How To Diagnose The Carcinoma
Experts use a range of diagnostic technologies and tools to identify the type of cancer and stage. The two tests mainly used during prostate cancer screening are a digital rectal exam and a PSA blood test. Diagnosing the disease can help assess the extent of its impact.
When diagnosing the carcinoma, the first thing doctors will look at is the Gleason score. If the Gleason score is low, typically around 2 to 4, it means that the cancer is not that aggressive. But, when the score is well over 7 to 10, it signifies you need urgent prostate cancer treatment.
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Risk Factors For Prostate Cancer
Because prostate cancer tends to not show symptoms in its early stages, risk factors are another useful tool to identify candidates for screening. The Mayo Clinic notes that risk certainly increases as you grow older, and obese men may be more likely to have prostate cancer that is aggressive or difficult to treat.
For unknown reasons, black men are also at a greater risk of prostate cancer than men of other races. Not only are they more likely to get prostate cancer, but the risk of prostate cancer being aggressive or advanced is also higher.
Finally, your family history or genetics can also help determine your prostate cancer risk. For example, men with close relatives who had prostate cancer are more likely to get it. Also, a family history of breast cancer or the presence of the genes BRCA1 or BRCA2 within the family also raises the likelihood of a man developing prostate cancer.
Genomic Variant And Aggressive Disease
Using genetic, genomic, molecular, and bioinformatic tools, Prof. Wei and his colleagues analyzed data from 2,738 cases of prostate cancer. The analysis confirmed the link between the rs11672691 variant and aggressive disease.
On further investigation, they found that a certain aggressive prostate cancer version of rs11672691 called the guanine allele was linked to higher expression of two particular genes.
The two genes called PCAT19 and CEACAM21 have previously been tied to growth of cells and progression of tumors in prostate cancer.
The team also found that the guanine allele of rs11672691 influences a third gene called HOXA2. This gene contains the instructions for producing a protein that controls the decoding of PCAT19 and CEACAM21.
Using CRISPR/Cas9 gene editing tools, the researchers then showed that they could manipulate the effect of rs11672691 on PCAT19 and CEACAM21 gene expression and the aggressiveness of prostate cancer cells.
They conclude that their findings reveal a plausible mechanism for rs11672691 in aggressive prostate cancer and thus lay the groundwork for translating this finding to the clinic.
Prof. Wei suggests that further research is now needed to investigate how this gene regulatory circuit accounts for pathogenesis and progression of prostate cancer.
We think the findings may be repurposed to stratify prostate cancer patients for personalized treatment and care.
Prof. Gong-Hong Wei
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Basal Stem Cell Signature
Evidence from several cancers suggests that an increased aggressiveness is associated with the up-regulation of signaling pathways and with the acquisition of properties seen in stem cells . Smith et al. developed a gene signature specific for human prostate basal cells that is differentially enriched in various phenotypes of late-stage metastatic PCa . The authors The author purified by Fluorescence Activated Cell Sorting purified and transcriptionally profiled basal and luminal epithelial populations from the benign and neoplastic areas of PCa. They showed that the basal cell population is defined by genes associated with stem cell invasiveness and signaling programs. A panel of a 91-gene basal signature, investigated in patients with organ-confined and mCRPCa, showed that metastatic SmCC was molecularly more stem-like than metastatic PCa and organ-confined PCa . In particular, analyses of the normal basal cell and of human small cell gene signatures identified a set of E2F target genes commonly present in prostate SmCC and primary normal basal cells of the prostate . Such information suggests that aggressive prostate cancer shares a conserved transcriptional program with normal adult prostate basal stem cells .
What Will Happen After Treatment
Youll be glad when treatment is over. But its hard not to worry about cancer coming back. When cancer comes back it is called a recurrence. Even when cancer never comes back, people still worry about it. For years after treatment ends, you will see your cancer doctor. At first, your visits may be every few months. Then, the longer youre cancer-free, the less often the visits are needed.
Be sure to go to all follow-up visits. Your doctors will ask about your symptoms, examine you, and might order blood tests and maybe other tests to see if the cancer has come back.
Having cancer and dealing with treatment can be hard, but it can also be a time to look at your life in new ways. You might be thinking about how to improve your health. Call us at 1-800-227-2345 or talk to your doctor to find out what you can do to feel better.
You cant change the fact that you have cancer. What you can change is how you live the rest of your life, making healthy choices and feeling as good as you can.
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Basal Cell Prostate Cancer
You might also hear this called adenoid cystic prostate cancer or basaloid carcinoma. Men who have basal cell prostate cancer can also have common prostate cancer at the same time. We dont know how aggressive it is. Some studies suggest it isnt very aggressive. But other studies suggest it might be more aggressive than common prostate cancer.
Basal cells dont produce PSA, and most men with basal cell prostate cancer have normal levels of PSA in their blood. This means that a PSA test probably wont help to diagnose basal cell prostate cancer.
