Future Predictors Of Prostate Cancer
Researchers are seeking more accurate ways of diagnosing, monitoring, and treating prostate cancer. Many of the studies focus on genes and genetic abnormalities of a cancer. Scientists have found that the product of a certain gene appears more often in advanced prostate cancers than in early stage prostate cancers. Now the goal is to determine if the presence of this gene product means that a cancer is more aggressive. Knowing this information can help doctors decide which patients may benefit from immediate treatment, and of what type. This and other genetic research will pave the way for earlier, more accurate predictors of cancer growth.
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.
Prostate Cancer Lives As It Is Born: Slow
- By Daniel Pendick, Former Executive Editor, Harvard Men’s Health Watch
This year, more than 238,000 American men will be diagnosed with prostate cancer. In most cases, the cancer consists of small knots of abnormal cells growing slowly in the walnut-sized prostate gland. In many men, the cancer cells grow so slowly that they never break free of the gland, spread to distant sites, and pose a serious risk to health and longevity.
Evidence is growing that early treatment with surgery or radiation prevents relatively few men from ultimately dying from prostate cancer, while leaving many with urinary or erectile problems and other side effects. As a result, more men may be willing to consider a strategy called active surveillance, in which doctors monitor low-risk cancers closely and consider treatment only when the disease appears to make threatening moves toward growing and spreading.
This week, a study by Harvard researchers found that the aggressiveness of prostate cancer at diagnosis appears to remain stable over time for most men. If thats true, then prompt treatment can be reserved for the cancers most likely to pose a threat, whereas men can reasonably choose to watch and wait in other cases.
If you have chosen active surveillance, then this could possibly make you feel more confident in your decision, says Kathryn L. Penney, Sc.D., instructor in medicine at Harvard Medical School and the lead author of a report published today in the journal Cancer Research.
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How Is Prostate Cancer Staged
With these tests, a stage is assigned to help decide the treatment plan. The stage of cancer, or extent of disease, is based on information gathered through the various tests as the diagnosis and work-up of the cancer is being performed.
Prostate cancer is most commonly staged using the TNM system plus the Gleason score. The TNM system is used to describe many types of cancers. In prostate cancer it has four components:
- T- Describes the extent of the “primary” tumor .
- N- Describes if there is cancer in the lymph nodes.
- M- Describes if there is spread to other organs .
- G- Describes the Gleason score and takes into account the PSA and the histologic grade of the tumor.
The staging system is very complex. The entire staging system is outlined at the end of this article. Though complicated, the staging system helps healthcare providers determine the extent of the cancer, and in turn, make treatment decisions for a patient’s cancer.
Signs That Warrant An Immediate Trip To A Doctor
Some common cancer signs that should result in a visit to the emergency room or to a doctor as soon as possible include:
- coughing up mucus tinged with blood
- blood in stools or urine
- lump in the breast, testicles, under the arm, or anywhere that it didnt exist before
- unexplained but noticeable weight loss
- severe unexplained pain in the head, neck, chest, abdomen, or pelvis
These and other signs and symptoms will be evaluated. Screenings, such as blood and urine tests and imaging tests, will be used if your doctor thinks its appropriate.
These tests are done both to help make a diagnosis as well as rule out various causes of your signs and symptoms.
When seeing a doctor, be prepared to share the following information:
- your personal medical history, including all symptoms you have experienced, as well as when they began
- family history of cancer or other chronic conditions
- list of all medications and supplements you take
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How Can I Prevent Prostate Cancer
The best way to try and prevent prostate cancer is to modify the risk factors for prostate cancer that you have control over. Eat a low-fat diet that is rich in fruits and vegetables and low in animal fats. It is always a good idea to maintain a healthy weight, get plenty of exercise and not to smoke or to quit smoking.
Genomic Variant And Aggressive Disease
Using genetic, genomic, molecular, and bioinformatic tools, Prof. Wei and his colleagues analyzed data from 2,738 cases of prostate cancer. The analysis confirmed the link between the rs11672691 variant and aggressive disease.
