Diagnosis And Treatment At Miskawaan Integrated Cancer Care
At Miskawaan Integrative Cancer Care, we deliver unique treatments to every patient that maximize the outcomes of conventional oncology while minimizing the side effects.
We diagnose prostate cancer through:
- Metavectum Tumor Therapy Test
- Edim Technology
Early detection of prostate cancer helps us employ precise prostate cancer treatment methods.
Our health care professionals are ready to take you through individualized treatment options. Contact Us Today.
American Cancer Society Guideline For Early Prostate Cancer Detection
The ACS recommends that asymptomatic men who have at least a 10-year life expectancy should have an opportunity to make an informed decision with their health care provider about whether to be screened for prostate cancer, after receiving information about the uncertainties, risks, and potential benefits associated with prostate cancer screening. Prostate cancer screening should not occur without an informed decision-making process. Men at average risk should receive this information beginning at age 50 years. Men at higher risk, including African American men and men who have a first-degree relative diagnosed with prostate cancer before age 65 years, should receive this information beginning at age 45 years. Men at appreciably higher risk should receive this information beginning at age 40 years. Men should either receive this information directly from their health care providers or be referred to reliable and culturally appropriate sources. Patient decision aids are helpful in preparing men to make a decision whether to be tested. For men who are unable to decide, the screening decision can be left to the discretion of the health care provider, who should factor into the decision his or her knowledge of the patient’s general health preferences and values.
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Table 3 Harm Outcomes
| Loeb et al. and Nam et al.28,29 | High |
The core age group, 136,689 screening tests were performed . Of these tests, 16.6% were positive, and 85.9% of the men with positive tests underwent prostate biopsy.
*The quality of evidence means how much confidence we have in the reported quantitative estimate. It does not mean the methodological quality of the study although the latter is one factor that affects confidence in the estimate.
Screening For Prostate Cancer
Australia has the highest incidence of prostate cancer in the world and 1 in 25 Australian men will die from it. Consequently, there has been significant debate in the past few decades testing) over the use of population screening programmes for prostate cancer.
There is not enough evidence currently to support screening men with no symptoms of prostate cancer. While early detection of prostate cancer is advantageous, screening has not been shown to reduce mortality or improve outcomes. There is also the risk of harm from further investigations, complications of treatment and psychological stress of false positive test results.
Australian guidelines recommend investigating for prostate cancer on a case by case basis with discussion of risks, benefits and alternatives. It is advised that men consider getting tested for prostate cancer from age 50. Men with significant risk factors for prostate cancer may require screening from age 4045. Men wishing to be screened for prostate cancer should see their general practitioner.
Prostate specific antigen test Prostate specific antigen is a protein that is produced by the cells of the prostate gland and can be detected by a simple blood test. PSA has been shown to be elevated 510 years prior to clinically evident prostate cancer.The use of PSA as a screening tool for prostate cancer became common in the 1990s, leading to a significant increase in the incidence of diagnosed prostate cancer.
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Benefits Of Screening In Studies Have Not Been Clear
Doctors are still studying if screening tests will lower the risk of death from prostate cancer. The most recent results from 2 large studies were conflicting, and didnt offer clear answers.
- Early results from a large study done in the United States found that annual screening with PSA and DRE did detect more prostate cancers than in men not screened, but this screening did not lower the death rate from prostate cancer. However, questions have been raised about this study, because some men in the non-screening group actually were screened during the study, which might have affected the results.
- A European study did find a lower risk of death from prostate cancer with PSA screening , but the researchers estimated that about 781 men would need to be screened to prevent one death from prostate cancer.
- Neither of these studies has shown that PSA screening helps men live longer overall .
Prostate cancer is often slow-growing, so the effects of screening in these studies might become clearer in the coming years. Both of these studies are being continued to see if longer follow-up will give clearer results. Prostate cancer screening is being studied in several other large studies, as well.
Getting A Prostate Biopsy
For some men, getting a prostate biopsy might be the best option, especially if the initial PSA level is high. A biopsy is a procedure in which small samples of the prostate are removed and then looked at under a microscope. This test is the only way to know for sure if a man has prostate cancer. If prostate cancer is found on a biopsy, this test can also help tell how likely it is that the cancer will grow and spread quickly.
For more details on the prostate biopsy and how it is done, see Tests to Diagnose and Stage Prostate Cancer.
For more information about the possible results of a prostate biopsy, see the Prostate Pathology section of our website.
