Precancerous Cells And Pin
Sometimes, the results will show that precancerous cells, or prostatic intraepithelial neoplasia , are present.
If these PIN are low grade, the doctor will not consider this a matter of concern. Many men have low grade PIN.
However, if the PIN are high grade, there is a chance that cancer may develop. In these cases, a doctor may suggest further tests.
Carcinoma in situ refers to cells that are not yet cancerous but could become so. They can occur almost anywhere in the body.
The outlook depends on the results of the biopsy and other tests.
If results show that cancer is present in or around the prostate gland only, there is an almost 100% chance of surviving at least another 5 years. This is because effective treatment is available, and because many types of prostate cancer are slow growing.
However, if cancer has spread to other organs, such as the liver or lungs, the chance of someone surviving another 5 years or more falls to 30%.
Factors that affect the outlook for a person with prostate cancer include:
- their age and overall health
- the type of cancer present
- how far cancer has spread
The Right Kind Of Biopsy Is Safe The Wrong Kind Can Put You At Risk
For American men, prostate cancer is the most common type of cancer, with 200,000 new cases diagnosed last year. The only way to definitively confirm the presence of cancer is by biopsy of the prostate. While it is widely recommended for men who are suspected of having the disease, stories have turned up in the media suggesting that prostate biopsies carry the risk of spreading cancer cells, increasing the likelihood of recurrence. Could the very test that diagnoses prostate cancer cause its spread? I posed this question to J. Stephen Jones, MD, who is the chairman of the department of regional urology at the Cleveland Clinic Glickman Urological and Kidney Institute and author of The Complete Prostate Book.
WHO NEEDS A BIOPSY?
The possibility that a man might have prostate cancer is first identified through early detection tests such as the prostate-specific antigen blood test and a digital rectal exam . If either suggests the possibility of prostate cancer, a prostate biopsy is the next step, says Dr. Jones. In the US, this is most commonly done with an ultrasound probe placed in the rectum and a core needle biopsy. Guided by the probe, the doctor inserts a narrow needle through the rectal wall into the prostate gland. When the needle is pulled out, it removes a sample of tissue. Usually performed under general anesthesia, this process is typically repeated 10 to 12 times or more in order to obtain tissue from different parts of the prostate.
Surgery For Prostate Cancer
There are many types of surgery for prostate cancer. Some are done to try to cure the cancer others are done to control the cancer or make symptoms better. Talk to the doctor about the kind of surgery planned and what you can expect.
Side effects of surgery
Any type of surgery can have risks and side effects. Be sure to ask the doctor what you can expect. If you have problems, let your doctors know so they can help you.
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What Will Happen After Treatment
Youll be glad when treatment is over. But its hard not to worry about cancer coming back. When cancer comes back it is called a recurrence. Even when cancer never comes back, people still worry about it. For years after treatment ends, you will see your cancer doctor. At first, your visits may be every few months. Then, the longer youre cancer-free, the less often the visits are needed.
Be sure to go to all follow-up visits. Your doctors will ask about your symptoms, examine you, and might order blood tests and maybe other tests to see if the cancer has come back.
Having cancer and dealing with treatment can be hard, but it can also be a time to look at your life in new ways. You might be thinking about how to improve your health. Call us at 1-800-227-2345 or talk to your doctor to find out what you can do to feel better.
You cant change the fact that you have cancer. What you can change is how you live the rest of your life, making healthy choices and feeling as good as you can.
What Is A Prostate Biopsy
The prostate gland is found only in males. It sits below the bladder andwraps around the urethra . Theprostate helps make semen.
A biopsy is a procedure used to remove a small piece of tissue or cellsfrom the body so it can be examined under a microscope.
In a prostate biopsy, prostate gland tissue is taken out with a biopsyneedle or during surgery. The tissue is checked to see if there are canceror other abnormal cells in the prostate gland.
A prostate biopsy may be done in several different ways:
Transrectal method. This is done through the rectum and is the most common.
Perineal method. This is done through the skin between the scrotum and the rectum.
Transurethral method. This is done through the urethra using a cystoscope .
Ultrasound is usually used to look at the prostate gland and guide thebiopsy needle.
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When Do I Need A Biopsy
Your doctor may order a biopsy if your prostate-specific antigen level in your blood work is elevated or there is an abnormal lump found during a digital rectal exam. During a digital rectal exam, your doctor inserts a finger up your bottom to feel if your prostate is enlarged or has bumps. Another option before a biopsy is an ultrasound. Instead of a finger, a small probe is inserted to take pictures of the prostate.
