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Nodules On Prostate Always Cancer

What Does It Mean If My Biopsy Report Mentions The Word Core

Recent changes to the diagnosis and treatment of prostate cancer

The most common type of prostate biopsy is a core needle biopsy. For this procedure, the doctor puts a thin, hollow needle into the prostate gland. When the needle is pulled out it removes a small cylinder of prostate tissue called a core. This is often repeated several times to sample different areas of the prostate.

Your pathology report will list each core separately by a number assigned to it by the pathologist, with each core having its own diagnosis. If cancer or some other problem is found, it is often not in every core, so you need to look at the diagnoses for all of the cores to know what’s going on with you.

What Is Intermediate To High

Although surgery is an effective treatment option for early stage prostate cancer, it becomes less effective as the risk of cancer having spread beyond the prostate increases. It is difficult for surgeons to completely remove the cancer once it has grown beyond the confines of the prostate gland. Several factors can potentially identify patients who are at a higher risk for having cancer outside the prostate.

These can include any of the following:

  • PSA > 10
  • A nodule felt to occupy half of the prostate gland or more on physical exam
  • A biopsy showing a more aggressive tumor, with a Gleason score > 6
  • A biopsy showing cancer invading around the small nerves in the prostate
  • Multiple positive prostate biopsies

How Is Each Condition Diagnosed

Youll see a specialist called a urologist to diagnose BPH or prostate cancer. Doctors use many of the same tests to diagnose both of these conditions.

  • Prostate-specific antigen test:This blood test detects PSA, a protein your prostate gland makes. When your prostate grows, it produces more of this protein. A high PSA level can only tell your doctor that your prostate has grown. It cant tell for sure that you have BPH or prostate cancer. Youll need more tests to confirm the diagnosis.
  • Digital rectal exam : Your doctor will insert a gloved, lubricated finger into your rectum. This test can show if your prostate is enlarged or abnormally shaped. Youll need more tests to find out if you have BPH or prostate cancer.

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What Is Evaluation Of The Primary Tumor In Prostate Cancer

Evaluation of the tumor :

  • TX: Cannot evaluate the primary tumor.
  • T0: No evidence of tumor.
  • T1: Tumor present but not detectable clinically or with imaging.
  • T1a: The tumor was incidentally found in less than 5% of prostate tissue resected .
  • T1b: The tumor was incidentally found in greater than 5% of prostate tissue resected.
  • T1c: The tumor was found in a needle biopsy performed due to an elevated serum PSA.
  • T2: The tumor can be felt on examination but has not spread outside the prostate.
  • T2a: The tumor is in half or less than half of one of the prostate gland’s two lobes.
  • T2b: The tumor is in more than half of one lobe but not both.
  • T2c: The tumor is in both lobes.
  • T3: The tumor has spread through the prostatic capsule .
  • T3a: The tumor has spread through the capsule on one or both sides.
  • T3b: The tumor has invaded one or both seminal vesicles.
  • T4: The tumor has invaded other nearby structures.
  • It should be stressed that the designation “T2c” implies a tumor which is palpable in both lobes of the prostate. Tumors which are found to be bilateral on biopsy only but are not palpable bilaterally should not be staged as T2c.

    Evaluation of the regional lymph nodes :

    • NX: The regional lymph nodes cannot be evaluated.
    • N0: There has been no spread to the regional lymph nodes.
    • N1: There has been spread to the regional lymph nodes.

    Evaluation of distant metastasis :

    So Lets Say Youre Diagnosed With Prostate Cancer What Do You Do Now

    Brady Urology at Johns Hopkins Hospital: Historical ...

    Dr. Samadi: Weve seen a lot of ads about radiation and surgery. The certain fact is that the one-size-fits-all is the wrong medical approach. You have to talk to your urologist about what would be the best option for treating your prostate cancer. What I like about surgery is the fact that, a lot of times, you remove the prostate and surgery is the only practice that gives you a very accurate staging. How much cancer you have, tracking changes in your PSA after surgery. The value should be zero and undetectable so you can rest at night. This is not the same with radiation. If somebody will get surgery first and the cancer comes back, you can try radiation. Meanwhile, after radiation, if the cancer comes back, in most cases, you cant get surgery. After the prostate is removed, we follow the PSA and as long as its undetectable youre cured.

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    Monitoring And Pharmacologic Therapy

    Ordinarily, in patients in whom only a single focus of PIN, particularly HGPIN, has been identified, therapy may not be necessary. In patients with multiple areas of HGPIN or ASAP on the initial biopsy or on subsequent biopsies, therapy may be considered, as the risk of cancer in these patients is 15 times that in patients without these entities. Prostate cancerprevention studies indicate that 5-alpha reductase inhibitors, antiandrogens, and selective estrogen receptor modulators are usually not effective in eliminating HGPIN and ASAP,. .

