Individualized Prostate Cancer Screening
Coltman says that men and their doctors can no longer rely on PSA levels alone when deciding whether to have a prostate biopsy.
“The situation now is that the individual man with his individual urologist will have to assess what the person feels are his risk factors,” he says. “In consultation with his doctor, the individual man must come to grips with the question of whether or not a biopsy should be done. It will become a more personalized interaction.”
Who’s at high risk? Men with the following factors have the highest risk of prostate cancer:
- Age. A man’s risk of prostate cancer increases with age.
- Race. “African American men have the highest incidence of prostate cancer and the highest death rate from prostate cancer of any men in the world,” Coltman says.
- Family history. A man’s risk increases if his brother or father has had prostate cancer.
What Are The Symptoms Of Bph And Prostate Cancer
BPH and prostate cancer have similar symptoms, so its sometimes hard to tell the two conditions apart. As the prostate grows for any reason, it squeezes the urethra. This pressure prevents urine from getting down your urethra and out of your body. Prostate cancer symptoms often dont start until the cancer has grown large enough to put pressure on the urethra.
Symptoms of both BPH and prostate cancer include:
- an urgent need to urinate
- feeling the urge to urinate many times during the day and night
- trouble starting to urinate or having to push to release urine
- weak or dribbling urine stream
- urine flow that stops and starts
- feeling like your bladder is never fully empty
If you have prostate cancer, you might also notice these symptoms:
- painful or burning urination
How Is Prostate Cancer Diagnosed
Medical interview and physical examination:
A proper medical interview eliciting a thorough medical history and a physical examination are essential in the diagnostic workup of any man in whom prostate cancer is suspected. He may be referred to a physician who specializes in urinary tract diseases or in urinary tract cancers . A man will be asked questions about his medical and surgical history, lifestyle and habits, and any medications he takes. Risk factors including family history of prostate cancer will be assessed .
Digital rectal examination is part of the physical examination: All men with firm swelling, asymmetry, or palpable, discrete, firm areas or nodules in the prostate gland require further diagnostic studies to rule out prostate cancer, particularly if they are over the age of 45 or have other risk factors for the disease .
Because urological symptoms can indicate a variety of conditions, a man may undergo further testing to pinpoint their cause. Initial screening tests include blood testing for PSA and urine testing for blood or signs of infection.
Prostate specific antigen :
PSA is an enzyme produced by both normal and abnormal prostate tissues. It may be elevated in noncancerous conditions, such as prostatitis and benign prostatic hypertrophy , as well as in cancer of the prostate. Therefore, confirmation of an elevated serum PSA is advisable prior to proceed to prostate biopsy.
The following standards have been set for PSA levels:
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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
Why Does Prostate Cancer Happen
The causes of prostate cancer are largely unknown. But certain things can increase your risk of developing the condition.
The chances of developing prostate cancer increase as you get older. Most cases develop in men aged 50 or older.
For reasons not yet understood, prostate cancer is more common in men of African-Caribbean or African descent, and less common in Asian men.
Men whose father or brother were affected by prostate cancer are at slightly increased risk themselves.
Recent research also suggests that obesity increases the risk of prostate cancer.
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Do Cancers Really Disappear Spontaneously Or Are They Just Eluding Us
Cancer specialists are comfortable with the terms partial remission and complete remission when patients undergo some sort of aggressive therapy such as radiation or chemo.
But the concept of spontaneous remission is more problematic, especially with low-risk prostate cancers in patients like me on active surveillance who have had no treatment at all.
Back in May, Michael Scott, a patient advocate and layman with loads of expertise with prostate cancer, went out on a limb to suggest in his blog that spontaneous remission was real and worthy of the attention of serious researchers.
Scott, founder of Prostate Cancer International and its Active Surveillance Virtual Support Group, mentioned my case and that of a man whose name he couldn’t recall.
I asked other men in two virtual support groups for men on AS if they had experienced spontaneous remission. James Simms, 72, a retired banker from Tampa, was the only one to reply. As it happens, he had described his case at Scott’s group.
Simms and Scott gave me a new perspective on what might have happened with my “lame” cancer, as my urologist calls it.
