History Of Untreated Prostate Cancer
The course of prostate cancer in the absence of treatment has been evaluated both in observational studies and randomized trials. Most of the evidence on the outcomes of men that are not treated for prostate cancer comes from those diagnosed in the era prior to when the disease was diagnosed at a more advanced state.
Vii Whats The Evidence
Loeb, Stacy, Carter, Herbert Ballentine, Wein. Early Detection, Diagnosis and Staging of Prostate Cancer. Campbell-Walsh Urolog. 2013.
AUA guideline on Early Detection of Prostate Cancer. 2013.
Den, Robert B, Hurwitz, Mark, Gomella, Leornard G.. Prostate Cancer, General. The 5-Minute Urology Consult. 2015.
Ramos-Esquivel, A. Androgen-deprivation therapy plus chemotherapy in metastatic hormone-sensitive prostate cancer. A systematic review and meta-analysis of randomized clinical trials. Urol Onc. Apr 2016.
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Types Of Prostate Cancer
The type of prostate cancer tells about the type of cell the cancer started in. Knowing this helps your doctor decide which treatment you need. They use the information about your prostate cancer type along with:
- how abnormal the cancer cells look under the microscope
- the size of the cancer and whether it has spread
Another way doctors may describe your cancer is as localised, locally advanced or advanced.
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Progression Of Prostate Cancer
In many cases, prostate cancer spreads so slowly that it never causes illness, and the patient will often die of other causes before the cancer can cause death. However, if the cancer is left untreated, it is possible that it will spread to local pelvic lymph nodes, and eventually spread to other parts of the body . This may eventually result in organ failure and death. Bony metastases from prostate cancer are common. For men who choose not to undergo definitive local treatment, their likelihood of survival relates to the aggressiveness of the prostate cancer.Without treatment, the 10 year disease-specific survival of men with grade 1 prostate cancer is 87%, with metastases present in 20%. Of men with grade 2 cancer, 42% develop metastases at 10 years. Ten year survival with grade 3 prostate cancer is 34% without treatment.Another study found that 40% of men who did not have treatment for their prostate cancer died from the disease after fifteen years. About 80% of men who chose radical prostatectomy survived.
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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Adenocarcinoma Of The Prostate
What is adenocarcinoma of the prostate gland?
Adenocarcinoma is a type of prostate cancer. It develops from the glands normally found in the prostate. Adenocarcinoma of the prostate is a relatively common cancer among older men. The risk of getting prostate cancer increases after a man turns 50 years old.
Prostatic adenocarcinoma can appear and progress very differently in each person. Many tumours grow slowly. Some men can live many years before the cancer is detected. Some tumours are aggressive. Aggressive cancer should be treated right away.
The prostate is a small organ that is found only in men. The prostate is normally the size and shape of a walnut. It is located at the bottom of the bladder and sits between the pubic bone and the rectum. The prostate also wraps around the urethra. The urethra is the tube that conducts urine from the bladder and semen from the ejaculatory ducts to the exterior of the body.
The prostate releases a fluid that helps feed and move sperm that comes from the testicles. This fluid is made in by a complex network of small structures called glands and is then transported out of the prostate through channels called ducts.
Risk factors for developing adenocarcinoma of the prostate
- Older age
- A family history of prostate cancer
- African or Caribbean ethnicity
How do pathologists make this diagnosis?
Other histologic types are rare but include:
Active Surveillance Of Prostate Cancer
Active surveillance is a management option for localized that can be offered to appropriate patients who would also be candidates for aggressive local therapies , with the intent to intervene if the disease progresses. Active surveillance should not be confused with , another observational strategy for men that would not be candidates for curative therapy because of a limited life expectancy. Active surveillance offers men with a prostate cancer that is thought to have a low risk of causing harm in the absence of treatment, a chance to delay or avoid aggressive treatment and its associated side effects.While prostate cancer is the most common non cutaneous cancer and second leading cause of cancer-related death in American men, it is conservatively estimated that approximately 100,000 men per year in the United States who would be eligible for conservative treatment through active surveillance, undergo unnecessary treatments. The management of localized prostate cancer is controversial and men with localized disease diagnosed today often undergo treatments with significant side effects that will not improve overall health outcomes. The 2011 NIH State-of-the-Science Conference Statement on the “Role of active surveillance in the management of men with localized prostate cancer” pointed out the many unanswered questions about observational strategies for prostate cancer that require further research and clarification. These included:
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Prostatic Adenocarcinoma: General Features
- Most common cancer and 2nd leading cause of cancer-related death in men.
- Common in elderly, incidence increases with age, 70% affected by 70 years.
- ~50% harbor TMPRSS2 and ETS gene fusion TMPRSS2:ERG .
