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What Percent Of Prostate Lesions Are Cancerous

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PSMA-Guided resection of metastatic prostate cancer lesions

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Cancer Lethality Set Early

The study looked for changes in cancer aggressiveness in men diagnosed with prostate cancer from 1982 to 2004. All of the men had their prostates removed after diagnosis, and biopsy samples were taken from the glands. The Harvard team reexamined the samples and graded them using a tool called the Gleason score, which assigns a number from 2 to 10 based on how abnormal the cells look under a microscope. High-scoring or high-grade cancers tend to be the most lethal.

Over the study period, fewer and fewer men were diagnosed with advanced, late-stage prostate cancers that had spread beyond the prostate gland. This reflected the growing use of prostate-specific antigen testing to diagnose prostate cancers earlier and earlier. In contrast, the proportion of high-grade cancers, as measured by the Gleason score, remained relatively stable rather than gradually becoming more aggressive. Previous studies have seen a similar pattern.

Its a very interesting study that confirms what previous studies have found, says Dr. Marc B. Garnick, a prostate cancer specialist at Harvard-affiliated Beth Israel Deaconess Medical Center who was not involved in the study. There may be rare exceptions, but in the vast majority the cancer is born with a particular Gleason score.

Understanding Prostate Cancers Progression

To determine the appropriate treatment, doctors need to know how far the cancer has progressed, or its stage. A pathologist, the doctor trained in analyzing cells taken during a prostate biopsy, will provide two starting pointsthe cancers grade and Gleason score.

  • Cancer grade: When the pathologist looks at prostate cancer cells, the most common type of cells will get a grade of 3 to 5. The area of cancer cells in the prostate will also be graded. The higher the grade, the more abnormal the cells.
  • Gleason score: The two grades will be added together to get a Gleason score. This score tells doctors how likely the cancer is to grow and spread.

After a biopsy confirms prostate cancer, the patient may undergo additional tests to see whether it has spread through the blood or lymph nodes to other parts of the body. These tests are usually imaging studies and may include a bone scan, positron emission tomography scan or computed tomography scan.

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What Causes A Prostate Nodule

A nodule is a lump or area of hardness under the surface of the prostate. In some cases, a prostate stone, which is similar to a kidney stone, can be felt under the surface. It may seem like a nodule, but its really a tiny formation of calcified minerals. A stone is usually harmless. A true prostate nodule is an abnormal growth of cells that may or may not be cancerous.

What Are Grade Groups

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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.

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Anatomy And Metastasis Of Prostate Cancer

The pudendal nerve innervates the few striated muscles within the prostatic capsule. The parasympathetic nerves emanate from S2 to S4 and form the pelvic nerve. The sympathetic preganglionic nerves, which reside in the thoracolumbar region between T6 and L2, provide the major neural input to the prostate and reach the pelvis through the hypogastric nerve .

Anatomic structures and major veins of the male pelvis.

FIGURE 1.

Anatomic structures and major veins of the male pelvis.

Prostate cancer has been shown to metastasize by following the venous drainage system through the lower paravertebral plexus, or Batson’s plexus.4,9 Although hematogenous spread of other malignancies is most commonly to the lungs and liver, 90 percent of prostatic metastases involve the spine, with the lumbar spine affected three times more often than the cervical spine. Prostate cancer also spreads to the lungs in about 50 percent of patients with metastatic disease, and to the liver in about 25 percent of those with metastases.4

Epidural metastases are the result of contiguous spread from lesions of the calvaria to the meninges. Because of the protective layer of the dura mater, subdural and intra-parenchymal metastases from prostate cancer are rare .

FIGURE 2.

FIGURE 2.

What Are The Risk Factors For Prostate Cancer

The most important factors that increase the risk of prostate cancer are African American race, a family history of prostate cancer, and increasing age. Black men have a 60% higher risk of prostate cancer than white men and are approximately twice as likely to die of prostate cancer. People with a family history of prostate cancer are at increased risk, and having more than one family member with prostate cancer increases the risk further. Older men have a higher risk of prostate cancer than younger men, with more than 50% of all diagnoses occurring after the age of 65 and 97% occurring after the age of 50. There are also certain genetic syndromes that increase the risk of prostate cancer such as BRCA1 and BRCA2 mutations and, as new evidence is suggesting, Lynch Syndrome .

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Prostate Cancer In New Zealand Men

Prostate cancer is the most commonly diagnosed cancer in Kiwi men. Every year nearly 4000 men are diagnosed and about 650 die from the disease the third highest cause of death after lung and bowel cancers.

Mori men have a slightly lower incidence of prostate cancer but have a higher death rate than other New Zealand men. The reasons for this may be a later diagnosis or treatment choices offered to them.

Overall, the number of men diagnosed in New Zealand is increasing, largely due to increased rates of testing and the death rate is slowly dropping, largely due to better outcomes from early diagnosis and improved treatments available.

