What Active Surveillance Means
For many men, prostate cancer never affects their lives, said Christopher L. Runz, DO, attending urologist at University of Maryland Shore Regional Health. Active surveillance means we actively watch the cancer and make sure it stays low-grade, which means the cancer may potentially never spread.
Active surveillance requires regular prostate specific antigen screenings and MRIs, with occasional biopsies. Men who are older and have a shorter life expectancy become candidates for active surveillance when they have a Gleason score of 7 .
How Is Prostate Cancer Diagnosed
Screenings are the most effective way to catch prostate cancer early. If you are at average cancer risk, youll probably have your first prostate screening at age 55. Your healthcare provider may start testing earlier if you have a family history of the disease or are Black. Screening is generally stopped after age 70, but may be continued in certain circumstances.
Screening tests for prostate cancer include:
- Digital rectal exam: Your provider inserts a gloved, lubricated finger into the rectum and feels the prostate gland, which sits in front of the rectum. Bumps or hard areas could indicate cancer.
- Prostate-specific antigen blood test: The prostate gland makes a protein called protein-specific antigen . Elevated PSA levels may indicate cancer. Levels also rise if you have BPH or prostatitis.
- Biopsy: A needle biopsy to sample tissue for cancer cells is the only sure way to diagnose prostate cancer. During an MRI-guided prostate biopsy, magnetic resonance imaging technology provides detailed images of the prostate.
Do You Need Surgery For Dcis Or Breast Cancer
Thats why treatment is recommended. A woman with DCIS does not need all the same treatment as a woman diagnosed with invasive breast cancer, but she does need surgery to remove the DCIS, and radiation to ensure that any stray, abnormal cells are destroyed. This lowers the risk that the DCIS will recur or that invasive breast cancer will develop.
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Treating Stage I Bladder Cancer
Stage I bladder cancers have grown into the connective tissue layer of the bladder wall , but have not reached the muscle layer.
Transurethral resection with fulguration is usually the first treatment for these cancers. But it’s done to help determine the extent of the cancer rather than to try to cure it. If no other treatment is given, many people will later get a new bladder cancer, which often will be more advanced. This is more likely to happen if the first cancer is high-grade .
Even if the cancer is found to be low grade , a second TURBT is often recommended several weeks later. If the doctor then feels that all of the cancer has been removed, intravesical BCG or intravesical chemo is usually given. If all of the cancer wasn’t removed, options are intravesical BCG or cystectomy .
If the cancer is high grade, if many tumors are present, or if the tumor is very large when it’s first found, radical cystectomy may be recommended.
For people who arent healthy enough for a cystectomy, radiation therapy might be an option, but the chances for cure are not as good.
Active Surveillance May Help Your Quality Of Life
With this approach, you have regular checkups, including a PSA test and rectal exam. Youll get a prostate biopsy if needed. You can start treatment at any time if the cancer starts to grow.
Active surveillance is a good choice for many men with low-risk prostate cancer, because they can avoid the side effects of treatment. This is an especially important choice if you are older or in poor health.
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When Is Brachytherapy Alone The Right Choice
For a patient with disease that is confined to the prostate and not too aggressive, brachytherapy alone is a good option. With the use of sophisticated real-time computer-based planning, we can use brachytherapy to deliver radiation in an extraordinarily precise way, with minimal exposure to the surrounding normal tissues. It is also convenient for the patient as it is done in an outpatient setting and most people are able to get back to work the next day.
But brachytherapy is not right for everyone. For some patients with less-aggressive disease, a watch-and-wait approach would also be very reasonable. At MSK, our philosophy is that when the disease is caught very early meaning a low PSA level, or nonaggressive disease as reflected by a Gleason score of 6 with evidence of cancer in only a few of the biopsy samples and no evidence from the MRI of a significant amount of disease then it would be very appropriate to do active surveillance and hold off on treatment.
Whats Lifeand Sexlike With Prostate Cancer
If youve completed treatment for prostate cancer, youll continue to be monitored to make sure your cancer doesnt return. Regular PSA tests are necessary.
That said, youre probably wondering about the elephant in the roomwhat about sex? Its true that treatment for this disease can radically change your sex life, but the good news is it does not have to end it. Different treatment options can trigger different side effects, and your age and health history all come into play, too. However, sexual side effects often go away, though perhaps not as soon as you would like. The Prostate Cancer Foundation says that most men see improvements within a year of surgery, for example, while the lack of sex drive that can accompany hormone therapy often resolves right after treatment ends. So remember: The road back to a healthy, active sex life is very frequently achievable.