On further investigation, they found that a certain aggressive prostate cancer version of rs11672691 called the guanine allele was linked to higher expression of two particular genes.
The two genes called PCAT19 and CEACAM21 have previously been tied to growth of cells and progression of tumors in prostate cancer.
The team also found that the guanine allele of rs11672691 influences a third gene called HOXA2. This gene contains the instructions for producing a protein that controls the decoding of PCAT19 and CEACAM21.
Using CRISPR/Cas9 gene editing tools, the researchers then showed that they could manipulate the effect of rs11672691 on PCAT19 and CEACAM21 gene expression and the aggressiveness of prostate cancer cells.
They conclude that their findings reveal a plausible mechanism for rs11672691 in aggressive prostate cancer and thus lay the groundwork for translating this finding to the clinic.
Prof. Wei suggests that further research is now needed to investigate how this gene regulatory circuit accounts for pathogenesis and progression of prostate cancer.
We think the findings may be repurposed to stratify prostate cancer patients for personalized treatment and care.
Prof. Gong-Hong Wei
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What Will Happen In The Last Weeks Days And Months
Every man will have a different experience at the end of his life.The burden of cancer on the body can cause a number of symptoms. Bone marrow may not be able to make enough red blood cells, which can cause anaemia. Cancer can affect your ability to get energy from food, which can make you feel weak. Sometimes organs, like the kidney and liver may not work so well, which can mean you get a build up of waste products in your blood. In the later stages of the disease you may feel drowsy and drift in and out of consciousness.However, its important to know that you may not experience all or any of these effects. And if you do, there are things your medical team could do to help relieve symptoms and make you comfortable.Macmillan Cancer Support and also provide information about what will happen in the last few weeks and days of life.
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Is There A Genetic Component To Prostate Cancer
As mentioned earlier, cancer is a direct result of mutated genes that can no longer participate in the healthy development and growth and development process. For every type of cancer, there is a specific set of genes thought to contribute to it. Having mutations or abnormal variants of these genes doesnt necessarily mean that a person will develop an associated condition or type of cancer, but rather, means that their risk is increased. For this reason, possessing these mutations is considered a risk factor until the mutations start to cause a disruption in healthy gene function. When the function of a gene is altered and it begins to contribute to cancer growth, then it develops into a cause.
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As Screening Falls Will More Men Die From Prostate Cancer
In active monitoring, men with localized prostate cancer do not get surgery or radiation right after theyre diagnosed. Instead, they have regular biopsies, blood tests, and MRIs to see if their cancer is progressing. If it is, they can receive treatment.
Although some oncologists advise men with early, low-grade prostate cancer to choose active surveillance and professional groups such as the American Society of Clinical Oncology recommend it many patients recoil at what sounds like lets just wait for your cancer to become really advanced. A decade ago fewer than 10 percent of men diagnosed with prostate cancer chose monitoring, UCLA researchers found. But that is changing. Now at least half of men do.
That made sense to Garth Callaghan, author of the best-selling Napkin Notes, a book of missives he tucked into his daughters lunch box. Diagnosed with early prostate cancer in 2012, he said, none of the choices seemed particularly attractive to a 43-year-old man who dreaded the possibility of side effects of surgery or radiation, including incontinence and impotence. I was completely torn. My previous experience was, just get it out of my body. But after his doctor explained that prostate cancer is grossly overtreated in the United States, I did a complete 180 and chose active monitoring.
How Active Surveillance Works
The Gleason score is just one way that doctors monitor prostate cancer during active surveillance. They also do periodic follow-up biopsies and measure PSA levels, which may rise if cancer starts to spread in the prostate. Doctors may recommend treatment sooner if PSA begins to rise quickly or if a follow up biopsy reveals a higher Gleason score or more widespread cancer within the prostate. Its an inexact science that depends on a doctors skill and experience and a mans willingness to wait for signs that a cancer poses a clear threat before opting for treatment and its potential for side effects.