Basal cell cancer can grow big enough to cause the urethra to narrow, this can cause difficulty urinating. So basal cell prostate cancer is often diagnosed when men have surgery called transurethral resection of the prostate to treat their urinary problems. Tissue removed during surgery is looked at under the microscope to confirm you have basal cell prostate cancer. You will also have scans to see if your cancer has spread.
Your treatment options will depend on how much the cancer has grown and whether it has spread to other parts of the body. You may be offered:
- or a combination of these treatments.
Your doctor or nurse will tell you what treatment options are available to you.
Psa And Prostate Cancer Staging
Prostate cancer stages run from 1 to 4, with 4 being the most advanced stage and 1 being the least advanced stage. PSA levels can help doctors to determine the stage of prostate cancer, as follows:
- Stage 1: The cancer is limited to one half of the prostate and has not spread to other tissues. PSA levels are below 10.
- Stage 2A: The cancer is limited to one half of the prostate and has not spread. PSA levels are between 10 and 20.
- Stage 2B: The cancer has affected both sides of the prostate, PSA levels are greater than 20, or both.
- Stages 3 and 4: The cancer has spread to other tissues. The extent to which this has occurred determines the stage. PSA levels are no longer considered.
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Predicting And Monitoring Advanced Prostate Cancer
Prostate cancer is a complex disease. Doctors cannot always predict how fast or slow it will grow. Nor do they agree on when to treat it, or which treatments to use. Predicting and monitoring the disease with accuracy helps doctors and patients make decisions that result in the best survival rates and quality of life.
What Does It Mean To Have A Gleason Score Of 6 7 8 Or 9
Because grades 1 and 2 are not often used for biopsies, the lowest Gleason score of a cancer found on a prostate biopsy is 6. These cancers may be called well differentiated or low-grade and are likely to be less aggressive that is, they tend to grow and spread slowly.
Cancers with Gleason scores of 8 to 10 may be called poorly differentiated or high-grade. These cancers are likely to grow and spread more quickly, although a cancer with a Gleason score of 9-10 is twice as likely to grow and spread quickly as a cancer with a Gleason score of 8.
Cancers with a Gleason score of 7 can either be Gleason score 3+4=7 or Gleason score 4+3=7:
- Gleason score 3+4=7 tumors still have a good prognosis , although not as good as a Gleason score 6 tumor.
- A Gleason score 4+3=7 tumor is more likely to grow and spread than a 3+4=7 tumor, yet not as likely as a Gleason score 8 tumor.
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Definitions Of Aggressive Prostate Cancer
Within our analytic dataset of prostate cancer cases, we examined the performance of various categorizations of clinical category and Gleason score . To develop a definition that is widely applicable for epidemiologic research, we focused on clinical factors that are commonly collected in prospective cohort studies, as determined via a brief, email-based survey that we sent to cohorts participating in the NCI Cohort Consortium . This consortium includes cohorts from 4 continents and is representative of studies that we encourage to report etiologic results using our definition. Only approximately one-half of all cohorts surveyed collected information on diagnostic PSA value, and of the cohorts with PSA data, many had high proportions of missingness. As a result, we elected to leave PSA out of the definitions tested in our primary analysis.
The AJCC 6th edition was used for clinical staging. Pathologic TNM staging was used, when available, in a sensitivity analysis. In all analyses, Gleason score was recorded as either clinical grade or pathologic grade, because separate variables for clinical and pathologic Gleason patterns were not available in SEER before 2010.
How Important Is The Gleason Score
The Gleason score is very important in predicting the behavior of a prostate cancer and determining the best treatment options. Still, other factors are also important, such as:
- The blood PSA level
- How much of each core is made up of cancer
- The number of cores that contain cancer
- Whether cancer was found in both sides of the prostate
- Whether the cancer has spread outside the prostate
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What Does It Mean When There Are Different Core Samples With Different Gleason Scores
Cores may be samples from different areas of the same tumor or different tumors in the prostate. Because the grade may vary within the same tumor or between different tumors, different samples taken from your prostate may have different Gleason scores. Typically, the highest Gleason score will be the one used by your doctor for predicting your prognosis and deciding on treatment options.
Ongoing Work To Learn More
Dr. Aggarwal and his colleagues are investigating how the t-SCNC subtype develops in men with metastatic castrate-resistant prostate cancer.
We think it arises from adenocarcinoma,â Dr. Aggarwal said. âThe cancer cells transform into this subtype of prostate cancer through genetic reprogramming.
Some aspects of this reprogramming event are understood, such as specific factors that control the transition. However, he added, more studies still need to be done to understand how and when it happens.
Potent hormone therapies such as abiraterone and enzalutamide may push prostate cancer toward this transformation, said Dr. Dahut. That may be why this subtype is more prevalent in men who have received treatment than in men with newly diagnosed prostate cancer, noted Dr. Aggarwal.