So my cancer potentially disappeared sometime in 2011, though that was not acknowledged at that time.
My urologist, Brian Helfand, MD, PhD, of NorthShore University HealthSystem in Glenview, Illinois, joked last year that if my PHI were any lower, I wouldn’t have cancer at all. Was he inadvertently on to something?
Pathologists weigh in
What Do You Do If Your Psa Blood Test Or Physical Exam Is Abnormal
If your primary care physician detects an abnormal PSA or a lump in your prostate during a physical exam, you will be referred to a Urologist for evaluation and consideration for a biopsy. This is a simple procedure that can be done in a few minutes in the Urologists office. With an ultrasound in the rectum, thin needles can be inserted into the prostate to remove tiny fragments for evaluation. Typically at least eight biopsies are performed, four from each side of the prostate.
These biopsies are sent to a lab where a physician will determine if cancer is present. If so, they will then determine how aggressive the cancer is. A scoring system, called the Gleason score, assigns the cancer a number from 2 10, with 2 being a less aggressive cancer, and 10 being a more aggressive cancer.
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How Is Each Condition Diagnosed
Youll see a specialist called a urologist to diagnose BPH or prostate cancer. Doctors use many of the same tests to diagnose both of these conditions.
- Prostate-specific antigen test:This blood test detects PSA, a protein your prostate gland makes. When your prostate grows, it produces more of this protein. A high PSA level can only tell your doctor that your prostate has grown. It cant tell for sure that you have BPH or prostate cancer. Youll need more tests to confirm the diagnosis.
- Digital rectal exam : Your doctor will insert a gloved, lubricated finger into your rectum. This test can show if your prostate is enlarged or abnormally shaped. Youll need more tests to find out if you have BPH or prostate cancer.
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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For Many Men Diagnosed With Prostate Cancer The Treatment May Be Worse Than The Disease
To screen or not to screen? For prostate cancerthe second leading cause of cancer deaths in men, after lung cancerthat is the bedeviling question.
The dilemma springs the wide variation in the potential of prostate cancers to spread to the rest of the body. The vast majority of these malignancies, especially those discovered with the extensively used prostate-specific antigen, or PSA, test, are slow-growing tumors that are unlikely to cause a man any harm during his lifetime. Yet in 10 to 15 percent of cases, the cancer is aggressive and advances beyond the prostate, sometimes turning lethal.
Use In Men Already Diagnosed With Prostate Cancer
The PSA test can also be useful if you have already been diagnosed with prostate cancer.
- In men just diagnosed with prostate cancer, the PSA level can be used together with physical exam results and tumor grade to help decide if other tests are needed.
- The PSA level is used to help determine the stage of your cancer. This can affect your treatment options, since some treatments are not likely to be helpful if the cancer has spread to other parts of the body.
- PSA tests are often an important part of determining how well treatment is working, as well as in watching for a possible recurrence of the cancer after treatment .
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How Do You Know If The Screening Isright For You
Medicare guidelines;state that youre eligible for a low-dose screening CT once a year if you are:
- Between 55-77 years of age.
- You dont have any signs or symptoms of lung cancer.
- You have a smoking history of at least 30 pack years.
- Youre a smoker or quit smoking within the last 15 years.
- You have a written doctors order.
Dr. Lamsays patients should know that there is a;slight risk of radiationexposure from a CT scan and a small chance of false-positives thatsometimes cause additional testing or surgery on a nodule thatis;non-cancerous.
But hesays the risks are worth it when weighed against the benefits of such ascreening. The National Lung Screening Trial found a;20% reduction;in lung cancer related death rates inhigh-risk patients who had CT screening over those who had chestX-rays,;he;says.
Tests Used To Check The Prostate
This first step lets your doctor hear and understand the “story” of your prostate concerns. You’ll be asked whether you have symptoms, how long you’ve had them, and how much they affect your lifestyle. Your personal medical history also includes any risk factors, pain, fever, or trouble passing urine. You may be asked to give a urine sample for testing.
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Detecting And Diagnosing Prostate Cancer
Prostate cancer is often detected during the course of a routine prostate exam and/or the PSA blood test, but diagnosing it may require other procedures.
