Studies have also shown that Asian Men living in the United States develop higher risk of prostate cancer than their counterparts living in Asia suggesting that change in lifestyle, and probabaly increased screening, could be the major contributors .
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Risks For Prostate Cancer
Certain behaviours, substances or conditions can affect your risk, or chance, of developing cancer. Some things increase your risk and some things decrease it. Most cancers are the result of many risks. But sometimes cancer develops in people who don’t have any risks.
The risk for prostate cancer increases as men get older. The chance of being diagnosed with prostate cancer is greater after age 50. Prostate cancer is most often diagnosed in men in their 60s.
The following can increase your risk for prostate cancer. Most of these risks cannot be changed.
Symptoms Of Prostate Cancer
Now that we know what prostate cancer is, how can we tell if we have it aside from being tested regularly? A lot of the symptoms of the disease have to do with discomfort while urinating while ejaculating. According to the Prostate Cancer Foundation, these can include:
- Blood in your urine
- Frequently having to urinate especially at night and not being able to hold it back
- Pain while urinating
- Trouble getting and maintaining an erection
- Loss of control of your bladder and bowels
- Pain in your hips, back, spine, and other parts of your body close to your prostate, indicating the cancer may have spread
- Pressure in your rectum
In its earliest stages, none of these symptoms may be present, which is why its important to get ahead of the disease with testing.
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Prostate Cancer Screening Ages 40 To 54
The PSA test is a blood test that measures how much of a particular protein is in your blood. Its been the standardfor prostate cancer screening for 30 years.
Your doctor will consider many factors before suggesting when to startprostate cancer screening. But hell probably start by recommending the PSAtest.
While the general guidelines recommend starting at age 55, you may need PSAscreening between the ages of 40 and 54 if you:
- Have at least one first-degree relative who has had prostate cancer
- Have at least two extended family members who have had prostate cancer
- Are African-American, an ethnicity that has a higher risk of developing more aggressive cancers
Definitions Of Cancer Risk Categories
Prostate cancer diagnosed among brothers of index cases was categorized as low risk , nonlow risk , or high risk . Most prostate cancers among fathers of the index persons were diagnosed before 1998 and were thus not registered in the NPCR of Sweden. Therefore, the severity of their cancers was categorized as low risk, nonlethal, or lethal. Low risk was defined as prostate cancer diagnosed before the age of 75 years in men who lived at least 10 years after their diagnosis, nonlethal cancer as any prostate cancer diagnosed in a father who did not die from prostate cancer , and lethal cancer was any prostate cancer diagnosed in a father who died from prostate cancer during the time of follow-up.
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Effectiveness Of Early Detection
Potential Benefits of Screening
To understand the potential benefits of PSA-based screening for prostate cancer, the USPSTF examined the results of the ERSPC, PLCO, and CAP trials and site-specific reports from 4 ERSPC trial sites. To understand the effectiveness of treatment of screen-detected, early-stage prostate cancer, the USPSTF also examined the results of 3 randomized trials and 9 cohort studies.3
The ERSPC trial randomly assigned a core group of more than 160,000 men aged 55 to 69 years from 7 European countries to PSA-based screening vs usual care.8 Four ERSPC sites reported on the cumulative incidence of metastatic prostate cancer. After a median follow-up of 12 years, the risk of developing metastatic prostate cancer was 30% lower among men randomized to screening compared with usual care . The absolute reduction in long-term risk of metastatic prostate cancer associated with screening was 3.1 cases per 1000 men.11 After a median follow-up of 13 years, the prostate cancer mortality rate among men aged 55 to 69 years was 4.3 deaths per 10,000 person-years in the screening group and 5.4 deaths per 10,000 person-years in the usual care group .8 The ERSPC trial did not find a reduction in all-cause mortality.8
Neither the ERSPC, PLCO, or CAP trials, nor any of the ERSPC site-specific analyses, found an overall all-cause mortality benefit from screening for prostate cancer.
Potential Benefits of Treatment
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Prostate Cancer In African American Men
Overall cancer incidence and mortality rates in the United States have continued to decline through the first decade of the 21stcentury. This is most likely a result of:a reduction in tobacco use early detection improved prevention measures and improved treatments. However, African Americans continue to have higher cancer mortality rates and shorter survival times than their white counterparts. This holds true in all of the screenable cancers colon cancer, breast cancer, cervical cancer, and prostate cancer.
These statistics represent stark and significant health inequity issues that must be seriously addressed by physicians, researchers, public health officials, and elected leaders.
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Obesity Insulin And Physical Activity
Obesity is linked to advanced and aggressive prostate cancer , and high body mass index is associated with more aggressive disease too and a worse outcome .
The possible explanation is that most of the time obese men present with alteration of circulating levels of metabolic and sex steroid hormones, which are known to be involved in prostate development as well as oncogenesis .
Obesity, particularly when combined with physical inactivity, leads to the development of insulin resistance with reduced glucose uptake. That, in turn, leads to chronically elevated blood levels of insulin. Insulin is a hormone that promotes growth and proliferation, thus is reasonable to add it in the list of risk factors that promote prostate cancer initiation and/or progression . Additionally, adipose cells represent a source of inflammation as well as of macrophages in adipose, which releases inflammatory mediators . Three meta-analyses reported a modest but consistent association between obesity and prostate cancer incidence independently of BMI increase . Data from three national surveys in the US population reported that obesity is associated with more aggressive prostate cancer and higher mortality despite its lower incidence .
Causes And Risk Factors
Prostate enlargement often develops in older men. Hormone changes can play a role. For instance, as men grow older, the levels of active testosterone plummet while the amount of estrogen remains the same.