    What Are The Symptoms Of Prostate Cancer

    Early-stage prostate cancer rarely causes symptoms. These problems may occur as the disease progresses:

    • Frequent, sometimes urgent, need to urinate, especially at night.
    • Weak urine flow or flow that starts and stops.
    • Painful urination .
    • Painful ejaculation and erectile dysfunction .
    • Blood in semen or urine.
    • Lower back pain, hip pain and chest pain.
    • Leg or feet numbness.

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    What Is The Prognosis For People Who Have Prostate Cancer

    Because prostate cancer tends to grow slowly, most men die from something other than the disease. Early detection is key to better outcomes. Almost all men 97% to 98% diagnosed with localized cancer that hasnt spread outside of the prostate live at least five years after diagnosis. When metastatic cancer has spread outside of the gland, one-third of men continue to survive after five years.

    Talking With Your Doctor

    What are the Treatment Options for Stage 2 Prostate Cancer?

    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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    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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    What Are Grade Groups

    Grade Groups are a new way to grade prostate cancer to address some of the issues with the Gleason grading system.

    As noted above, currently in practice the lowest Gleason score that is given is a 6, despite the Gleason grades ranging in theory from 2 to 10. This understandably leads some patients to think that their cancer on biopsy is in the middle of the grade scale. This can compound their worry about their diagnosis and make them more likely to feel that they need to be treated right away.

    Another problem with the Gleason grading system is that the Gleason scores are often divided into only 3 groups . This is not accurate, since Gleason score 7 is made up of two grades , with the latter having a much worse prognosis. Similarly, Gleason scores of 9 or 10 have a worse prognosis than Gleason score 8.

    To account for these differences, the Grade Groups range from 1 to 5 :

    • Grade Group 1 = Gleason 6
    • Grade Group 2 = Gleason 3+4=7
    • Grade Group 3 = Gleason 4+3=7
    • Grade Group 4 = Gleason 8
    • Grade Group 5 = Gleason 9-10

    Although eventually the Grade Group system may replace the Gleason system, the two systems are currently reported side-by-side.

    Anatomic structures and major veins of the male pelvis.

    FIGURE 1.

    Anatomic structures and major veins of the male pelvis.

    FIGURE 2.

    FIGURE 2.

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    What Is Benign Prostatic Hyperplasia

    Benign prostatic hyperplasia is very common in men above the age of 40 and can cause the urinary tract to be obstructed. Unlike prostate cancer, BPH is not cancerous nor is it fatal. As you age, your testosterone levels increase, which, in turn, causes your prostate to grow in size or become enlarged.

    During a physical exam, if you have BPH, your doctor will notice your prostate feels larger than it should be. Your PSA tests will also come back elevated. Whereas in prostate cancer, the sides of the prostate are usually affected, in BPH the central portion of the prostate is usually affected. Also, unlike cancer, BPH cannot spread.

    The most common symptoms of BPH include urinary symptoms such as frequency of urination, hesitancy, dribbling, and frequent nighttime urination. Depending on the severity of your symptoms, treatment can range from nothing to medication to shrink the prostate, or surgery to remove the central part of the prostate to allow better flow of urine.

    Make Your Decision Stay Informed And Positive


    Key to making the right decision on treatment of your cancer is seeking expert help. With any big decision, a second or third opinion, will only help to ensure that you are making the best possible decision. The Prostate Cancer Free Foundation leverages the work of experts from around the globe. Use the information from the Prostate Cancer Free web site and your copy of the Prostate Cancer Study to make the best decision for you. Share this information with your Doctors. Ask for their view on which treatment outcome will most likely leave you Prostate Cancer Free.

    Reduce the stress in your life, watch your diet and exercise regularly. Keep aware of advancements in the fight against prostate cancer. Receive emails on the latest updates, news and information for the treatment of prostate cancer by subscribing to the Prostate Cancer Free website below.

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    Prostate Cancer Treatment Side Effects

    If you happen to be diagnosed with intermediate or high risk prostate cancer, ask carefully about treatment side effects such as incontinence and impotence. Your personal preferences with consideration to age and other health factors play an important role when making your final decision about treatment.

    What Do You Do Once Diagnosed With Prostate Cancer

    If the biopsy shows the presence of prostate cancer, the next step is to determine how much cancer is present and to make sure that it has not spread. Our prostate cancer experts will expertly review your PSA blood tests, physical exam findings, and biopsy results. Some simple and painless tests such as a CT scan, bone scan, MRI,and possibly a PET scan can help make sure there is no cancer that has spread outside the prostate.

    Using the above information, we can then calculate the likelihood of the cancer being completely confined to the prostate, having spread beyond the confines of the prostate, or having spread some distance to the lymph glands in the pelvis.

    This information, as well as an evaluation of your overall medical condition and well-being, is critical in determining which treatment options will offer you the best chance for a cure.