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Features Of Pin Cells

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Basal cellspecific monoclonal antibodies directed against highmolecular weight keratin are used to identify HGPIN cells. Normal prostatic epithelial cells are consistently stained with these antibodies, showing a continuous, intact, circumferential basal cell layer. Cancer cells have lost their receptors for these antibodies.

Basal cell disruption affects 56% of patients with HGPIN and is usually found in glands adjacent to invasive cancer. The degree of disruption correlates with HGPIN. More than one third of the basal cell layer is lost in 52% of foci that contain HGPIN.

In persons with HGPIN and in many with low-grade cancer, the basement membrane that surrounds the prostatic glands remains intact. The expression of collagenase type 4 in PIN and associated cancer cells is abnormally high. The presence of collagenase type 4 and other enzymes is associated with a degradation of the basement membrane, allowing cell invasion into the stroma. Concurrently, the basal cell layer is diminished. This seems to occur primarily at sites of glandular outpouching.

Increased angiogenesis with an increased number of microvessels is associated with the progression of HGPIN to cancer. The microvessels in HGPIN are shorter than those in benign epithelium and have irregular contours and open lumens, an increased number of endothelial cells, and a greater distance from the basement membrane.

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Monitoring And Pharmacologic Therapy

Ordinarily, in patients in whom only a single focus of PIN, particularly HGPIN, has been identified, therapy may not be necessary. In patients with multiple areas of HGPIN or ASAP on the initial biopsy or on subsequent biopsies, therapy may be considered, as the risk of cancer in these patients is 15 times that in patients without these entities. Prostate cancerprevention studies indicate that 5-alpha reductase inhibitors, antiandrogens, and selective estrogen receptor modulators are usually not effective in eliminating HGPIN and ASAP,. .

Tests To Diagnose And Stage Prostate Cancer

Most prostate cancers are first found as a result of screening. Early prostate cancers usually dont cause symptoms, but more advanced cancers are sometimes first found because of symptoms they cause.

If prostate cancer is suspected based on results of screening tests or symptoms, tests will be needed to be sure. If youre seeing your primary care doctor, you might be referred to a urologist, a doctor who treats cancers of the genital and urinary tract, including the prostate.

The actual diagnosis of prostate cancer can only be made with a prostate biopsy .

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How Fast Does Prostate Cancer Spread To The Bones

Early detection can catch prostate cancer even before there are any symptoms. Some types of prostate cancer grow very slowly.

There are four main stages of prostate cancer. Within each stage, the cancer is graded based on factors like the size of tumor, prostate-specific antigen level, and other clinical signs.

If the cancer has spread to the bones, its considered to be the most advanced, or stage 4.

Newer lab tests look at the genes inside cancer cells. This can provide more information on how quickly the prostate cancer may progress.

Theres also a grading system known as the Gleason system, which assigns the cancer into a grade group based on how closely it resembles normal tissue.

During the biopsy to diagnose prostate cancer, the cells are closely examined. The more abnormal cells that are in the biopsy sample, the higher the Gleason score and grade group.

When more abnormal cells are present, the cancer is more likely to spread quickly.

Stage 2 Prostate Cancer

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In stage 2, the tumor is still confined to your prostate and hasnt spread to lymph nodes or other parts of your body. A doctor may or may not be able to feel the tumor during a prostate exam, and it may appear on ultrasound imaging. The survival rate is still near 100 percent.

The PSA score for stage 2 is less than 20 ng/mL.

Stage 2 cancer is further divided into three phases depending on the grade group and Gleason scores:

  • Grade group: 1
  • Gleason score: 6 or less

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Prostate Cancer Survival Rates Are Favorable Overall

Thinking about survival rates for prostate cancer takes a little mental stretching. Keep in mind that most men are around 70 when diagnosed with prostate cancer. Over, say, five years, many of these men will die from other medical problems unrelated to prostate cancer.

To determine the prostate cancer survival rate, these men are subtracted out of the calculations. Counting only the men who are left provides whats called the relative survival rate for prostate cancer.

Taking that into consideration, the relative survival rates for most kinds of prostate cancer are actually pretty good. Remember, were not counting men with prostate cancer who die of other causes:

  • 92% of all prostate cancers are found when they are in the early stage, called local or regional. Almost 100% of men who have local or regional prostate cancer will survive more than five years after diagnosis.
  • Fewer men have more advanced prostate cancer at the time of diagnosis. Once prostate cancer has spread beyond the prostate, survival rates fall. For men with distant spread of prostate cancer, about one-third will survive for five years after diagnosis.