The prostate size increases when these hormone changes cause prostate cell growth. Experts also suggest that the DHT male hormone affects prostate development. Prostate enlargement occurs when an accumulation of androgens stimulates cell proliferation.
It prevents prostatic cell death, thus enhancing the size of the prostate gland. The BPH incidence increases with age. Many risk factors can contribute to the development of BPH. These are metabolic syndrome, hypertension, genetic predisposition, and obesity.
Men who are at risk of developing the condition are those:
- over the age of 50
- with a history of BPH
- obesity and overweight.
Choosing To Stop Treatment Or Choosing No Treatment At All
For some people, when treatments have been tried and are no longer controlling the cancer, it could be time to weigh the benefits and risks of continuing to try new treatments. Whether or not you continue treatment, there are still things you can do to help maintain or improve your quality of life.
Some people, especially if the cancer is advanced, might not want to be treated at all. There are many reasons you might decide not to get cancer treatment, but its important to talk to your doctors and you make that decision. Remember that even if you choose not to treat the cancer, you can still get supportive care to help with pain or other symptoms.
Prostate Cancer: Where Can You Find A Helping Hand
This is your one-stop source for information on prostate cancer. You can easily search for support groups, doctors, and clinical trials. And, your donation to the PCF funds prostate cancer research, with 84 cents of every dollar going toward their research mission.
PCRI focuses on improving the lives of prostate cancer patients and caregivers. We love that you can take a prostate cancer staging quiz to find out more about your prognosis. To take it, youll need to know the results of your PSA, biopsy, digital rectal exam, bone scan, and CT scan.
The American Cancer Society is considered the go-to source for reliable cancer information. Their site offers news releases, clinical trial opportunities, online support groups, and more. We especially like their Understanding Health Insurance page, which navigates you through the often complex process of utilizing health insurance for cancer treatments.
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Family History And Genetic Factors
It is estimated that about 20% of patients with prostate cancer report a family history, which may develop not only because of shared genes but also for a similar pattern of exposure to certain environmental carcinogens and common lifestyle habits . Several studies reported that inherited genetic background is associated with increased risk for prostate cancer, contributing to about 5% of disease risks . Particularly, this risk is increased by several folds when high-penetrance genetic âriskâ alleles are inherited, conversely to more common low-penetrance loci that increase the risk only modestly.
The X chromosome is also believed to have a role in prostate cancer inheritance, because it contains the androgen receptor and because small deletions in Xq26.3-q27.3 region were noted in sporadic and hereditary forms of prostate cancer . More recent studies in 301 hereditary prostate cancer affected families defined a number of other loci that may contribute to hereditary prostate cancer .
When Should You See A Doctor
Its a good idea to contact a doctor if you notice any potential symptoms of prostate cancer, even if the symptoms dont seem serious. Its especially important to see a doctor if you notice blood in your urine since it can also be a symptom of a serious kidney or bladder condition.
A definitive diagnosis is made with a prostate biopsy, where a doctor removes a small sample of cells for lab analysis.
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Rate Of Diagnosis By Age Group
The Centers for Disease Control and Prevention put together rates of diagnosis of new lung cancers by age group.
The case counts per 100,000 people are as follows:
The largest group with new lung cancer diagnoses was the 70 to 74 age group, followed by the 65 to 69 age group. They did not have data for many age groups younger than 15, but they did have 16 cases per 100,000 in the 1 to 4 age group, surprisingly. There was no explanation given for this.
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Prostate Cancer Mortality Rate In Canada
In recent years Prostate cancer mortality rate in Canada significantly decreases due to better health facilities, new treatment options of prostate cancer and measurements taken by Canadian government to reduce the mortality rate of prostate cancer in Canada.According to some surveys and research data current mortality rate is 6.6 per 100,000 Canadian men.
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Prostate Cancer Screening Ages 55 To 69
This is the age range where men will benefit the most from screening.Thats because this is the time when:
- Men are most likely to get cancer
- Treatment makes the most sense, meaning when treatment benefits outweigh any potential risk of treatment side effects
Most men will get prostate cancer if they live long enough. Some prostatecancers are more aggressive others can be slow-growing. Doctors will takeyour age and other factors into consideration before weighing the risks andbenefits of treatment.
You should ask your doctor how often he or she recommends you get screened.For most men, every two to three years is enough.
Depending on the results of your first PSA test, your doctor may recommendyou get screened less frequently.
Recent Trends In Prostate Cancer Incidence By Age Cancer Stage And Grade The United States 20012007
1Division of Cancer Prevention and Control, National Center for Chronic Disease Prevention and Health Promotion, CDC, 4770 Buford Hwy, MS K55, Atlanta, GA 30341, USA
2Department of Urology and Winship Cancer Institute, School of Medicine, Emory University, 1365C Clifton Road, Atlanta, GA 30322, USA
Prostate cancer is the most commonly diagnosed non-skin cancer and the second leading cause of cancer death among American men. Each year, approximately 220,000 men are diagnosed with prostate cancer and 29,000 die from it . With the introduction of the prostate-specific antigen testing in the mid-1980s, prostate cancer incidence rate increased drastically, at about 12% per year, and peaked in 1992 . The rate subsequently declined, at about 10% per year for the following three years and then appeared to stabilize from 1995 to 2005 . In 2011, Kohler et al. reported a stable trend of prostate cancer incidence from 1998 to 2007 however, demographic and clinical factors were not examined in this study . With the widespread use of the PSA test, the mean age at diagnosis dropped substantially, from 72.2 years between 1988-1989 to 67.2 years between 2004 and 2005 . Studies using Surveillance, Epidemiology, and End Results Program data have shown that the distribution of prostate cancer stage and grade has also dramatically changed, with localized and moderately differentiated tumors becoming predominant .
2. Patients and Methods
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