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Aggressive Types Of Prostate Cancer

Transitional Cell Prostate Cancer

Aggressive Prostate Cancer Treatment History and New Methods

This is also known as urothelial carcinoma. This cancer starts in the cells that line the urethra . Transitional cell cancer can start in the bladder and spread to the prostate or, more rarely, it can start in the prostate itself.

Studies of men with transitional cell prostate cancer show that PSA levels can be low or high. More research is needed before we can know whether PSA tests can help to diagnose transitional cell prostate cancer.

Men with this cancer often have difficulty urinating and find blood in their urine. This is because the cancer grows around the urethra, causing it to narrow. This means transitional cell carcinoma is often diagnosed when men have surgery called transurethral resection of the prostate to treat their urinary problems, as the tissue removed during surgery is looked at under the microscope.

If the cancer started in the prostate and has not spread outside the prostate, then you may be offered surgery and radiotherapy. If the cancer has spread to areas just outside the prostate or to more distant areas of the body such as the bones then chemotherapy and/or radiotherapy may be an option.

Your doctor or nurse will tell you what treatment options are available to you. Read more about how these cancers are treated below.

Alterations In The Dna

Emerging clinically relevant subcategories in AVPCa include disease that demonstrates not only NE differentiation but also tumors with somatic and/or germline alterations in the DNA repair pathway . Identification of these subtypes has direct clinical relevance with regard to the potential benefit of platinum-based chemotherapy, poly polymerase inhibitors, and likely further therapies as new therapeutic targets are identified in these groups .

A recent study by Aparicio et al. dealt with AVPCa, defined by them as a clinically defined subset of the disease that shares virulent and atypical clinical features and chemotherapy sensitivity with the small cell prostate carcinomas . They observed that clinically defined AVPC shares molecular features with SmCC and is characterized by combined alterations in RB1, Tp53 and/or PTEN. According to the authors, such molecular signature accounts for the shared clinical features, resistance to AR inhibition and chemotherapy sensitivity and should serve as the foundation for a biologically-defined therapeutically relevant classification of prostate cancer .

Aggressive And Nonaggressive Types Of Prostate Cancer

by Dr. Sanjiv Khanse | Cancer

Prostate cancer is the second most common cause of cancer in American men after skin cancer. It is still a lethal disease considering that it is the second leading cause of death due to cancer among men in the U.S. with about 94 men dying from it every day.

It is necessary for your doctor to understand the type of prostate cancer you may have. It helps in the treatment process.

Low-risk prostate cancer grows slowly and is not likely to spread quickly. High-risk prostate cancer is aggressive and likely to spread quickly outside the prostate to the other parts of the body.

There are different types of prostate cancer. The most common type is called acinar adenocarcinoma.

Other prostate cancers are rare and include prostate sarcomas, neuroendocrine tumors, small cell carcinomas, transitional cell carcinomas, and squamous cell carcinomas. Because they are so rare, not much research has been done on them.

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Who Is At Risk Of Prostate Carcinoma

Scientists havent found the exact cause for prostate malignancy. But, like any other carcinoma, prostate cancer can develop in individuals with a family history of the disease or constant exposure to dangerous chemicals.

Whatever is causing the problem will trigger a cell mutation. This mutation is the one that causes the disease. Although prostate carcinoma can happen in any man, certain risk factors can make them more susceptible to the disease. These factors are:

  • Obesity
  • Old age
  • Ethnicity

For example, African Americans are found to have the highest risk of this particular illness. Also, those who are obese can become more vulnerable to the disease. Thats where understanding the risk factors could prove useful. It may help lessen the risk, particularly in older adults.

Initial Treatment Of Prostate Cancer By Stage

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The stage of your cancer is one of the most important factors in choosing the best way to treat it. Prostate cancer is staged based on the extent of the cancer and the PSA level and Gleason score when it is first diagnosed.

For prostate cancers that haven’t spread , doctors also use risk groups to help determine treatment options. Risk groups range from very low risk to very high risk, with lower risk group cancers having a smaller chance of growing and spreading compared to those in higher risk groups.

