Diagnosing Rare Prostate Cancers
Rarer prostate cancers can be harder to diagnose. For example, some dont cause your prostate specific antigen level to rise. This means theyre not always picked up by a PSA test. Because of this, some rare cancers may not be diagnosed until they have already spread outside the prostate. Read more about the PSA test and other tests used to diagnose prostate cancer.
Some rare prostate cancers may only be picked up after having a biopsy to check for prostate cancer, or surgery called transurethral resection of the prostate to treat an enlarged prostate. The tissue removed during the biopsy or TURP is looked under a microscope to see if you have common prostate cancer or a rare type of prostate cancer. Rare cancers arent always given a Gleason score after a biopsy. This is because they can behave differently to common prostate cancer and cant be measured in the same way.
Because rare cancer can be aggressive and spread outside the prostate, you will probably have more tests to see if they have spread. These include:
Biggest Risk Of Aggressive Prostate Cancer Falls On Older And African American Men
- Biggest Risk of Aggressive Prostate Cancer Falls on Older and African American Men
The findings represent the first suggestion that these two demographic groups might benefit the most from PSA testing, which is designed to detect the cancer at an early stage, described in clinical terms as T1cN0M0. Physicians usually cannot feel tumors at this point, and they do not show up on imaging studies or cause symptoms. The URMC study indicates that a significant number of elderly and black men might be harboring an aggressive cancer that can only be diagnosed through a PSA test.
Lead author Hong Zhang, M.D., Ph.D., associate professor of Radiation Oncology at URMC and chief of Radiation Oncology at Highland Hospital, was invited to present the data at a Genitourinary Cancers Symposium organized by the American Society of Clinical Oncology in conjunction with the American Society of Radiation Oncology and the Society of Urologic Oncology, on Feb. 14-16, 2013, in Orlando. ASCO chose to showcase the URMC research at the meetings press program.
PSA screening is a controversial issue. In 2012 the U.S. Preventive Services Task Force recommended against PSA screening in all men although a subsequent report from ASCO said that for men with a life expectancy of more than 10 years, the test has benefits that might outweigh the drawbacks.
Aggressive Prostate Cancer Diagnoses On The Rise
Jason M. BroderickUrology Times Journal
The downgrade of PSA screening over the past 15 years has reduced the overdiagnosis and overtreatment of low-grade prostate cancer however, there has been a simultaneous increase in the rate of metastatic cancer at diagnosis, according to a study published in the Journal of the National Cancer Institute.1,2
To our knowledge, this is the first study to demonstrate nationally that low-grade prostate cancer is no longer the most commonly diagnosed type of prostate cancer, senior author Jim Hu, MD, MPH, the Ronald P. Lynch Professor of Urologic Oncology at Weill Cornell Medicine and director of the LeFrak Center for Robotic Surgery at NewYork-Presbyterian/Weill Cornell Medical Center, stated in a news release. One of the weaknesses of PSA/prostate cancer screening was that it led to over-detection of indolent cancers that would not harm men, subjecting them to anxiety and future testing.
With their study, Hu et al sought to determine the overall impact of the screening downgrade on Gleason Grade Group at diagnosis and radical prostatectomy pathology. Using the SEER Registry Database, the researchers identified 438,432 men with newly diagnosed prostate cancer in the period from 2010 to 2018.
References
1. Less Prostate Cancer Screening Reduces Overdiagnosis but May Miss Aggressive Cases. Published online April 22, 2022. Accessed April 22, 2022. https://bit.ly/3w1iSnx.
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Initial Treatment Of Prostate Cancer By Stage
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 havenât 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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What Makes Prostate Cancer Become Aggressive Study Investigates
They suggest that the finding could help predict disease aggressiveness, improve personalized treatments, and open the door to precision medicine for advanced prostate cancer.
In a study paper now published in the journal Cell, they describe how they investigated a genomic variant known to be linked to aggressive prostate cancer.
Using state-of-the-art tools, they confirmed the link in a large group of people with prostate cancer.
They also identified how the variant influences a genetic circuit involving three genes that could potentially drive the disease to an incurable stage.
The genomic variant is a difference in a DNA building block located in chromosome 19q13 that is known as the single nucleotide polymorphism rs11672691.
Previous studies had already linked this particular variant to aggressive prostate cancer. But they did not explain how the link worked.
Comparing the order in which millions of DNA building blocks occur in the human genomes of any two individuals would reveal hardly any differences. But where they do occur, these differences or variants can give rise to disease.
How human genomic variants, says senior study author Gong-Hong Wei, a professor in the Faculty of Biochemistry and Molecular Medicine at the University of Oulu in Finland, cause disease and its progression is in general one of the most compelling puzzles and questions in medicine.
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Where Prostate Cancer Spreads
If left untreated, diagnosed prostate cancer can grow and possibly spread outside of the prostate to local tissues or distantly to other sites in the body. The first sites of spread are typically to the nearby tissues.
The cancer can spread down the blood vessels, lymphatic channels, or nerves that enter and exit the prostate, or cancer could erode directly through the capsule that surrounds the prostate.
The seminal vesicles are a site of particularly common early spread. More extensive local spread can occur with cancer invading the nearby bladder or rectum.
Further advancement of cancer can occur when cancer cells enter the blood vessels and lymphatic channels. Once cancer has entered into these vessels, prostate cancer cells can seed into virtually any other part of the body.
Prostate cancer is known to have a particular affinity for spreading or metastasizing to the bones especially the lower spine, pelvis, and femur. Other organs such as the liver, brain, or lungs can also be the sites of spread, but these are much rarer.
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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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What Are The Treatment Options For Low
Men with low-risk prostate cancer have four treatment options: active surveillance, external radiotherapy, internal radiotherapy and surgery to remove the prostate.
