How Soon Can We Detect This
One of the main advantages of surgery over radiotherapy for prostate cancer is that following prostate removal, the PSA should be very low , which we can of course detect with blood tests. If metastasis occurs, because the metastatic cells originated in the prostate and therefore make PSA, the PSA level in the blood starts to rise. Once it has reached a given threshold additional or salvage treatment will be discussed.
A PSA level of more than 0.2 ng/ml defines biochemical recurrence. At this stage the cancer is still much too small to be seen on scanning. If it can be seen on a scan it is termed clinical recurrence, which generally does not occur until the PSA level is more than 0.5 ng/ml. Symptoms, such as bone pain, dont usually occur until the PSA is more than 20 ng/ml.
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Staging: The Tnm System
Staging is done as part of the diagnosis process to determine how extensive your cancer is within your prostate and whether it has spread to lymph nodes or other organs.
Prostate cancer is typically staged using the TNM system, which is based on:
- The extent of the primary tumor
- Whether the cancer has spread to nearby lymph nodes
- The presence or absence of distant metastasis
- Your PSA level at the time of diagnosis
- Your Gleason score and the amount of cancer
Using this information, prostate cancer is then grouped into stages I through IV, with stage I being the least advanced and stage IV being the most advanced.
- Stage I: Cancer is confined to your prostate. Gleason score is 6 or below. PSA level is less than 10.
- Stage II: The tumor is more advanced but does not extend beyond your prostate.
- Stage III: The tumor extends beyond your prostate and may be in a seminal vesicle. Cancer has not spread to lymph nodes.
- Stage IV: The tumor has spread to another part of your body, such as your bladder, rectum, lymph nodes or bones.
A protein made by the prostate gland and found in the blood. Prostate-specific antigen blood levels may be higher than normal in men who have prostate cancer, benign prostatic hyperplasia , or infection or inflammation of the prostate gland.
How Is Prostate Cancer Diagnosed
If you have symptoms of prostate cancer, your provider will perform a digital rectal exam and a PSA blood test. If either of those two tests are abnormal, then most likely your provider will recommend that you have a prostate biopsy. A biopsy is the only way to know for sure if you have cancer, as it allows your providers to get cells that can be examined under a microscope.
The most common way that a biopsy is done is with a trans-rectal ultrasound . A trans-rectal ultrasound is a thin cylinder that puts out sound waves and monitors them when they bounce off of tissue. It is inserted into your rectum, and allows the provider performing the biopsy to view your prostate and choose where to remove the tissue for further evaluation. Any suspicious areas are biopsied. In addition, some tissue will be removed from all of the different parts of the prostate . The procedure is done while you are awake, with the help of some numbing medicine. Unfortunately, a trans-rectal ultrasound isnÃ¢t a perfect tool. Even though many samples are taken, it can occasionally miss the area of the cancer. If this happens, and your PSA remains elevated, you may need to have the procedure repeated.
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Heres What Specific Stages Mean:
Stage 1 Prostate Cancer: The cancer cannot be found during a digital rectal exam. It is found as a result of prostate biopsies for a high or rising PSA, or discovered by chance when surgery is done for another reason, usually for lower urinary tract symptoms.
Stage 2 Prostate Cancer: The cancer can be felt during a prostate exam, but it has not spread outside the prostate.
Stage 3 Prostate Cancer: The cancer has spread outside the prostate. It may be in the tissues near the prostate, or it may have invaded the tissues around the prostate or seminal vesicles. It has not spread to the lymph nodes.
Stage 4 Prostate Cancer: This stage is called metastatic cancer, because it has metastasized, or spread, to distant parts of the body. The cancer may be in nearby pelvic muscles or organs . It may have spread to the lymph nodes. It may have spread to other parts of the body.
Accurate staging provides your medical team with information that will be very important for creating the best treatment plan for you.
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How Does Kidney Cancer Appear
Kidney cancer is the growth of malignant cells in one or both kidneys. The two kidneys, located deep in the body at about the middle of the back, control the fluid balance in the body and filter wastes out of the blood and into the urine. The renal pelvis is the site in the kidney where the urine pools. From there, it moves through a narrow conduit and empties into the bladder. There are three main types of kidney cancer: renal cell carcinoma , transitional cell cancer , and Wilms tumorwhich affects young children. Renal cell carcinoma accounts for 85% of all kidney cancers. Remember, only one kidney is necessary to support life. So if a kidney is cancerous and has to be removed, the other kidney takes over the function of the missing one.
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What Are The Clinical Signs
Given the location of the prostate, the most common clinical signs include blood in the urine, a change in urination habits, inability to urinate, and excessive drinking. The colon, located just above the prostate, may become compressed, making it difficult to pass bowel movements. Pets may strain to urinate or defecate, and the stools may become flattened or ribbonlike. Other signs may include lethargy, exercise intolerance, reduced appetite, weight loss, and pain . The pain may be significant in pets that have evidence of metastasis to the bones of the lower back and pelvis.