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A Roundtable Discussion With Brian F Chapin Md Jonathan I Epstein Md And Maha Hussain Md Facp Fasco
Physician-Patient Communication Oncologist counsels patient about options for treatment of prostate cancer. Photo courtesy of Thinkstock.
Prior to ASCOs 2016 endorsement of the Cancer Care Ontario guideline on active surveillance in the management of localized prostate cancer,1 most menover 90%diagnosed with low-risk localized disease were treated with active therapy.2 Today, about 50% of American men with low-risk disease opt for active surveillance instead of therapy. In Sweden, nearly 80% of men with low-risk prostate cancer undergo surveillance rather than treatment.3
This year, approximately 165,000 men in the United States will be diagnosed with prostate cancer,4 and half of those men will have low-risk tumors that pathologists rate as Gleason 6 disease. Changes to the Gleason score grading system in 2014 by the International Society of Urological Pathology classified Gleason 6 as grade 1, putting the cancer in the very lowrisk category.
Strong evidence suggests that Gleason 6 disease, when not associated with higher-grade cancer, almost never develops into aggressive cancer requiring treatment. Thus, many patients with Gleason 6 cancer are able to sidestep therapy, such as surgery and radiation therapy, and its attendant side effects, including sexual, urinary, and bowel dysfunction, for active surveillance, which is increasingly being adopted as the standard of care for men with a Gleason 6 score.
Defining Gleason 6 Cancer
Managing Localized Prostate Cancer
Active Surveillance For Prostate Cancer Is It Right For You
HomeNews & MediaNewsActive Surveillance for prostate cancer is it right for you?
21 August 2020
If you have low risk prostate cancer, Active Surveillance is increasingly being recommended as a management option for your disease, in order to avoid unnecessary and invasive treatments when it is clinically safe to do so. Estimates suggest about 60% of low risk prostate cancers in Australia are managed with Active Surveillance. If you decide on Active Surveillance to manage your prostate cancer, it’s important to follow your surveillance protocol, in consultation with your doctor and specialists. This ensures that if your cancer starts to grow, it can be caught and treated before it spreads beyond the prostate. If you miss any tests on Active Surveillance, you increase your risks of unchecked disease progression, which could be harmful.
So, what is Active Surveillance, and is it a good treatment option for you?
How are prostate cancer treatment decisions made?
In deciding how best to treat your prostate cancer, your doctor needs to determine the type of cancer you have and how likely it is to progress to advanced disease.
Cancers that are not likely to grow and spread are considered low-risk prostate cancer, while those that are more likely to progress to advanced disease are considered high-risk prostate cancer. The grade and stage of the cancer helps determine the risk level.
To learn more about prostate cancer grading visit PCFAs website here.
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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.
Most Common Options For Treating Prostate Cancer
Prostate cancer treatments have come a long way in a very short amount of time, allowing men to choose from a wide variety of treatments tailored to their specific situation. Learn more about some of the most common options for treating prostate cancer.
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If you or a loved one has been diagnosed with prostate cancer, its important to research all of your treatment options. What worked for a friend may not be right for you, and you should choose a treatment that will provide you with the best outcome and quality of life.
Most cancers are graded from stage 1 to 4 in level of severity, but prostate cancer uses a different system called the Gleason score. In the Gleason system, prostate cancer is graded using numbers from 1 to 5. Often, prostate cancer has sections with different grades, so those grades are added together to calculate the Gleason score. The highest number on the Gleason score is 10. Your Gleason score helps determine what treatment options are possible.
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Box : Criteria For The Diagnosis Of Prostatic Adenocarcinoma9
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Major criteria
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Architectural: infiltrative small glands or cribriform glands too large or irregular to represent highgrade prostatic intraepithelial neoplasia
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Single cell layer
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Nuclear atypia: nuclear and nucleolar enlargement
Minor criteria
Intraluminal wispy blue mucin
Nuclear hyperchromasia
Before searching for these criteria, it is important to scan sections of the needle core tissue, at both lowpower and highpower magnification, in order to appreciate the architecture and cytological features of benign glands in the tissue. The arrangement of the benign glands and the nuclear appearances of the lining cells serve as important points of reference for comparison when evaluating atypical glands because there can be substantial variability between individual cases in histological characteristics because of differences in fixation, section thickness and H& E staining.
Figure 6Comedocarcinoma, highgrade Gleason pattern 5, with comedonecrosis.
Figure 8Penetration of smallgland prostatic adenocarcinoma into the seminal vesicle or ejaculatory duct wall. It is difficult to tell, on needle biopsy, whether this is definitely a seminal vesicle or an ejaculatory duct. Seminal vesicle or ejaculatory duct glands are crowded larger glands at lower right.