The research teams ultimate goal is to find therapies for t-SCNC. Master regulator proteins are opportune drug targets, Dr. Aggarwal explained, because they control many pathways that contribute to cancer growth and survival.
Several of the master regulators that they identified in t-SCNC tumors can be targeted directly or indirectly by drugs that are in development, and the team hopes to be able to test these in clinical trials of men with this subtype of prostate cancer.
Dr. Dahut also speculated that a better understanding of the genetic reprogramming event that creates t-SCNC could potentially lead to the discovery of drugs that prevent the development of this hard-to-treat subtype.
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Prognosis For Prostate Cancer
It is not possible for a doctor to predict the exact course of a disease, as it will depend on each person’s individual circumstances. However, your doctor may give you a prognosis, the likely outcome of the disease, based on the type of prostate cancer you have, the test results, the rate of tumour growth, as well as your age, fitness and medical history.
Prostate cancer often grows slowly and even more aggressive types tend to grow more slowly than other types of cancer. If diagnosed early, prostate cancer has one of the highest five year survival rates.
Focal Neuroendocrine Differentiation In Pca
Almost all PCas show focal NE differentiation, in general in the form of only rare or sparse single NE cells, highlighted by NE markers. In 5%10% of PCas, there are zones with a large number of single or clustered NE cells, either single or clusters .
Occasionally, NE cells with cytoplasmic eosinophilic granules, resembling the Paneth cells of the gastro-intestinal tract , are seen in a patchy manner in normal as well as in neoplastic tissues. A recent investigation showed that among cases with Paneth cell-like rich areas resembling high grade PCa, none showed evidence of progression.
The prognostic significance of NE differentiation in primary untreated PCa is unclear, with some studies showing an independent negative effect upon prognosis, whereas others did not confirm such an observation .
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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.
Large Cell Neuroendocrine Carcinoma
Few cases of prostatic LCNEC have been described . Morphologically, LCNEC is composed of solid sheets and ribbons of cells with abundant amphophilic cytoplasm, large nuclei with coarse chromatin and prominent nucleoli, along with foci of necrosis and brisk mitotic activity. LCNEC may be easily mistaken for Gleason score 5 + 5 = 10 PCa and, hence, the likelihood of being underdiagnosed is high . LCNEC is positive for chromogranin A, synaptophysin, CD56 and P504S/alpha methylacyl CoA racemasethis last marker is usually expressed in PCa. It is focally positive for PSA and negative AR staining. The prognosis for LCNEC is similar to that of SmCC. Patients with de novo tumors mixed with prostatic adenocarcinoma may respond to ADT and might present a better outcome than those with pure LCNEC or post-ADT LCNEC of the prostate .
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What Is The Difference Between Prostate Cancer And Advanced Prostate Cancer
Prostate cancer occurs when cells in the prostate gland begin to grow out of control. In the early stages of prostate cancer, the cancer cells are only present in the prostate and have not spread to nearby tissues.
Advanced prostate cancer, also known as stage 4 prostate cancer, occurs when cancer cells have spread to other areas of the body.
How Prostate Cancer Is Diagnosed And Staged
Cancer staging helps you and your doctor understand how advanced your cancer is and how much it has spread at the time of diagnosis. Knowing your cancer stage also helps your doctor determine the best treatment options for you and estimate your chance of survival.
The most widely used staging system for cancer is the TNM system that classifies cancer from stage 1 to stage 4.
TNM stands for:
- Tumor: the size and extent of the tumor
- Nodes: the number or extent of nearby lymph node involvement
- Metastasis: whether cancer has spread to distant sites in the body
The TNM scale is used for many types of cancer. When a doctor uses it to determine your prostate cancer stage, theyll consider several other factors as well, including:
- grade groups
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You Have Cap What This Means
As suggested above, if it is common knowledge that we all have cancer in us all the time, then what can we consider to be a real CaP? When speaking to my patients, I reframe real as reproducible or significant CaP. This refers to the potential that a CaP would be discovered at the same location and in relatively the same number of cores on a biopsy. In other words, if a patient was to undergo multiple biopsies , what are the chances that the same Gleason-grade cancer would be discovered at the same location? This conceptualization reduces the confusion and reality that numerous, random, CaP cells likely exist daily and could be picked up on biopsy and lead to unnecessary surgery.
Clinical indicators for a significant CaP include, but are not limited to, a positive digital rectal exam , overt lesions on imaging, worrisome PSA kinetics, and/or elevated molecular CaP testing results . Of course, the most definitive indicator would be the biopsy itself. Although a biopsy is subject to misinterpretation, these criteria can be considered positive for a significant CaP if any of the following criteria are met: > 3 cores positive, any core > 30% CaP, or any core containing > Gleason 7. These criteria are currently used by urologists as a reasonable standard for distinguishing an active surveillance case from a surgical one.