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Screenings To Detect Prostate Cancer Early
One of the best ways to detect prostate cancer early is through screening testing to find the disease in men with no prostate cancer symptoms.
Screening can help find some types of cancer at an early stage, when they may have a better prognosis. In fact, screening alone is credited for one-third of the recent decrease in prostate cancer deaths.
The two most common screening tests for prostate cancer are:
- Digital rectal exam
- Prostate-specific antigen test
Talk with your doctor about the benefits and risks of these screenings. Decisions should be based on:
- Your individual prostate cancer risk
- Your overall health and life expectancy
- Your desire for treatment if you are diagnosed with the disease
For a DRE, a doctor inserts a gloved, lubricated finger into your rectum to:
- Feel your prostate gland.
- Assess the texture of the back of the gland, where most prostate cancers begin.
- Check for any bumps or hard areas that might be cancer.
This exam usually isnt painful and only takes a few seconds.
Since the PSA test was introduced in the late 1980s, doctors have commonly used it along with a DRE to screen for prostate cancer. Because the DRE can sometimes find cancers in men with normal PSA levels, Seattle Cancer Care Alliance recommends men 55 or older talk to their doctor about whether DRE is right for them. For some men, such as African-Americans or those with a family history of cancer, doctors may recommend screenings starting at an earlier age.
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Guideline Development And Methods
The process began by commissioning a series of systematic evidence reviews. The three broad content areas included early detection of prostate cancer, harms of therapy for localized prostate cancer, and shared and informed decision making in prostate cancer screening.
Within the domain of early detection of prostate cancer, search strategies addressed the following subdomains: 1) efficacy of screening in reducing mortality from prostate cancer 2) test characteristics of prostate cancer screening in asymptomatic men, including sensitivity, specificity, and predictive value and 3) physical and psychological harms associated with screening. Abstracted information included the study setting and design, screening test, participant characteristics , study arms , proportion of participants screened, follow-up duration, confirmatory tests, outcome measures , and measure of associations . For the subdomain of screening harms, information on methods used for measuring harms was abstracted.
Can Prostate Cancer Be Found Early
Screening is testing to find cancer in people before they have symptoms. For some types of cancer, screening can help find cancers at an early stage, when they are likely to be easier to treat.
Prostate cancer can often be found early by testing for prostate-specific antigen levels in a mans blood. Another way to find prostate cancer is the digital rectal exam . For a DRE, the doctor puts a gloved, lubricated finger into the rectum to feel the prostate gland. These tests and the actual process of screening are described in more detail in Screening Tests for Prostate Cancer.
If the results of either of these tests is abnormal, further testing is often done to see if a man has cancer.
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Psa Screening Risks And Benefits
In recent years, PSA screening has come under fire because of concerns that it has led to overdiagnosis and overtreatment. At SCCA, we believe there are several good reasons to continue PSA screening.
PSA screening has yielded a dramatic transformation in how prostate cancer patients present meaning, the status of their disease when they first get the diagnosis. More men begin care with early-stage and potentially curable disease.
PSA screening has likely saved many lives, but it also uncovers many cases of prostate cancer that may not need to be treated. The main harm in screening is not the PSA test itself but the possibility that the results may lead to overtreatment of low-risk cancers in older men.
Men who are younger and appear to be healthy are most likely to benefit from screening that leads to early detection and treatment. Some low-risk prostate cancers can be carefully followed with active surveillance rather than treated initially with the typical more aggressive measures.
Most importantly, there is no doubt that prostate cancer deaths have decreased by about 40 percent since the advent of PSA screening, as shown in a National Cancer Institute investigation.1
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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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Expert Review And References
- Prostate cancer. American Cancer Society. American Cancer Society . Atlanta, GA: American Cancer Society 2013: .
- Andriole GL, Crawford ED, Grubb RL 3rd, et al. Prostate cancer screening in the randomized Prostate, Lung, Colorectal, and Ovarian Cancer Screening Trial: mortality results after 13 years of follow-up. Journal of the National Cancer Institute. 2012.
- National Cancer Institute. Prostate Cancer Screening Health Professional Version. Bethesda, MD: National Cancer Institute 2014: .
- Scher HI, Scardino PT, Zelefsky. Cancer of the prostate. DeVita VT Jr, Lawrence TS, Rosenberg SA. Cancer: Principles and Practice of Oncology. 10th ed. Philadelphia: Wolters Kluwer Health/Lippincott Williams & Wilkins 2015: 68:932-980.