PSA test: PSA is a protein found in prostate cells that helps to keep semen liquified. Most cases of prostate cancer develop in these cells, so an elevated PSA count may be a sign of prostate cancer. However, PSA results are more of an indicator than a firm diagnostic tooltheres not a certain PSA score that means a man has prostate cancer. Instead, there are various ranges that are considered average for different age groups. If the PSA score is elevated for your age, further testing may be recommended.
PSA levels are measured as ng/mL. According to the ACS:
- Men with a PSA level between 4 and 10 have about a 25 percent chance of having prostate cancer.
- Men with a PSA level higher than 10 have more than a 50 percent chance of having prostate cancer.
Not all men with high PSA levels have prostate cancer. High levels may also be caused by a urinary tract infection, prostatitis or benign prostatic hyperplasia, all of which are noncancerous conditions. Conversely, men with a low PSA level may still develop prostate cancer.
PSA tests are not an indication of how aggressive the prostate cancer may be. Many prostate cancers are slow-growing and dont require immediate treatment.
The National Comprehensive Cancer Network suggests these screening guidelines and recommendations for men older than 45:
To Treat Or Not To Treat
Up until now, with a few notable exceptions, doctors have myopically focused on treating prostate cancer, says Adami. They are willing to spend tens of thousands of dollars on chemotherapy that has minimal effects on cancer mortality, often with substantial side effects. But we ignore entirely the fact that large groups of prostate cancer patients die from other causes that actually are preventable.
Among older patients especially, that activity can take the form of vigorous walking. Recently, Mucci has spearheaded an intervention with Adami and other colleagues in Sweden, Iceland, and Ireland in which men walk in groups with a nurse three times a week. In a pilot study, researchers found improvements in just 12 weeks in body weight, blood pressure, sleep, urinary function, and mental health.
Scientists at HSPH are also searching for genetic and lifestyle markers that help predict how aggressive a patients prostate cancer will be. For example, an ongoing project led by Mucci and Adami draws on detailed cancer registries in Nordic countries, including an analysis of 300,000 twins, to tease out the relative contribution of different genes to prostate cancer incidence and survival.
is a Boston-based journalist and author of The Coke Machine: The Dirty Truth Behind the Worlds Favorite Soft Drink.
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Questions You May Want To Consider Asking Your Doctor Include:
- What type of prostate problem do I have?
- Is more testing needed and what will it tell me?
- If I decide on watchful waiting, what changes in my symptoms should I look for and how often should I be tested?
- What type of treatment do you recommend for my prostate problem?
- For men like me, has this treatment worked?
- How soon would I need to start treatment and how long would it last?
- Do I need medicine and how long would I need to take it before seeing improvement in my symptoms?
- What are the side effects of the medicine?
- Are there other medicines that could interfere with this medication?
- If I need surgery, what are the benefits and risks?
- Would I have any side effects from surgery that could affect my quality of life?
- Are these side effects temporary or permanent?
- How long is recovery time after surgery?
- Will I be able to fully return to normal?
- How will this affect my sex life?
- How often should I visit the doctor to monitor my condition?
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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Complication Rates After Trus
A new report from another group of Canadian researchers has reported a twofold to fourfold increase in the rate of hospital admissions in Ontario within 30 days of the procedure for men receiving a transrectal;ultrasound-guided prostate biopsy between 1996 and 2005. This is probably not a finding that will make anyone in Canada very happy.
TRUS-guided biopsy has always been associated with the development of;significant morbidity in a small proportion of patients. One might assume that there has been a vast increase in the number of TRUS-guided;biopsies in Canada over the past 15 years, and that this might help to explain why the morbidity rate associated with this procedure has been rising . However, the annual number of TRUS-guided biopsies seems to have been about the same in 1996 as it was in 2005 .
Nam et al.;carried out a population-based analysis of urological;complications associated with TRUS-guided;biopsies in the province of Ontario, Canada. Between 1996 and 2005 a total of 75,190 men had such a biopsy. These biopsies were carried;out by a relatively small number of specialist physicians . The authors used hospital and cancer registry databases to estimate the rates of hospital admission and mortality due to urological complications associated with the procedure.
They demonstrated the following results: