The Role Of The Phi Test Prior To Decisions About Prostate Biopsies
Yesterday morning, a newly published paper was brought to my attention. It reports that use of the Prostate Health Index or phi test in a partially prospective study can and did change urologists opinions about whether selected patients really do or dont need to have a prostate biopsy.
The phi test was designed to help urologists and their patients make better decisions about who really did and who really did not need a biopsy if the patient had an elevated PSA level of 4 to 10 ng/ml but no other significant indicator of risk for prostate cancer.
While this study by White et al. is not a perfect study , it may still be a very important one.
What the study did was to enroll 506 men who appeared to have some degree of risk for prostate cancer and give them a phi test. These men were individually selected by urologists practicing at one of four large, US-based, urology practice groups, if they met the following citeria:
- They had to
- Be 50 years of age
- Have a non-suspicious rectal exam
- Have a total serum PSA level of 4 to 10 ng/ml within 6 months of the DRE
And here is what the study found:
Factors That Increase Risk Of Recurrence
There are many different factors that can help you determine what your risk of recurrence is. Your doctor will go over these during the initial course of treatment, therefore stressing the importance of follow up appointments.
One factor is the involvement of your lymph nodes. If your cancer has metastasized to your lymph nodes, recurrence is more likely. Similarly, the larger the tumor, the more likely that you are to experience complications and rates of recurrence. If the tumor is intertwined or growing into other areas of your body, this also increases risk. The Gleason score is a system of grading your prostate cancer based on severity and localization. The higher the grade, the more likely youll experience recurrence. Finally, the stage of prostate cancer affects recurrence rates. When caught early, recurrence is not as likely as cancers that are in stage three or four.
Cancer can be extremely aggressive and will change your life forever. Make sure that youre doing everything you can to avoid potential problems. Eat well, exercise regularly, and get enough sleep. Strengthening your immune system is a great way to reduce your risk of recurrence.
What Factors Influence Cancer Predictions If The Psa Level Is Elevated
As previously noted, PSA rising after surgery can mean many different things in terms of the status of prostate cancer. These different prognoses are based on several different factors, outlined below:
- Gleason Score of Prostate Cancer: The Gleason score is a measure of how aggressive the cells of prostate cancer are. The higher the score, the more aggressive cancer. Men with higher Gleason scores who experience PSA recurrence are at greater risk for metastasis of prostate cancer than those men with lower Gleason scores. Is the Gleason Score 7 or less or is it 8 or higher?
- Time from Surgery: How soon after surgery the PSA reappears is one indicator specialists use to determine the aggressiveness of cancer. Generally, the longer the time between surgery and PSA recurrence, the less likely cancer is aggressive and going to spread. In turn, the better rate of survival will be. Is the time greater or less than 2 years?
- PSA Doubling Time: The term refers to the time it takes for the PSA to double in value. The value measures the rate at which the PSA rises, and can be a very significant indicator of the aggressiveness of cancer. Men with a shorter PSA doubling time postoperatively are more likely to have more aggressive disease. In these cases, a more aggressive secondary treatment plan may be advised. Is the PSA doubling in less or greater than 10 months?
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About Prostate Cancer Recurrence
Whats the prostate cancer recurrence rate? Can I do anything to prevent it? What treatment options are offered for the recurrence of prostate cancer?
Follow the paragraphs below to get the answers.
If you want to have presonalised health answer for as little as 5 usd from a real doctor
First of all, I want you to understand that the recurrence occurs after the entire treatment has been terminated. That means that tumor appears again in the same location or/and other locations .
At the same time, the recurrence rate depends on various factors. So, if a radiation therapy is used as a treament of choice, the chance of recurrent prostate cancer is highest. This area is considered the most high risk zone.
The following table will show the risk rates for different types of treatment.
Table
I want you also to realize that the risky zone comprises only 10% of the affected population. What is more, the majority may not face this scenario in their life time.
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Talking With Your Doctor
Different kinds of doctors and other health care professionals manage prostate health. They can help you find the best care, answer your questions, and address your concerns. These health care professionals include:
- Family doctors and internists
- Physician assistants and nurse practitioners
- Urologists, who are experts in diseases of the urinary tract system and the male reproductive system
- Urologic oncologists, who are experts in treating cancers of the urinary system and the male reproductive system
- Radiation oncologists, who use radiation therapy to treat cancer
- Medical oncologists, who treat cancer with medications such as hormone treatments and chemotherapy
- Pathologists, who identify diseases by studying cells and tissues under a microscope
View these professionals as your partnersâexpert advisors and helpers in your health care. Talking openly with your doctors can help you learn more about your prostate changes and the tests to expect.
