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.
What Can You Do To Prevent Prostate Cancer
The high lifetime risks of prostate cancer development, the morbidities associated with treatment of established prostate cancer, and the inability to eradicate life-threatening metastatic prostate cancer offer compelling reasons for prostate cancer prevention.
However, because the cause of prostate cancer is uncertain, preventing prostate cancer may not be possible. Certain risk factors, such as age, race, sex, and family history, cannot be changed. Nevertheless, because diet and other lifestyle factors have been implicated as a potential cause, living a healthy lifestyle may afford some protection.
- Proper nutrition, such as limiting intake of foods high in animal fats and increasing the amount of fruits, vegetables, and grains, may help reduce the risk of prostate cancer.
- The following supplements should NOT be used to prevent prostate cancer:
- Vitamin E
5-alpha reductase Inhibitors :
Positron Emission Tomography Scan
A PET scan is similar to a bone scan, in that a slightly radioactive substance is injected into the blood, which can then be detected with a special camera. But PET scans use different tracers that collect mainly in cancer cells. The most common tracer for standard PET scans is FDG, which is a type of sugar. Unfortunately, this type of PET scan isnt very useful in finding prostate cancer cells in the body.
However, newer tracers, such as fluciclovine F18, sodium fluoride F18, and choline C11, have been found to be better at detecting prostate cancer cells.
Other newer tracers, such as Ga 68 PSMA-11 and 18F-DCFPyl , attach to prostate-specific membrane antigen , a protein that is often found in large amounts on prostate cancer cells. Tests using these types of tracers are sometimes referred to as PSMA PET scans.
These newer types of PET scans are most often used if its not clear if prostate cancer has spread. For example, one of these tests might be done if the results of a bone scan arent clear, or if a man has a rising PSA level after initial treatment but its not clear where the cancer is in the body.
The pictures from a PET scan arent as detailed as MRI or CT scan images, but they can often show areas of cancer anywhere in the body. Some machines can do a PET scan and either an MRI or a CT scan at the same time, which can give more detail about areas that show up on the PET scan.
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Can Prostate Cancer Be Prevented Or Avoided
Some risk factors, such as family history and hormone levels, cant be prevented. However, your weight, physical activity, and diet may lower your risk for prostate cancer. Work toward a healthy lifestyle by eating the recommended daily amount of fruits and vegetables, exercising, and maintaining a healthy weight .
Doctors Answer The Most Frequently Asked Questions:
Back to Prostate Cancer book
Cancer is characterized by uncontrolled growth of abnormal cells. After a while, groups of these cells form a detectable lump known as a tumour. Cancer can affect any type of cell in an organ, a gland, muscle tissue, blood or the lymphatic system. In the case of prostate cancer, the secretory cells are usually the ones that become cancerous. In theory, there are two types of prostate cancer: slow-growing and aggressive. In reality, most cases are somewhere between the two, growing at a moderate rate. For the moment, science does not have the tools to accurately predict the growth rate of a persons cancer once it has been diagnosed.
Over time, the malignant cells in cancerous tumours can invade neighbouring tissue or organs. They may even spread to the rest of the body through the blood or lymphatic system. The presence of prostate cancer cells anywhere outside of the prostate is called metastasis. The most common sites of metastasis in prostate cancer are the lymph nodes and the bones.
Yes. Prostate cancer is the most common cancer among Canadian men . According to the Canadian Cancer Society, in 2011, an estimated 25,500 Canadian men were diagnosed with prostate cancer and 4,100 died of it. Every day, on average, 70 Canadian men are diagnosed with prostate cancer and 11 die of it. One in seven men will develop prostate cancer during his lifetime and one in 28 will die of it.
Not in any significant manner.
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Sex And The Prostate: Overcoming Erectile Dysfunction When You Have Prostate Disease
If you are concerned about erectile function, its important to understand what erectile dysfunction really is. Failing to have an erection one night after youve had several drinks or even for a week or more during a time of intense emotional stress is not erectile dysfunction. Nor is the inability to have another erection soon after an orgasm. Nearly every man occasionally has trouble getting an erection, and most partners understand that.
Erectile dysfunction is the inability to attain and maintain an erection sufficient for sexual intercourse at least 25% of the time. The penis doesnt get hard enough, or it gets hard but softens too soon. The problem often develops gradually. One night it may take longer or require more stimulation to get an erection. On another occasion, the erection may not be as firm as usual, or it may end before orgasm. When such difficulties occur regularly, its time to talk to your doctor.