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    What Can You Do To Prevent Prostate Cancer

    The high lifetime risks of prostate cancer development, the morbidities associated with treatment of established prostate cancer, and the inability to eradicate life-threatening metastatic prostate cancer offer compelling reasons for prostate cancer prevention.

    However, because the cause of prostate cancer is uncertain, preventing prostate cancer may not be possible. Certain risk factors, such as age, race, sex, and family history, cannot be changed. Nevertheless, because diet and other lifestyle factors have been implicated as a potential cause, living a healthy lifestyle may afford some protection.

    • Proper nutrition, such as limiting intake of foods high in animal fats and increasing the amount of fruits, vegetables, and grains, may help reduce the risk of prostate cancer.
    • The following supplements should NOT be used to prevent prostate cancer:
    • Vitamin E

    5-alpha reductase Inhibitors :

    Living With Prostate Cancer

    What Causes Prostate Cancer? – The Nebraska Medical Center

    Living with prostate cancer depends on how early you were diagnosed. Also, it depends on the type of treatment you received. For example, if you had to have your prostate removed, you may have to live with sexual dysfunction. If you had hormone or chemotherapy, you may have long-terms effects from the medicines used on those treatments. Ask your doctor how you can improve the quality of your life after treatment.

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    What Do The Dre Results Mean

    A digital rectal examination is a test used to see if you might have a prostate problem or prostate cancer.

    Your prostate may feel:

    • normal a normal size for your age with a smooth surface
    • larger than expected for your age this could be a sign of an enlarged prostate
    • hard or lumpy this could be a sign of prostate cancer.

    The DRE is not a completely accurate test. Your doctor or nurse cant feel the whole prostate. And a man with prostate cancer might have a prostate that feels normal.

    How Is Prostate Cancer Treated With Chemotherapy

    Chemotherapy is also used against prostate cancer.

    • The utility of chemotherapy in the management of metastatic prostate cancer continues as an area of ongoing research.
    • This therapeutic option has been explored most in patients with the hormone-resistant disease.

    Newer chemotherapy medicines, such as docetaxel , have shown some promise in prolonging the survival of some patients with extensive prostate cancer. They may also decrease the pain related to widespread cancer. However, this comes at the cost of significant side effects that may impact the quality of life.

    Symptom palliation: The primary approach to the management of symptoms in patients with advanced prostate cancer is systemic therapy with both older and newer forms of hormonal treatments, then chemotherapy. Today immunotherapy and radioactive isotope treatments may be used. Radiation to painful bone lesions may be used. Throughout all of this, optimal pain medication use and other therapies for cancer-related symptoms should be administered. For patients with castrate-resistant prostate cancer, palliative therapy may be indicated to treat symptomatic bone metastases or symptoms arising from progressive disease.

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    How Is Prostate Cancer Diagnosed

    Medical interview and physical examination:

    A proper medical interview eliciting a thorough medical history and a physical examination are essential in the diagnostic workup of any man in whom prostate cancer is suspected. He may be referred to a physician who specializes in urinary tract diseases or in urinary tract cancers . A man will be asked questions about his medical and surgical history, lifestyle and habits, and any medications he takes. Risk factors including family history of prostate cancer will be assessed .

    Digital rectal examination is part of the physical examination: All men with firm swelling, asymmetry, or palpable, discrete, firm areas or nodules in the prostate gland require further diagnostic studies to rule out prostate cancer, particularly if they are over the age of 45 or have other risk factors for the disease .

    Because urological symptoms can indicate a variety of conditions, a man may undergo further testing to pinpoint their cause. Initial screening tests include blood testing for PSA and urine testing for blood or signs of infection.

    Prostate specific antigen :

    PSA is an enzyme produced by both normal and abnormal prostate tissues. It may be elevated in noncancerous conditions, such as prostatitis and benign prostatic hypertrophy , as well as in cancer of the prostate. Therefore, confirmation of an elevated serum PSA is advisable prior to proceed to prostate biopsy.

    The following standards have been set for PSA levels:

    Tests Used To Check The Prostate

    An orthotopic metastatic prostate cancer model in SCID ...

    This first step lets your doctor hear and understand the story of your prostate concerns. Youll be asked whether you have symptoms, how long youve had them, and how much they affect your lifestyle. Your personal medical history also includes any risk factors, pain, fever, or trouble passing urine. You may be asked to give a urine sample for testing.

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    Drugs To Treat Cancer Spread To Bone

    If prostate cancer spreads to other parts of the body, it almost always goes to the bones first. These areas of cancer spread can cause pain and weak bones that might break. Medicines that can help strengthen the bones and lower the chance of fracture are bisphosphonates and denosumab. Sometimes, radiation, radiopharmaceuticals, or pain medicines are given for pain control.

    Side effects of bone medicines

    A serious side effect of bisphosphonates and denosumab is damage to the jaw, also called osteonecrosis of the jaw . Most people will need to get approval from their dentist before starting one of these drugs.


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