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Understanding The Recurrent Prostate Cancer
Recurrent prostate cancer is when prostate cancer returns after the initial treatment or partial to complete remission has occurred. This is due to the reemergence of surviving prostate cancer cells that have grown large enough to be detected.
Following a prostatectomy, your prostate-specific antigen levels being to decrease. Eventually, they are no longer detectible, which is an indication that prostate cancer is no longer present. However, there is no clear reference for a normal PSA. It differs between men and can be affected by a number of factors. Following your initial prostate cancer treatment, PSA levels should stabilize and be low enough to where theyre not detected on blood tests. In some cases, PSA levels begin to rise again, indicating a need for further tests.
Even if youve had a prostatectomy, prostate cancer can recur in the immediately surrounding tissue, lymph nodes, seminal vesicles, muscles that control urination, the rectum, the wall of the pelvic, or metastasize into lymph nodes and bones further away.
Symptoms Of Prostate Cancer
- Frequent urge to pass urine, especially at night
- Weak or interrupted urine stream
- Pain or burning when passing urine
- Blood in the urine or semen
- Painful ejaculation
- Nagging pain in the back, hips, or pelvis
Prostate cancer can spread to the lymph nodes of the pelvis. Or it may spread throughout the body. It tends to spread to the bones. So bone pain, especially in the back, can be a symptom of advanced prostate cancer.
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How Common Is Prostate Cancer
About one in nine men will receive a prostate cancer diagnosis during his lifetime. Prostate cancer is second only to skin cancer as the most common cancer affecting males. Close to 200,000 American men receive a diagnosis of prostate cancer every year. There are many successful treatments and some men dont need treatment at all. Still, approximately 33,000 men die from the disease every year.
The Prostate Health Index And The Need For Biopsy
It will come as no great surprise to regular readers that your Sitemaster has been less than enthusiastic to date about the potential of the Prostate Health Index or phi test as a tool for assessment of risk for prostate cancer. However, new data is starting to give him slightly greater hope regarding the value of this test.
In a paper by de la Calle et al. just published in the Journal of Urology, the authors used prospective data from two independent patient cohorts in an attempt to assess the ability of the phi test to differentiate between risk for aggressive prostate cancer and risk for indolent or no cancer in a biopsy-naive population. We shall be blunt in saying that the involvement of two highly respected researchers in the development and implementation of this study gives it a stature that has not been quite so evident in some of the earlier research.
The authors used a primary cohort of 561 biopsy-naive patients from one clinical trial site and another 395 biopsy-naive patients from a secondary trial site to build and validate their hypothesis. Specifically, they then set out to compare the diagnostic specificity of the phi test to the specificity of total and %free PSA data by using prostate biopsy results, where aggressive prostate cancers were classified as those with a Gleason score of 7 or higher as opposed to indolent prostate cancers or no prostate cancer on biopsy.
Here are the core study findings from Cohort A:
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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%
Am I At Risk Of Prostate Cancer
In the UK, about 1 in 8 men will be diagnosed with prostate cancer in their lifetime. We don’t know exactly what causes prostate cancer but there are some things that may mean you are more likely to get it these are called risk factors.
There are three main risk factors for getting prostate cancer, which are things you can’t change. These are:
If you have any of these risk factors or if you have any symptoms, speak to your GP. They can talk to you about your risk, and about the tests that are used to diagnose prostate cancer. You can also get in touch with our Specialist Nurses, who can help you understand your risk of prostate cancer.
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Survival By Disease Recurrence
If a man develops an elevated PSA level after cancer surgery, then the disease is viewed as recurrent.
The number of lymph nodes at the time of prostatectomy can influence the risk of recurrence. One study suggests the removal of a large number of nodes is associated with an improvement in odds of recurrence, but this doesn’t appear to impact overall survival.
But disease recurrence doesn’t always influence survival times. If a recurrence does occur, the 15-year survival rate at the time of diagnosis may be as high as 94% in those with low-risk recurrence.