- Tangen CM, Neuhouser ML, Stanford JL. Prostate cancer. Thun MJ . Schottenfeld and Fraumeni Cancer Epidemiology and Prevention. 4th ed. New York, NY: Oxford University Press 2018: 53:997-1018.
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Vitamin E And Selenium
In a clinical study known as the SELECT trial, researchers studied whether selenium and vitamin E, taken together or alone, could help prevent prostate cancer.
As reported in the 2011 results, men who took vitamin E supplements alone had a 17 percent relative increase in prostate cancer. For this reason, we suggest you avoid taking vitamin E supplements and focus instead on consuming foods rich in vitamin E. These include nuts , vegetable oils , seeds, wheat germ, whole grain products, and spinach and other dark, green leafy vegetables.
As reported in the studys 2008 and 2011 results, there were more cases of diabetes in men taking only selenium, and men taking selenium alone or in combination with vitamin E were more likely to develop prostate cancer. The findings were not statistically significant and cannot be definitely linked to selenium. However, we recommend against taking selenium supplements. The best source of selenium is food. Foods rich in selenium include Brazil nuts, wheat germ, bran, brown rice, whole wheat bread, barley, onions, garlic, turnips, soybeans, mushrooms, fish, and eggs.
Positron Emission Tomography Scan
A PET scan is similar to a bone scan, in that a slightly radioactive substance is injected into the blood, which can then be detected with a special camera. But PET scans use different tracers that collect mainly in cancer cells. The most common tracer for standard PET scans is FDG, which is a type of sugar. Unfortunately, this type of PET scan isnt very useful in finding prostate cancer cells in the body.
However, newer tracers, such as fluciclovine F18, sodium fluoride F18, and choline C11, have been found to be better at detecting prostate cancer cells.
Other newer tracers, such as Ga 68 PSMA-11 and 18F-DCFPyl , attach to prostate-specific membrane antigen , a protein that is often found in large amounts on prostate cancer cells. Tests using these types of tracers are sometimes referred to as PSMA PET scans.
These newer types of PET scans are most often used if its not clear if prostate cancer has spread. For example, one of these tests might be done if the results of a bone scan arent clear, or if a man has a rising PSA level after initial treatment but its not clear where the cancer is in the body.
The pictures from a PET scan arent as detailed as MRI or CT scan images, but they can often show areas of cancer anywhere in the body. Some machines can do a PET scan and either an MRI or a CT scan at the same time, which can give more detail about areas that show up on the PET scan.
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Benefits/harms Of Implementing The Guideline Recommendations
- Appropriate use of prostate cancer screening
- An approach to prostate-specific antigen based prostate cancer screening has to take into account the controversies surrounding available data and the fact that over a decade the benefits are modest in terms of prostate cancer deaths averted 1 death per 1,000 men screened in the European Randomized Study of screening for Prostate Cancer. However the relative benefit could be very meaningful at the population level. The potential benefits of screening could extend beyond survival as a primary outcome, and will depend on the relevant time horizon for an individual. Further, disconnecting screening from automatic treatment will significantly impact the risk benefit ratio.
Refer to the “Benefits of PSA Screening” section in the original guideline document for additional discussion.
Harms from Screening
Refer to the “Harms” section in the original guideline document for additional discussion.
Harms Of Active Surveillance And Watchful Waiting
On the basis of reports of excellent outcomes for low-grade and medium-grade prostate cancer that is managed conservatively, and on concerns regarding the high rate of overdiagnosis in such cases, active surveillance has emerged over the past decade as an increasingly used management option. Active surveillance refers to the process of regularly monitoring disease activity through clinical parameters and possibly periodic rebiopsy, with active treatment offered to men whose disease appears to be progressing. This differs from watchful waiting, which generally implies less aggressive surveillance and no treatment until progressive symptoms or evidence of metastatic disease develop. The principal benefit of active surveillance is its capacity to reduce overtreatment, that is, the treatment of disease that would not have become apparent clinically during the patient’s lifetime, which is particularly problematic for less aggressive tumors. Early reports with follow-up as long as 8 years cite prostate cancer-specific survival rates and metastasis-free survival rates of 99% to 100%., However, based on the ERSPC finding that the mortality benefit from screening and treatment started to accrue only at 9 to 10 years after randomization, it is premature to gauge the effectiveness of active surveillance compared with immediate treatment.
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