Erectile dysfunction can have many causes, including some forms of prostate disease and medications and surgery for prostate cancer. Fortunately, in many cases, this problem can often be effectively addressed. Some men find relief by taking medications to treat erectile dysfunction. If these arent effective for you, a number of other options, including injections and vacuum devices, are available. The possibility of finding the right solution is now greater than ever.
Is Prostate Cancer Curable
Prostate cancer is the most common type of cancer among men, second only to skin cancer. Learning that one has any type of cancer isnt easy, but the first question on most patients minds after diagnosis is, is prostate cancer curable?
The short answer is yes, prostate cancer can be cured, when detected and treated early. The vast majority of prostate cancer cases are discovered in the early stages, making the tumors more likely to respond to treatment. Treatment doesnt always have to mean surgery or chemotherapy, either. Non-invasive radiation therapy can effectively treat prostate cancer in the case of Pasadena CyberKnife, radiosurgery treatment generally takes less than a week, and you can typically resume your normal activities the same day you receive treatment.
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What Should I Do If I Have Prostate Cancer Symptoms
If you are displaying one or more signs of prostate cancer, be sure to promptly consult with a physician. Even benign prostate conditions like prostate enlargement warrant timely medical attention, so dont delay seeking treatment. And, like most other malignancies, prostate cancer is usually more easily treated when it is detected at an early stage.
If Youre The Receiving Partner
Youll want to be as relaxed and aroused as possible, because itll make the experience easier and more enjoyable.
The whole poop-comes-out-of-the-butt thing gives some people a case of the heebie-jeebies even when its their own butt.
Remedy this by taking a shower and paying a little extra attention back there to get it squeaky clean. Some people like to use an enema before engaging in butt play, but it isnt necessary.
Use the bathroom before getting started. Prostate stimulation can make you feel like you need to pee, and anal penetration can cause the sensation of needing to poop.
Even though you wont actually do either, worrying that you might can interfere with your ability to let go and enjoy yourself. Knowing your bladder and bowels are empty can help.
Getting used to the sensation of having your prostate touched can help, too. Practice with an anal sex toy, like a butt plug, or your fingers.
Be sure to set the mood so that youre turned on and primed for action. Light candles, watch porn, or engage in some good old-fashioned masturbation or foreplay to get there.
Finally, be sure to lube up real good. Applying a water-based lubricant will allow for easier penetration and make for some easy gliding if stimulating your prostate externally.
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Staging: The Tnm System
Staging is done as part of the diagnosis process to determine how extensive your cancer is within your prostate and whether it has spread to lymph nodes or other organs.
Prostate cancer is typically staged using the TNM system, which is based on:
- The extent of the primary tumor
- Whether the cancer has spread to nearby lymph nodes
- The presence or absence of distant metastasis
- Your PSA level at the time of diagnosis
- Your Gleason score and the amount of cancer
Using this information, prostate cancer is then grouped into stages I through IV, with stage I being the least advanced and stage IV being the most advanced.
- Stage I: Cancer is confined to your prostate. Gleason score is 6 or below. PSA level is less than 10.
- Stage II: The tumor is more advanced but does not extend beyond your prostate.
- Stage III: The tumor extends beyond your prostate and may be in a seminal vesicle. Cancer has not spread to lymph nodes.
- Stage IV: The tumor has spread to another part of your body, such as your bladder, rectum, lymph nodes or bones.
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What Causes Prostate Cancer
Doctors dont know exactly what causes prostate cancer. However, they do know that certain risk factors may increase your risk for the disease. Those risk factors include:
- Older age. Men of any age can get prostate cancer. However, its most common in men older than 65 years of age.
- African-American men are more likely to develop prostate cancer than Caucasian men.
- Family history. Men who have had a father or brother with prostate cancer are at increased risk of developing the disease.
- Obesity. Obese men who are diagnosed with prostate cancer are more likely to have an advanced or aggressive cancer.
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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.
What Exactly Is Psa
PSA stands for Prostate Specific Antigen. It is a chemical produced only by prostate cells, both normal and cancerous. It can be measured easily in the blood. Your physician must carefully review your PSA results. Traditionally, it had been thought in the past that a PSA of 4 was normal. We now know that a normal PSA depends on your age and the size of your prostate, amongst other factors. What is a normal PSA for one man, may, in fact, be very abnormal for another.
Generally speaking, as men age and their prostates enlarge, the normal level for PSA increases. Likewise, for men with prostate cancer, as the amount of prostate cancer increases, the PSA level typically increases. Your physician will typically be alerted when your PSA is above what is expected for your age or if it shows a significant rise from the previous year. Because not all cancers can be found by an elevated PSA, it is critical that you also have regular physical exams to feel for abnormal growths of the prostate.