Figure 9Minimal adenocarcinoma. Compared with staining by haematoxylin and eosin , the 34E12 and p63 immunohistochemical stains highlight the invasion of the malignant glands, which lack basal cells .
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.
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Treating Stage Iv Bladder Cancer
These cancers have reached the pelvic or abdominal wall , may have spread to nearby lymph nodes , and/or have spread to distant parts of the body . Stage IV cancers are very hard to get rid of completely.
Chemotherapy is usually the first treatment if the cancer has not spread to distant parts of the body . The tumor is then rechecked. If it appears to be gone, chemo with or without radiation or cystectomy are options. If there are still signs of cancer in the bladder, chemo with or without radiation, changing to another kind of chemo, trying an immunotherapy drug, or cystectomy may be recommended.
Chemo is typically the first treatment when bladder cancer has spread to distant parts of the body . After this treatment the cancer is rechecked. If it looks like it’s gone, a boost of radiation to the bladder may be given or cystectomy might be done. If there are still signs of cancer, options might include chemo, radiation, both at the same time, or immunotherapy.
In most cases surgery cant remove all of the cancer, so treatment is usually aimed at slowing the cancers growth and spread to help people live longer and feel better. If surgery is a treatment option, it’s important to understand the goal of the operation whether it’s to try to cure the cancer, to help a person live longer, or to help prevent or relieve symptoms from the cancer.
Because treatment is unlikely to cure these cancers, many experts recommend taking part in a clinical trial.
What Exactly Is The Prostate
Here are some basics about the prostate:
The prostates job is to produce fluid that, together with sperm cells, makes up semen. The muscles of the prostate then provide the force needed for ejaculation.
Two smaller glands called the seminal vesicles are attached to each side of the prostate they secrete the fluid that partly comprises semen.
The prostate is the size of a walnut and weighs about an ounce.
It can be found just below your bladder and in front of your rectum.
It surrounds part of your urethra, a tube that runs from your bladder through your penis. Urine flows through your urethra when you pee.
Your prostate, then, plays an essential role in both sex and reproductionits helping to deliver sperm in search of an egg along with a great orgasm. But things can go wrong with it. The cells in your prostate can start to grow out of control. As those abnormal cells accumulate, fed by male sex hormones like testosterone, they can clump together to form cancerous tumors.
However, prostate cancer can sometimes be aggressive and fast-moving. It can spread beyond your prostate to other parts of your body. First, it may reach your prostates neighbors, like the seminal vesicles, the bladder, or your rectum. It can then move on to your lymph nodes, organs, and, commonly, your bones. Once it has traveled from the prostate, it becomes tougher to treat.
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Focal Therapy For Prostate Cancer
With recent advances in MRI and targeted biopsy, we are better able to locate the exact area of prostate cancer. Men who do not have an enlarged prostate, who have prostate cancer that is detected only in a single region of the prostate and have intermediate grade cancer can be a candidate for focal therapy. This type of therapy treats only the cancerous tissue and spares the normal prostate, thereby preserving urinary and sexual function
Here at UCLA we commonly use cryotherapy or HIFU to focally treat prostate cancer. Given that this is a relatively new form of treatment, we have established rigorous post-treatment protocols using MRI and biopsies to ensure that the cancer has been adequately treated.
Differential Diagnosis Of Adenocarcinoma In Needle Biopsy Tissue
Numerous entities, both benign and malignant, should be considered in the differential diagnosis of prostatic adenocarcinoma. Indepth discussion of these entities is beyond the scope of this review.
Recent reviews have highlighted the benign lesions or pseudoneoplasms that may mimic prostatic adenocarcinoma., Atypical adenomatous hyperplasia and atrophy are the benign conditions that are most likely to be misdiagnosed as prostatic carcinoma.,, Crowded benign glands may also be mistaken for prostatic adenocarcinoma. The pathologist should always consider the possibility of a benign mimicker of prostatic carcinoma, particularly atrophy, but also all other entities , before making a diagnosis of adenocarcinoma of the prostate.
A descriptive diagnosis which may be rendered if the histological or immunohistochemical findings are thought to be worrisome but not fully diagnostic of carcinoma, is atypia,, also known as atypical suspicious for carcinoma or atypical small acinar proliferation. Such a diagnosis is given in about 45% of all prostate needle biopsy specimens.,
The main nonprostatic, secondary malignancy to think about before diagnosing prostatic carcinoma in needle biopsy of the prostate is urothelial carcinoma involving the prostate.,
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