Many men with prostate cancer actually will live much longer than five years after diagnosis. What about longer-term survival rates? According to the American Society of Clinical Oncology, for men with local or regional prostate cancer:

  • the relative 10-year survival rate is 98%
  • the relative 15-year survival rate is 96%

Surprising Prostate Cancer Statistics

2020-07-3030 July 2020

Prostate cancer is common, but did you know that its the second most common cancer diagnosed in American men? Here are eight other surprising prostate cancer statistics, according to the American Cancer Society:

  • Prostate cancer is the second most common cause of cancer death in American men.
  • 1 in 9 men will be diagnosed with prostate cancer.
  • Prostate cancer has race-related risk factors and is diagnosed more frequently in African American men.
  • Men under 40 are rarely diagnosed with prostate cancer.
  • More than half of prostate cancer diagnoses are men who are 65 or older.
  • The average age of diagnoses is 66.
  • This year, 200,000 new cases of prostate cancer will be diagnosed.
  • 34,000 men will die from prostate cancer this year.

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Better Understanding Of Prostate Cancer

Were using the power of big data, working with partners to analyse and combine data from tens of thousands of men whove been diagnosed and treated for different types and stages of prostate cancer. The aim is to find patterns in when the cancers started, how they developed and how aggressive they are. In the future this could help doctors predict how particular prostate cancers are likely to develop so we can choose the most appropriate treatment for each man.

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Are Older Men Undertreated

Prostatic Intraepithelial Neoplasia (PIN)

Schwartz and colleagues reviewed the treatment decisions and factors influencing them in a cohort of men with localized prostate cancer. Age, comorbidity, and Gleason score were found to be independent predictors of suboptimal treatment. It was concluded that most men older than 70 years with moderately or poorly differentiated tumors and no to mild comorbidity were given suboptimal treatment. Most of these men were undertreated, receiving watchful waiting therapy when potentially curative therapy could have been applied. With optimal treatment, clinical outcomes could have been improved.

Thompson and colleagues investigated otherwise healthy octogenarians diagnosed with prostate cancer who underwent radical prostatectomy. At the last follow-up visit, 10 patients had survived more than a decade after surgery, and 3 patients had died within 10 years of surgery. The remaining 6 patients were alive at less than 10 years of follow-up. Seventy-four percent of patients were continent. No patient had died of prostate cancer, and the 10-year, all-cause survival rate was similar to that observed in healthy patients 60 to 79 years old undergoing radical prostatectomy. These findings indicate that careful selection of patients even older than 80 years can achieve satisfactory oncologic and functional outcomes after surgery. It is important to note, however, that the rate of urinary incontinence after surgery exceeds that of younger counterparts.

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Deaths From Prostate Cancer

Prostate cancer is the second leading cause of cancer death in American men, behind only lung cancer. About 1 man in 41 will die of prostate cancer.

Prostate cancer can be a serious disease, but most men diagnosed with prostate cancer do not die from it. In fact, more than 3.1 million men in the United States who have been diagnosed with prostate cancer at some point are still alive today.

Our team is made up of doctors and oncology certified nurses with deep knowledge of cancer care as well as journalists, editors, and translators with extensive experience in medical writing.

American Cancer Society. Facts & Figures 2021. American Cancer Society. Atlanta, Ga. 2021.

National Cancer Institute. SEER Cancer Stat Facts: Prostate Cancer. Accessed at https://seer.cancer.gov/statfacts/html/prost.html on March 15, 2019.

Noone AM, Howlader N, Krapcho M, Miller D, Brest A, Yu M, Ruhl J, Tatalovich Z, Mariotto A, Lewis DR, Chen HS, Feuer EJ, Cronin KA . SEER Cancer Statistics Review, 1975-2015, National Cancer Institute. Bethesda, MD, https://seer.cancer.gov/csr/1975_2015/, based on November 2017 SEER data submission, posted to the SEER web site, April 2018.

American Cancer Society. Facts & Figures 2021. American Cancer Society. Atlanta, Ga. 2021.

National Cancer Institute. SEER Cancer Stat Facts: Prostate Cancer. Accessed at https://seer.cancer.gov/statfacts/html/prost.html on March 15, 2019.

Last Revised: January 12, 2021

Prostate Cancer Survival Rates

Answering the question of how curable is prostate cancer? first requires understanding what doctors mean when they refer to curability. Regardless of the type of cancer, doctors consider cancer cured when a patient remains cancer-free for a specified period after treatment. The higher the number of patients who stay cancer-free for five years or longer, the higher the curability of that particular disease.

Prostate cancer, therefore, has one of the highest curability rates of all types of cancer, thanks in large part to early detection standards and advances in treatment, such as the stereotactic body radiation therapy offered by Pasadena CyberKnife. When the cancer is detected in the early local or regional stages that is, before the cancer has spread or when it has only spread to limited areas in the pelvic regions the five-year survival rate is nearly 100 percent.

Survival rates decline significantly when cancer is detected at later stages however, the good news is that only about five percent of men are diagnosed after the cancer has become widespread throughout the body. In short, more than 90 percent of men who are diagnosed with prostate cancer live for five years or longer after treatment, making it one of the most curable forms of cancer.

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