The main factors influencing survival rates are:
- The Gleason score
- The PSA doubling time
- Whether the recurrence occurred within three years or after three years
A recurrence that occurs within three years reduces survival rates by anywhere from 15 to 20%and even more, if the doubling time is short.
So What Does This All Mean
If theres anything to take away from all of this, its that theres still a lot we dont know about the g-spot .
Nonetheless, lots of people talk about g-spot orgasmsusually meaning non-clitoral orgasms. There are some things to keep in mind about that to make your journey achieving this female prostate or g-spot orgasm easier.
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After Surgery To Remove The Prostate
Following a prostatectomy, the course of treatment generally follows a similar path for all patients, with variations and adjustments made as needed based on test results, physical response, and overall progression of recovery, from both a provider and patient perspective. Almost universally among post-operative men who have had a cancerous prostate removed, levels of PSA are expected to drop, and this decrease is seen in a measurable way that follows suit.
However, prostate cancer is not limited to the borders of the gland itself, and it is commonly found to metastasize in the tissues directly surrounding the prostate, or in the nearby seminal vesicles . If cancer spreads after a prostatectomy, it is likely going to be found in one or both of these areas. It can also cause the affected individual to exhibit elevated levels of PSA, which, as youll recall, should be steadily dropping or fully depleted after surgery has been completed.
Inflammation Of The Prostate
Some studies have suggested that prostatitis may be linked to an increased risk of prostate cancer, but other studies have not found such a link. Inflammation is often seen in samples of prostate tissue that also contain cancer. The link between the two is not yet clear, and this is an active area of research.
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A Look At Prostate Stem Cells
Its now possible to ask whether there are factors that mark high-risk tumors early on. Garraway compares these tiny samples of metastatic tumor cells to non-cancerous prostate tissue, hoping they can provide a clue as to the cause of the formers aggressive behavior.
She does this by focusing on the stem cells normally found in the prostate, which can generate any cell type in this tissue . But stem cells show up in prostate tumors, too. Garraway hypothesizes that these prostate-specific stem cells might have features that make tumors more dangerous. Comparing the genes that are active in both prostate stem cells and cancers gave us ideas about how these more aggressive cancers are co-opting benign stem cell traits. The stem cells primitive embryonic-type properties can facilitate infestation and spreading, she says.
Because prostate stem cells can generate new glands, theyre really good at moving around and invading other parts of the body. And theyre more hardy. They can survive things differentiated cells cant survive, Garraway says. Theyre resistant to radiation and chemotherapy, and they can survive damage to their DNA. We think activating these survival mechanisms supports tumor initiation.
This research is still in the very early stages. Garraway calls it an example of how research and discovery is done, but it shouldnt be considered a potential new therapy for now.
Who Is More Likely To Have Prostate Cancer Recurrence
In general, the further your cancer has spread and the more aggressive it is, the more likely it is to recur. Specific factors include:
- Tumor size: In general, the larger the tumor, the more likely it is to recur.
- Gleason score: A higher Gleason score means a more aggressive cancer and a higher rate of recurrence.
- Cancer staging: Staging refers to how far the cancer has spread. Higher stage cancers have spread further at initial treatment and have higher rates of recurrence.
- Involvement of the lymph nodes: Prostate cancer that has entered the lymph nodes prior to treatment is more likely to recur.
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Understanding The Underlying Causes
For cancer researchers in general, were always seeking out the origins. Where does it start, what cells does it start in, how is it co-opting the processes of normal cells to evade the immune system or invade areas where it shouldnt be? says UCLAs Dr. Garraway. Just like other cancers, the whole idea is to understand the biology of the prostate tumors better so you can find the Achilles heel of that tumor.
The challenge, Garraway tells Ars, is that for a long time, research into what causes prostate cancer growth was focused on the indolent versions of the disease that were curable. More surgeries removed slow-growing tumors, leaving researchers with more access to these tissue samples. Metastatic patients were less likely to undergo surgery because their cancers had spread to other parts of their body, so those samples were studied less often.
For those 10 percent or so who are destined to have this metastatic disease, at least half of them already had spreading of their cancer at diagnosis, she says. They werent surgical candidates, so we werent capturing their tissues. And its a challenge to get enough tissue from a metastatic lesion.
Most men are diagnosed with prostate cancer in their senior years and only 1 out of 36 men die from it. Death from prostate cancer most often happens when cancer has spread to other organs in the body. This is known as the advanced stage of prostate cancer.