- 75-80% occurs in peripheral zone, 15-25% in transition zone.
- Gross: solid yellow or gray-white areas, although often tumor is not grossly discernible.
- Spectrum of architectures .
- Diagnosis of well-differentiated tumors is most difficult due to overlap with benign glands and lesions.
- Diagnosed by architectural, nuclear, cytoplasmic, and intraluminal features some may be seen in benign glands .
- Malignant gland should lack basal cells!
- Large nuclei with prominent nucleoli that can be multiple.
- Cytoplasmic tincture different to adjacent benign glands.
- Lumen may have blue mucin , crystalloids and amorphous eosinophilic secretions.
Data Analysis And Synthesis
The case reports were included in qualitative analysis while quantitative analysis was limited to the case series. There was heterogeneity in terms of disease description and outcome reporting among the case series and hence meta-analysis was limited to only those studies relevant for each outcome analyzed . Where relevant, relative risk was calculated using Revman statistical software. Primary outcomes investigated included incidence, PSA at diagnosis, T,N,M stage at diagnosis, BCR after RT and RP treatment, and cancer-specific and overall survival .
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Understanding Your Pathology Report: Prostate Cancer
When your prostate was biopsied, the samples taken were studied under the microscope by a specialized doctor with many years of training called a pathologist. The pathologist sends your doctor a report that gives a diagnosis for each sample taken. Information in this report will be used to help manage your care. The questions and answers that follow are meant to help you understand medical language you might find in the pathology report from your prostate biopsy.
Compression Of Medical Images
Medical imaging techniques produce very large amounts of data, especially from CT, MRI and PET modalities. As a result, storage and communications of electronic image data are prohibitive without the use of compression. image compression is used by the standard for storage and transmission of medical images. The cost and feasibility of accessing large image data sets over low or various bandwidths are further addressed by use of another DICOM standard, called , to enable efficient streaming of the compressed image data.
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What Are Grade Groups
Grade Groups are a new way to grade prostate cancer to address some of the issues with the Gleason grading system.
As noted above, currently in practice the lowest Gleason score that is given is a 6, despite the Gleason grades ranging in theory from 2 to 10. This understandably leads some patients to think that their cancer on biopsy is in the middle of the grade scale. This can compound their worry about their diagnosis and make them more likely to feel that they need to be treated right away.
Another problem with the Gleason grading system is that the Gleason scores are often divided into only 3 groups . This is not accurate, since Gleason score 7 is made up of two grades , with the latter having a much worse prognosis. Similarly, Gleason scores of 9 or 10 have a worse prognosis than Gleason score 8.
To account for these differences, the Grade Groups range from 1 to 5 :
- Grade Group 1 = Gleason 6
- Grade Group 2 = Gleason 3+4=7
- Grade Group 3 = Gleason 4+3=7
- Grade Group 4 = Gleason 8
- Grade Group 5 = Gleason 9-10
Although eventually the Grade Group system may replace the Gleason system, the two systems are currently reported side-by-side.
Adenocarcinoma Of The Pancreas
Risk factors include smoking, high blood sugar, high BMI, and a diet consisting of coffee, alcohol, and processed foods. As many as 10% of people with pancreatic cancer have a family history of the disease. The ABO blood type and a personal history of cystic fibrosis may also lead to a greater susceptibility to the disease.
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What Questions Should I Ask My Healthcare Provider
If you have prostate cancer, you may want to ask your healthcare provider:
- Why did I get prostate cancer?
- What is my Gleason score? What is my Grade Group? What do these numbers mean for me?
- Has the cancer spread outside of the prostate gland?
- What is the best treatment for the stage of prostate cancer I have?
- If I choose active surveillance, what can I expect? What signs of cancer should I look out for?
- What are the treatment risks and side effects?
- Is my family at risk for developing prostate cancer? If so, should we get genetic tests?
- Am I at risk for other types of cancer?
- What type of follow-up care do I need after treatment?
- Should I look out for signs of complications?
A note from Cleveland Clinic
Prostate cancer is a common cancer that affects males. Most prostate cancers grow slowly and remain in the prostate gland. For a small number, the disease can be aggressive and spread quickly to other parts of the body. Men with slow-growing prostate cancers may choose active surveillance. With this approach, you can postpone, and sometimes completely forego, treatments. Your healthcare provider can discuss the best treatment option for you based on your Gleason score and Group Grade.
The Grade Group And Psa Level Are Used To Stage Prostate Cancer
The stage of the cancer is based on the results of the staging and diagnostic tests, including the prostate-specific antigen test and the Grade Group. The tissue samples removed during the biopsy are used to find out the Gleason score. The Gleason score ranges from 2 to 10 and describes how different the cancer cells look from normal cells under a microscope and how likely it is that the tumor will spread. The lower the number, the more cancer cells look like normal cells and are likely to grow and spread slowly.