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Table 2 What Guides Treatment Recommendations
Both of the situations below involve men diagnosed with a tumor that is small in size , yet who may require quite different treatments, based on their PSA level and Gleason score. Of course, many men have clinical profiles that vary from these two extremes.
Clinical profile Low PSA
Low Gleason score
80% of men with this profile probably have locally confined disease.
It is likely that fewer than 3% will have evidence of cancer in lymph nodes.
Surgery, radiation, or active surveillance . High PSA
High Gleason score
5% of men with this profile probably have locally confined disease.
More than 20% probably have evidence of cancer in the lymph nodes.
Systemic therapy rather than surgery .
Radical prostatectomy . The surgeon removes the prostate and seminal vesicles . In some cases, pelvic lymph nodes are also sampled. This is most often performed through an abdominal incision abdominal surgery may also be done with a laparoscope. A third option is the perineal technique, involving an incision in the area between the scrotum and the anus . The most common side effects are
- impotence
- mild to severe incontinence .
External beam radiation therapy. After a CT scan constructs a three-dimensional picture of the prostate and seminal vesicles, the radiation oncologist directs rays of high-energy radiation at the prostate tumor and sometimes at nearby lymph nodes. The most common side effects are
- impotence
- mild to severe incontinence .
- impotence
- mild to severe incontinence .
What Do You Do Once Diagnosed With Prostate Cancer
If the biopsy shows the presence of prostate cancer, the next step is to determine how much cancer is present and to make sure that it has not spread. Our prostate cancer experts will expertly review your PSA blood tests, physical exam findings, and biopsy results. Some simple and painless tests such as a CT scan, bone scan, MRI,and possibly a PET scan can help make sure there is no cancer that has spread outside the prostate.
Using the above information, we can then calculate the likelihood of the cancer being completely confined to the prostate, having spread beyond the confines of the prostate, or having spread some distance to the lymph glands in the pelvis.
This information, as well as an evaluation of your overall medical condition and well-being, is critical in determining which treatment options will offer you the best chance for a cure.
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What Are Some Common Causes Of Prostate Nodules
Following are some common causes of prostate nodules:
- Prostate Cancer: Adenocarcinoma of prostate gland usually presents with prostate nodules. Other rare cancers that also presents with prostate nodules are transitional cell carcinoma, neuroendocrine carcinoma, small cell carcinoma, and sarcoma. Malignancy of prostate gland is the most frequently reported cancer in the United States. According to latest estimates, more than 161,360 new cases of prostate cancer will be diagnosed in 2017 causing more than 26,000 deaths due to cancer related complications.
- Prostatitis: Inflammation of prostate gland due to bacterial infection affects more than 50% of the male population at some point of their life. Symptoms of prostatitis vary, according to the cause, and may include fever, chills, rigor, painful urination, pelvic pain, appearance of blood in the urine and pelvic nodule. Some cases of prostatitis may be asymptomatic. Prostatitis can be managed by taking appropriate antibiotic regimens.
- Prostate calculi: Prostate stones can also present with nodules. It is believed that prostate stones are formed by the accumulation of pus, cellular debris or ongoing infection. Other classic symptoms of prostate calculi are urinary obstruction, bacterial infection, and other urinary complaints
Use In Men Who Might Have Prostate Cancer
The PSA blood test is used mainly to screen for prostate cancer in men without symptoms. Its also one of the first tests done in men who have symptoms that might be caused by prostate cancer.
PSA in the blood is measured in units called nanograms per milliliter . The chance of having prostate cancer goes up as the PSA level goes up, but there is no set cutoff point that can tell for sure if a man does or doesnt have prostate cancer. Many doctors use a PSA cutoff point of 4 ng/mL or higher when deciding if a man might need further testing, while others might recommend it starting at a lower level, such as 2.5 or 3.
- Most men without prostate cancer have PSA levels under 4 ng/mL of blood. Still, a level below 4 is not a guarantee that a man doesnt have cancer.
- Men with a PSA level between 4 and 10 have about a 1 in 4 chance of having prostate cancer.
- If the PSA is more than 10, the chance of having prostate cancer is over 50%.
If your PSA level is high, you might need further tests to look for prostate cancer.
To learn more about how the PSA test is used to look for cancer, including factors that can affect PSA levels, special types of PSA tests, and what the next steps might be if you have an abnormal PSA level, see Screening Tests for Prostate Cancer.
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