- Active surveillance involves monitoring the prostate cancer, and only treating it if there are signs that it is progressing. This approach is based on the fact that low-risk prostate cancer often grows very slowly or doesnt grow at all, so treatment often isnt needed.
- In external radiotherapy, the cancer is exposed to radiation from outside the body, through the skin.
- In internal radiotherapy , the cancer is exposed to radiation from slightly radioactive seeds that are implanted inside the body.
- The aim of surgery wird is to remove the tumor, together with the whole prostate, seminal vesicles and outer capsule.
Radiation and the surgical removal of the prostate are also referred to as curative treatments because the aim is to remove all of the tumor cells. But a few cancer cells may stay in the body, or new cancer cells might develop. For this reason, men who have had radiotherapy or surgery are still advised to have regular PSA tests.
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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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Genetic Features Of Neuroendocrine Tumors
The researchers also examined patterns of gene expression in the t-SCNC tumors and compared them with those of adenocarcinoma tumors. This analysis identified a group of 61 genes that were expressed differentially between the two subtypes. The investigators also identified the topmost upregulated master regulatorsproteins that control hundreds or thousands of other genes that are critical for cancer growth and survivalin the t-SCNC tumors.
Based on these findings, the researchers developed a unique pattern of gene expressioncalled a signaturefor t-SCNC tumors that correctly distinguished t-SCNC tumors from adenocarcinoma prostate tumors in separate sets of tumor samples.
The validated signature has several potential clinical uses, said Dr. Aggarwal, such as to identify genes or pathways that potentially can be targeted by drugs. And if effective drugs become available, the signature could also be used to help diagnose t-SCNC prostate tumors in cases where a traditional tumor biopsy is not possible or would be unreliable, he added.
Taken together, these findings suggest that t-SCNC tumors may have unique molecular characteristics that can potentially be targeted by drugs, Dr. Aggarwal explained.
Prostate Cancer Risk Groups
In addition to stage, doctors may use other prognostic factors to help plan the best treatment and predict how successful treatment will be. Examples of these include the National Comprehensive Cancer Network risk group categories and the Cancer of the Prostate Risk Assessment risk score from University of California, San Francisco.
Information about the cancers stage and other prognostic factors will help the doctor recommend a specific treatment plan. The next section in this guide is Types of Treatment. Use the menu to choose a different section to read in this guide.
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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.
Does Overdiagnosis Lead To Overtreatment Of Older Men
The widespread use of PSA screening has led to an increase in the diagnosis and treatment of early localized prostate cancer. Data from the US Cancer of the Prostate Strategic Urological Research Endeavor database suggest a significant decrease in risk in the last 2 decades in the United States, with more patients being identified with low-risk disease at diagnosis, but the role of active treatment of low- and intermediate-risk disease in elderly men remains controversial.
The median time from diagnosis to death from prostate cancer for men with nonpalpable disease is approximately 17 years., Considering that the US male life expectancy at the age of 65 years is 16 years, aggressive therapy will hardly extend life expectancy of older men with no palpable prostate cancer at the time of diagnosis. Twenty to 30% of prostate cancers detected by PSA screening programs show Gleason scores of 6 or lower and, thus, are not poorly differentiated and have volumes smaller than 0.5 cm3.
Histologic evaluation of radical prostatectomy specimens demonstrated that about 20% to 30% of cancers are small volume, show low Gleason scores, and are consequently clinically harmless., Many of these cancers pose little threat to life, especially for older men. Has PSA screening resulted in prostate cancer overdiagnosis?
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Hormonal Therapy For Aggressive Prostate Cancer: How Long Is Enough
- By Charlie Schmidt, Editor, Harvard Medical School Annual Report on Prostate Diseases
Men weighing treatment options for intermediate- or high-risk cancer that is still localized to the prostate can face a tricky question. A standard approach in these cases is to give radiation to the prostate along with drugs that block testosterone, a hormone that makes the cancer cells grow faster. For how long should this hormone therapy last? Thats not entirely clear. The drugs have side effects, such as fatigue, impotence, and a loss of muscle mass. But radiation doesnt control prostate cancer effectively without them. Doctors therefore aim to give hormone therapy only for as long as it takes to help their patients, without causing any undue harm.
Now, newly published results from a phase 3 clinical trial are providing some needed guidance.
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Active Surveillance And Watchful Waiting
If prostate cancer is in an early stage, is growing slowly, and treating the cancer would cause more problems than the disease itself, a doctor may recommend active surveillance or watchful waiting.
Active surveillance. Prostate cancer treatments may seriously affect a person’s quality of life. These treatments can cause side effects, such as erectile dysfunction, which is when someone is unable to get and maintain an erection, and incontinence, which is when a person cannot control their urine flow or bowel function. In addition, many prostate cancers grow slowly and cause no symptoms or problems. For this reason, many people may consider delaying cancer treatment rather than starting treatment right away. This is called active surveillance. During active surveillance, the cancer is closely monitored for signs that it is worsening. If the cancer is found to be worsening, treatment will begin.
ASCO encourages the following testing schedule for active surveillance:
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A PSA test every 3 to 6 months
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A DRE at least once every year
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Another prostate biopsy within 6 to 12 months, then a biopsy at least every 2 to 5 years
Treatment should begin if the results of the tests done during active surveillance show signs of the cancer becoming more aggressive or spreading, if the cancer causes pain, or if the cancer blocks the urinary tract.
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Risk Of Prostate Cancer
About 1 man in 8 will be diagnosed with prostate cancer during his lifetime.
Prostate cancer is more likely to develop in older men and in non-Hispanic Black men. About 6 cases in 10 are diagnosed in men who are 65 or older, and it is rare in men under 40. The average age of men at diagnosis is about 66.