An MRI-guided prostate biopsy may be used in patients who have a rising PSA level, yet a negative ultrasound-guided biopsy. It also may be used in situations where a diagnostic prostate MRI performed because of rising PSA demonstrates a very small abnormality that may not be easily targeted by ultrasound. An MRI image to guide a biopsy can improve the ability to detect prostate tumors which may require treatment.
Imaging Tests For Prostate Cancer
Imaging tests use x-rays, magnetic fields, sound waves, or radioactive substances to create pictures of the inside of your body. One or more imaging tests might be used:
- To look for cancer in the prostate
- To help the doctor see the prostate during certain procedures
- To look for spread of prostate cancer to other parts of the body
Which tests you might need will depend on the situation. For example, a prostate biopsy is typically done with transrectal ultrasound and/or MRI to help guide the biopsy. If you are found to have prostate cancer, you might need imaging tests of other parts of your body to look for possible cancer spread.
The imaging tests used most often to look for prostate cancer spread include:
Epithelial Cellular Material Analysis
Peripheral blood samples were taken in EDTA tubes. The first sample was not used for blood analysis in order to reduce the amount of epithelial cellular material from the skin when the blood sampling needle was placed in the arm vein. The blood was processed through a prototype liquid biopsy cell sample preparation instrument as previously described . The resulting concentrated cellular material was suspended in proprietary buffer, sedimented onto slides, washed, and stained using the anti-cytokeratin antibody anti-CD45 and DAPI. EPM was visualized using either a bright field or a confocal microscope.
Cancer Biopsies Do Not Promote Cancer Spread Research Finds
- Mayo Clinic
- A study of more than 2,000 patients has dispelled the myth that cancer biopsies cause cancer to spread. The researchers show that patients who received a biopsy had a better outcome and longer survival than patients who did not have a biopsy.
A study of more than 2,000 patients by researchers at Mayo Clinics campus in Jacksonville, Florida, has dispelled the myth that cancer biopsies cause cancer to spread. In the Jan. 9 online issue of Gut, they show that patients who received a biopsy had a better outcome and longer survival than patients who did not have a biopsy.
The researchers studied pancreatic cancer, but the findings likely apply to other cancers because diagnostic technique used in this study fine needle aspiration is commonly used across tumor types, says the studys senior investigator and gastroenterologist Michael Wallace, M.D., M.P.H., professor of medicine.
Fine needle aspiration is a minimally invasive technique that uses a thin and hollow needle to extract a few cells from a tumor mass. A long-held belief by a number of patients and even some physicians has been that a biopsy can cause some cancer cells to spread.
While there have been a few case reports that suggest this can happen but very rarely there is no need for patients to be concerned about biopsies, says Dr. Wallace.
Dr. Wallace and his team have conducted two separate studies to examine the risk of biopsy.
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Use In Men Who Might Have Prostate Cancer
The PSA blood test is used mainly to screen for prostate cancer in men without symptoms. Its also one of the first tests done in men who have symptoms that might be caused by prostate cancer.
PSA in the blood is measured in units called nanograms per milliliter . The chance of having prostate cancer goes up as the PSA level goes up, but there is no set cutoff point that can tell for sure if a man does or doesnt have prostate cancer. Many doctors use a PSA cutoff point of 4 ng/mL or higher when deciding if a man might need further testing, while others might recommend it starting at a lower level, such as 2.5 or 3.
- Most men without prostate cancer have PSA levels under 4 ng/mL of blood. Still, a level below 4 is not a guarantee that a man doesnt have cancer.
- Men with a PSA level between 4 and 10 have about a 1 in 4 chance of having prostate cancer.
- If the PSA is more than 10, the chance of having prostate cancer is over 50%.
If your PSA level is high, you might need further tests to look for prostate cancer.
To learn more about how the PSA test is used to look for cancer, including factors that can affect PSA levels, special types of PSA tests, and what the next steps might be if you have an abnormal PSA level, see Screening Tests for Prostate Cancer.
Ben Stiller Reveals Prostate Cancer Diagnosis Says Psa Test Saved His Life
No genetic tests on the market have been shown to identify which men with a high PSA can skip biopsy, but one that Dr. Brian Helfand of NorthShore University HealthSystem and his colleagues are developing based on more than 100 DNA variants is showing promise. It seems to pick out the one-third of patients who are most likely to have aggressive prostate cancer, meaning other men can opt out of biopsy.