Other factors, such as your age, overall health, life expectancy, and personal preferences are also taken into account when looking at treatment options. In fact, many doctors determine a mans possible treatment options based not just on the stage, but on the risk of cancer coming back after the initial treatment and on the mans life expectancy.

You might want to ask your doctor what factors he or she is considering when discussing your treatment options. Some doctors might recommend options that are different from those listed here.

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Various Types Of Prostate Cancer You Should Know About

Researchers have identified 5 unique types of prostate carcinoma. Learning about their differences can help people understand how the tumor is growing and spreading, including how to manage the health issue.

Knowing the stage boosts your chances for recovery. Take a look at the different aggressive and non-aggressive forms of cancer to find out more.

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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Blood In Semen Or Urine

One of the prevalent symptoms of prostate cancer is the appearance of blood in urine or semen. Finding blood in semen or urine is not normal, and in the eventuality that this occurs, seeking advice from a healthcare provider is important. The bloody semen and urine might not be due to prostate cancer, but in any case, it could mean that there is an issue such as inflammation or infection.

How To Diagnose The Carcinoma

Assessing aggressive prostate cancers using a genetic test

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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Transrectal Magnetic Resonance Imaging

This test is done to see whether the cancer has spread to other tissues that are nearby apart from the prostate. The test uses radio waves, a magnet, and a computer to create pictures of your bodys internal parts. This test uses a probe that is inserted inside your rectum. Through this test, your doctor can see your prostate and the tissues nearby.

Types Of Prostate Cancer Cell

Prostate tumors contain a variety of cell types, each posing a different level of risk.

The UEA scientists set out to develop a classification system for the most common cell types based on patterns of gene activity, known as gene expression pattern.

Their previous research used some complex math called Latent Process Decomposition to identify the unique molecular signature of an aggressive expression pattern they call DESNT.

In their new work, they analyzed patterns of gene expression in 1,785 tumor samples. They then correlated the amount of DESNT in each tumor sample with the outcome of the disease for that individual.

The researchers found that the more DESNT cells a sample contained, the more likely it was that the cancer would metastasize.

At the same time, the researchers identified three other prostate cancer molecular subtypes, making it a total of four categories of gene expression patterns in prostate cancer.

In the future, they hope to develop a classification system based on the four cell types that will not only help identify people whose cancers will metastasize but also predict their response to different drug treatments.

They note that a similar classification system for breast cancer has been developed using the same mathematical technique and is already being used to guide treatment.

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Prostate Cancer Is Generally Slow

Most prostate cancers are relatively slow-growing. This means that a prostate tumor typically takes many years to grow and reach a size that is detectable. Likewise, it usually takes even a longer time for prostate cancer to spread beyond the prostate. Nevertheless, in a small percentage of men, prostate cancer can grow rapidly and spread aggressively to other areas. Because of this, it is quite difficult to know with certainty which prostate cancers are likely to grow slowly and which ones are likely to grow aggressively. It can be quite difficult to make the right treatment decisions.

Terminology And Definition Of The Aggressive Variant Prostate Cancer


The terminology of the aggressive variant of CRPC lacks consensus among experts.

These aggressive tumors have been called Anaplastic Prostate Cancer and Anaplastic Prostate Carcinoma . The term APCa is not accepted by pathologists because the word anaplastic is a well-recognized term used to refer to pleomorphic cytology . “Anaplastic” is used to describe clinical features, and does not imply a histologic correlate that might not be present in the morphologic spectrum of this disease .

The term Neuroendocrine prostate cancer has also been used to refer to this group of tumors . This term is debated as a way to describe this phenotype with a clinical aggressive course. It implies that a predominantly neuroendocrine histology or small cell carcinoma is present in tissue samples, when it is known that many of such cases do not show typical morphology or immunohistochemical profiles of NE differentiation .

The term Intermediate Atypical Prostate Cancer has also been used to refer to CRPCa in men who develop mixed pathologic and molecular features overlapping with NEPCa . However, the term is not accepted in the uro-oncology community because it does not reflect the whole clinical, morphological and molecular spectrum of the rapidly progressive disease.