Penney says she and her Harvard colleagues are among the many scientists now searching for better ways to predict which prostate cancers are likely to be lethal and which can be monitored and not treated. The answer may be found in genetic changes in prostate cancer cells that signal a higher threat. But finding a better way to predict which prostate cancers are likely to turn lethal is far from guaranteed.
Some believe its not possible, Penney says. After the cancer is diagnosed, so many things can change in unknown ways. Diet, exercise, and other lifestyle factors, for example, could affect whether low-risk prostate cancers become more aggressive or threatening over time.
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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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Are Older Men Undertreated
Schwartz and colleagues reviewed the treatment decisions and factors influencing them in a cohort of men with localized prostate cancer. Age, comorbidity, and Gleason score were found to be independent predictors of suboptimal treatment. It was concluded that most men older than 70 years with moderately or poorly differentiated tumors and no to mild comorbidity were given suboptimal treatment. Most of these men were undertreated, receiving watchful waiting therapy when potentially curative therapy could have been applied. With optimal treatment, clinical outcomes could have been improved.
Thompson and colleagues investigated otherwise healthy octogenarians diagnosed with prostate cancer who underwent radical prostatectomy. At the last follow-up visit, 10 patients had survived more than a decade after surgery, and 3 patients had died within 10 years of surgery. The remaining 6 patients were alive at less than 10 years of follow-up. Seventy-four percent of patients were continent. No patient had died of prostate cancer, and the 10-year, all-cause survival rate was similar to that observed in healthy patients 60 to 79 years old undergoing radical prostatectomy. These findings indicate that careful selection of patients even older than 80 years can achieve satisfactory oncologic and functional outcomes after surgery. It is important to note, however, that the rate of urinary incontinence after surgery exceeds that of younger counterparts.
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Finding Out If The Cancer Has Spread
To find out if cancer has spread outside of the prostate, doctors may perform the imaging tests listed below. Doctors are able to estimate the risk of spread, called metastasis, based on PSA levels, tumor grade, and other factors, but an imaging test can confirm and provide information about the cancers location.
Imaging tests may not always be needed. A CT scan or bone scan may not be necessary for those with no symptoms and low-risk, early-stage prostate cancer, as determined with information from the PSA test and biopsy. Learn more about when these tests are recommended to find out if the cancer has spread.
For people with advanced prostate cancer, ASCO recommends that 1 or more of the imaging tests below be done to provide more information about the disease and help plan the best treatment. This includes when there is a newly diagnosed, high-risk cancer if metastasis is suspected or confirmed if the cancer has returned following treatment or when the cancer grows during the treatment period. Learn more about this guideline on the ASCO website.
Magnetic resonance imaging . An MRI scan uses magnetic fields, not x-rays, to produce detailed images of the body. An MRI can be used to measure the tumors size, and a scan can focus specifically on the area of the prostate or on the whole body. A special dye called contrast medium is given before the scan to create a clearer picture, which is injected into a patients vein.
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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What Causes Prostate Cancer And Am I At Risk
Every man is at risk for prostate cancer as he ages. Although prostate cancer can affect younger men, about 6 out of 10 cases are diagnosed in men over the age of 65. The average age of diagnosis is 66. After non-melanoma skin cancer, prostate is the most common cancer diagnosed in men in the United States. The American Cancer Society estimates there will be 248,530 new cases of prostate cancer each year.
Although there are several known risk factors for getting prostate cancer, no one knows exactly why one man gets it and another doesn’t. Some important risk factors for prostate cancer are:
Why Does Prostate Cancer Happen
The causes of prostate cancer are largely unknown. But certain things can increase your risk of developing the condition.
The chances of developing prostate cancer increase as you get older. Most cases develop in men aged 50 or older.
For reasons not yet understood, prostate cancer is more common in men of African-Caribbean or African descent, and less common in Asian men.
Men whose father or brother were affected by prostate cancer are at slightly increased risk themselves.
Recent research also suggests that obesity increases the risk of prostate cancer.
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