One 64-year-old patient had a PSA of 4.6, considered the low end of elevated and one that leads many physicians to recommend biopsy, but a genetic risk score 40 percent below the average, Helfand said: Other urologists he saw were advocating a repeat biopsy, but I recommended we hold off, which the man did.
At the AUA meeting, European researchers will describe a combination of six biomarkers proteins in the blood that reduced unneeded prostate biopsies in men with PSAs of 2 to 10. Of 474 men in the study, 141 of 236 negative biopsies could have been avoided, the researchers will report, which is significantly more accurate than alone in determining the absence of prostate cancer. The biomarker approach could halve the number of unnecessary prostate biopsies, they estimate.
The second problem both sides in the PSA wars want to solve is that too many men, after a biopsy suggests a dangerous prostate cancer, undergo treatment that they actually didnt need . Todays system of analyzing biopsies cant reliably tell threatening cancers from harmless ones.
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Why Is It Important To Get A Recommended Biopsy
A biopsy is often the best way to definitively say whether or not you have cancer. Other tools, such as ultrasound and magnetic resonance imaging , can tell the doctor if an area looks suspicious. But in most cases, the only way to make a definitive cancer diagnosis is to perform a biopsy and look at those suspicious cells under a microscope. Many biopsies are performed with imaging guidance, called image-guided biopsies, where tools like ultrasound or computed tomography scans are used to help locate areas of concern and obtain biopsy material.
Sometimes, a biopsy reveals that the suspicious area contains only benign, or non-cancerous, cells. This might mean you do not need treatment, such as surgery, radiation therapy, or chemotherapy. Other times, a biopsy can tell the doctor how aggressive a cancer appears to be and what the extent of the disease may be. This refers to a cancers stage and grade. A biopsy can also explain what type of cancer cells are inside the tumor. All of this information helps determine the best course of action for treating the cancer.
Possible Harms From Diagnosis
Screening finds prostate cancer in some men who would never have had symptoms from their cancer in their lifetime. Treatment of men who would not have had symptoms or died from prostate cancer can cause them to have complications from treatment, but not benefit from treatment. This is called overdiagnosis.
Prostate cancer is diagnosed with a prostate biopsy. A biopsy is when a small piece of tissue is removed from the prostate and looked at under a microscope to see if there are cancer cells. Older men are more likely to have a complication after a prostate biopsy.
A prostate biopsy can cause
- Blood in the semen or ejaculate.
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Lymph Node Biopsy As A Separate Procedure
A lymph node biopsy is rarely done as a separate procedure. Its sometimes used when a radical prostatectomy isnt planned , but when its still important to know if the lymph nodes contain cancer.
Most often, this is done as a needle biopsy. To do this, the doctor uses an image to guide a long, hollow needle through the skin in the lower abdomen and into an enlarged node. The skin is numbed with local anesthesia before the needle is inserted to take a small tissue sample. The sample is then sent to the lab and looked at for cancer cells.
Possible Harms From Treatment
The most common treatments for prostate cancer are surgery to remove the prostate and radiation therapy.
The most common harms from prostate cancer treatment are
- Urinary incontinence . About 1 out of every 5 men who have surgery to remove the prostate loses bladder control.
- Erectile dysfunction . About 2 out of every 3 men who have surgery to remove the prostate become impotent, and about half of men who receive radiation therapy become impotent.
- Bowel problems, including fecal incontinence and urgency . About 1 out of every 6 men who has radiation therapy has bowel problems.
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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.
What Happens After A Biopsy
A negative biopsy indicates that none of the biopsy samples found any evidence of prostate cancer. This is usually good newshowever, this does not necessarily mean that there is no prostate cancer present. Your doctor may want to continue to monitor your PSA levels or do a repeat biopsy at some point in the future.
A positive biopsy indicates that there is evidence of prostate cancer. This would be considered a diagnosis of prostate cancer. At this point, you should also have some idea of the approximate location, size, and aggressiveness of the cancer. What happens next is a decision between you and your doctor. There are some additional tests you can take to give you a better idea of your diagnosis. For example, genomic tests can help provide information on how likely your cancer is to spread, or how aggressive it is likely to be.
In addition, there are additional new tests that can be performed with a biopsy to help make diagnosis and determine the aggressiveness of the cancer:
- ERG Protein Marker
- A marker used on prostate tissue after a biopsy, which measures ERG protein assays. This helps doctors identify patients who have the disease or have pre-cancerous lesions that indicate a patient is more likely to develop prostate cancer over time.
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