  • Histologic evidence of small-cell NEPCa

  • The presence of exclusively visceral metastases

  • Radiographically predominant lytic bone metastases by plain x-ray or CT scan

  • elevated serum LDH ,

  • malignant hypercalcemia,

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    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,” Dr. Aggarwal said. “The 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.

    Emergence Of The Neuroendocrine Subtype

    Potent hormone therapies like abiraterone and enzalutamide can be effective treatments for men with castrate-resistant prostate cancer. However, almost all men eventually develop drug resistance to these agents.

    In some cases, the drug-resistant cancer may look and behave differently than the original cancer, so much so that it is considered a different subtype of the disease. For example, some men who were originally diagnosed with adenocarcinoma prostate cancer develop t-SCNC after treatment with abiraterone or enzalutamide.

    Under the microscope, t-SCNC looks quite different from adenocarcinoma: the cells are smaller and more crowded together. And compared to adenocarcinoma prostate tumors, tumors of the t-SCNC subtype are thought to have less hormone signaling and lower prostate-specific antigen.

    In addition, t-SCNC shares some features with a small-cell neuroendocrine subtype of prostate cancer that appears in less than 1% of men with newly diagnosed prostate cancer.

    To understand how frequently t-SCNC develops after hormone treatment, Dr. Aggarwal and his colleagues analyzed metastatic tumor samples from 202 men with castrate-resistant prostate cancer who had received treatment at multiple institutions. The samples were obtained from metastatic tumors in the bone, lymph nodes, liver, or other soft tissues.

    The anatomical site where the metastatic tumor sample had been taken did not appear to affect the frequency of the neuroendocrine subtype, the researchers found.

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    Screening For Prostate Cancer

    There are no tests available with sufficient accuracy to screen populations of men for early signs of prostate cancer. However, early detection and treatment can significantly improve prostate cancer survival.

    The test most commonly used to aid early detection of prostate cancer is the prostate specific antigen blood test. This is not a diagnostic test as it can only indicate changes in the prostate. If you are concerned about prostate cancer you should talk to your doctor and make an informed choice about whether to have one of the tests designed to find early signs of prostate cancer, in view of the potential risks and benefits.

    There are no proven measures to prevent prostate cancer.

    What Are The Treatment For Prostate Cancer

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    Treatment possibilities differ, depending on the stage, symptoms of prostate cancer, and how aggressive the cells are.

    Surgery and radiation therapy are both great treatment options for attempting to eliminate prostate cancer. They are the two most validated therapies for prostate cancer and both have shown long-term cancer management and recovery.

    Although radiation and surgery have never been compared in a clinical trial, they have closely related success rates of cancer control and cure. They also have almost the same effects on a patients post-treatment quality of life with similar chances of erectile and urinary problems. Both radiation and surgery are wonderful treatment options for prostate cancer.

    People who feel uncertain about the best treatment for their unique situation may find some clarity by consulting with a radiation oncologist and urologic surgeon to understand the pros and cons of each treatment.

    The most important part of the journey is to become educated about the different types of prostate cancer, treatment options, and for each patient to determine the best treatment protocol for his particular circumstances and risk sensitivity.

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    About Rare Prostate Cancers

    Although prostate cancer is a common cancer in men, there are different types of prostate cancer, and some of these are rare. Because they are rare, we dont know as much about them. If you are diagnosed with one of the cancers mentioned here, speak to your doctor or nurse about what that means and what treatments are suitable for you.

    Like most things in our body, the prostate is made up of different types of cells . The type of cancer that develops depends on the cell it starts in.

    The most common type of prostate cancer starts in some of the cells that line the prostate, called glandular epithelial cells. There are two types of gland cells basal cells and luminal cells . Prostate cancer can develop in either of these cells.

    When we talk about common prostate cancer here, we mean this type of prostate cancer. You may hear it called adenocarcinoma or acinar adenocarcinoma or see this written in your biopsy results .

    Rarer types of cancer can also develop from gland cells, or from other types of cells in the prostate.

    Some men have more than one type of prostate cancer. For example, they may have some common prostate cancer as well as a rare cancer.

    Some of the rare cancers may be more aggressive than common prostate cancer. This means they may grow faster and are more likely to spread outside the prostate.


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