The Grade Group depends on the Gleason score. See the General Information section for more information about the Gleason score.
- Grade Group 1 is a Gleason score of 6 or less.
- Grade Group 2 or 3 is a Gleason score of 7.
- Grade Group 4 is a Gleason score 8.
- Grade Group 5 is a Gleason score of 9 or 10.
The PSA test measures the level of PSA in the blood. PSA is a substance made by the prostate that may be found in an increased amount in the blood of men who have prostate cancer.
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What Does It Mean If In Addition To Cancer My Biopsy Report Also Mentions Acute Inflammation Or Chronic Inflammation
Inflammation of the prostate is called prostatitis. Most cases of prostatitis reported on biopsy are not caused by infection and do not need to be treated. In some cases, inflammation may increase your PSA level, but it is not linked to prostate cancer. The finding of prostatitis on a biopsy of someone with prostate cancer does not affect their prognosis or the way the cancer is treated.
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.
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What Are Prostate Cancer Treatment Side Effects
Some prostate cancer treatments can affect the bladder, erectile nerves and sphincter muscle, which controls urination. Potential problems include:
- Incontinence: Some men experience urinary incontinence. You may leak urine when you cough or laugh, or you may feel an urgent need to use the bathroom even when your bladder isnt full. This problem can improve over the first six to 12 months without treatment.
- Erectile dysfunction : Surgery, radiation and other treatments can damage the erectile nerves and affect your ability to get or maintain an erection. Some men regain erectile function within a year or two . In the meantime, medications like sildenafil or tadalafil can help by increasing blood flow to the penis.
- Infertility: Treatments can affect your ability to produce or ejaculate sperm, resulting in male infertility. If you think you might want children in the future, you can preserve sperm in a sperm bank before you start treatments. After treatments, you may undergo sperm extraction. This procedure involves removing sperm directly from testicular tissue and implanting it into a womans uterus.
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.
Denosumab, a monoclonal antibody, may be used to preventbone metastases.
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Prostate Cancer Is A Disease In Which Malignant Cells Form In The Tissues Of The Prostate
The prostate is agland in the malereproductive system. It lies just below the bladder and in front of the rectum . It is about the size of a walnut and surrounds part of the urethra . The prostate gland makes fluid that is part of the semen.
Prostate cancer is most common in older men. In the U.S., about 1 out of 5 men will be diagnosed with prostate cancer.
Prostatic Adenocarcinoma With Mucinous Features
It is important to note that when prostatic adenocarcinoma with extraluminal mucin is present in a TURP specimen or needle core biopsies , a diagnosis of Prostatic adenocarcinoma with mucinous features should be rendered. This is due to the fact that the entire tumor has to be present to confirm that the extraluminal mucinous component is indeed greater than 25% before a definitive diagnosis of mucinous adenocarcinoma of the prostate can be made. In addition, if the extraluminal mucinous component is < 25% in a radical prostatectomy specimen , then a diagnosis of Prostatic adenocarcinoma with mucinous features should also be rendered.
Prostatic adenocarcinoma with mucinous features. Needle core biopsy . Prostatic adenocarcinoma with mucinous features. Needle core biopsy . Prostatic adenocarcinoma with mucinous features. Needle core biopsy . Prostatic adenocarcinoma with mucinous features. Needle core biopsy .
Similar to conventional acinar prostatic adenocarcinoma, markers such as PSA, PAP, PSMA, ERG, P501S, P504S, PTEN, etc are also variably expressed in mucinous adenocarcinoma of the prostate and prostatic adenocarcinoma with mucinous features. , , , ,
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Risks Of Over Treatment Of Prostate Cancer
Over diagnosis is the detection of a cancer that would otherwise not have been diagnosed in the lifetime of the host if the detection test had not been performed. Treatment of men who would otherwise not have known about their cancer in the absence of PSA testing and biopsy are over treated. Over treatment exacts a cost to the health care system and potential harm to a patient , with no benefit. Over treatment is most likely to occur when a low grade is detected, especially in an older man. Data from various sources suggest that in the PSA range where many men are undergoing prostate biopsy today , 15-25% will have prostate cancer detected, and 80-90% will be low grade.
The rate of in the U.S. is similar to the rate of over diagnosis since the majority of men undergo curative intervention after receiving a prostate cancer diagnosis. A range of estimates of over diagnosis between 23% and 42% have been reported based on U.S. incidence. Depending upon the age at diagnosis, and the disease characteristics, the likelihood that a screen detected cancer has been over diagnosed can vary from below 5% to more than 75%.