Simple And Endoscopic Intervention
The majority of surgical anastomotic stenoses respond to simple urethral dilatation or visual urethrotomy . This includes office-based techniques such as passage of urethral sounds or filiform followers and is often supplemented with a regime of clean intermittent self-catheterization . This correlates with the SEER data, which suggests that patients with BOO post-treatment for prostate cancer, 44% of patients will require more than one procedure . Park et al. demonstrated post-retropubic radical prostatectomy patients with anastomotic stenoses who underwent dilatation followed by CISC, was successful in 92% at 1 year follow up, although it must be noted 27% required two or more procedures . They suggested that men with hypertrophic scars were at greater risk of anastomotic stricture, suggesting pathological wound healing.
Steroids, with the most described agent triamcinolone , work by enhancing collagenase activity, act to break down peptide bonds in collagen to allow tissue remodeling. Eltahawy et al. evaluated 24 patients with recurrent or resistant bladder neck stenoses post-RRP who underwent Holmium laser BNI with injection of triamcinolone, with a success rate of 83% at 24 months .
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Transitional Cell Carcinoma Is The Most Common Form Of Bladder Cancer
Essentially, there are three types of bladder cancers, transitional cell carcinomas which begin in the layer of cells lining the bladder, squamous cell carcinomas which originate in one type of cell in the bladders lining, and adenocarcinomas that begin in glandular cells. Bladder cancers are further identified according to how theyve spread. If the cancer is only found within in the bladders lining, its characterized as superficial cancer, while carcinomas which have spread to the muscle wall are referred to as invasive. Transitional cell carcinoma is the most common type of cancer of the bladder and accounts for approximately 90% of bladder cancer cases.
Its worth noting that 70% of transitional cell carcinoma cases are the superficial kind and, therefore, unlikely to metastasize. Unfortunately, the remaining 30% of TCC occurrences fall into the muscle invasive group, having invaded the bladders muscular wall and potentially other nearby organs. Prompt diagnosis is crucial as treatment options are determined by how deeply the carcinoma has invaded the bladder, whether or not its metastasized, and if so, to where.
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Advanced Prostate Cancer Symptoms
Men with advanced prostate cancer may experience additional symptoms. Thats because the cancer has spread from the prostate to other parts of the body, such as the bones or lymph nodes.
A wide range of treatment options are available for managing advanced cancer. These treatments kill cancer cells, but they may also help patients manage pain.
Signs of metastatic prostate cancer may include:
- Swelling in legs or pelvic area
- Numbness or pain in the hips, legs or feet
- Bone pain that persists or leads to fractures
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What About Other Treatments I Hear About
When you have cancer you might hear about other ways to treat the cancer or treat your symptoms. These may not always be standard medical treatments. These treatments may be vitamins, herbs, special diets, and other things. You may wonder about these treatments.
Some of these are known to help, but many have not been tested. Some have been shown not to help. A few have even been found to be harmful. Talk to your doctor about anything youre thinking about using, whether its a vitamin, a diet, or anything else.
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Lymph Node Evaluation On Multiparametric Magnetic Resonance Imaging
MRI of the of the abdomen and pelvis is an alternative, but less commonly utilized, modality for evaluating lymph nodes in patients with suspected or known bladder cancer . When consideration is made as to whether or not to obtain an MRI, the potential benefits of multiparametric assessment of nodal characteristics, should be weighed against a number of potential contraindications, including the patientâs ability to lie still for a prolonged period of time, claustrophobia, the presence of regional orthopedic hardware, and potential MR incompatibility of any implantable medical devices that the patient may have .
The role of MRI in assessment of nodal involvement is an area of active investigation . Similar to CT, metastatic lymph nodes are conventionally identified when short axis diameter lymph node exceeds 8â10 mm however, assessment of nodal size by MRI suffers from the same limitations as CT, in that normal sized lymph nodes may still harbor metastatic disease .
Figure 6Figure 7Figure 8Figure 9
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Find Efficient Treatment For Prostate Cancer Today
At Comprehensive Urology in the Beverly Grove community of Los Angeles, we concentrate on both medical diagnosis and treatment for prostate cancer treatment in LA. Furthermore, Dr. Michel and his professional group work relentlessly to enhance your results and offer the very best options offered. To get evaluated for prostate cancer, schedule a visit with Comprehensive Urology today. You can schedule by phone or book online today!
Risk Factors For Formation Of Urethral Stenosis And Stricture
Risk factors include age, obesity, hypertension, diabetes, previous TURP , longer follow-up, higher radiation dose, HDR-BT, adjuvant RT and combination with BT . Delaying adjuvant RT for more than 9 months after RP may decrease stricture formation, however this is at the expense of an increase in cancer-specific mortality . Zelefsky found that intensity modulated RT increases the risk of late urinary toxicities including urethral stricture compared to 3-D conformal RT, but with lower rectal toxicity . However, a recent review found no difference in urethral stricture between 3-dimensional conformal radiotherapy and IMRT . Similar to ERBT, BT strictures affect the bulbomembranous urethra in the majority of cases, which could be due to a ÃÂ¢hot spotÃÂ¢ in the distal bulbar urethra or due to caudal needle shifting in patients receiving HDR-BT , although Hindson found no relation between needle shifting and stricture incidence . A prospective, matched-pair analysis by Diez found no association between urethral stricture incidence and urethral dosimetry in patients receiving HDR-RT, however the number of events was too small to draw a definitive conclusion .
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Managing Bone Pain And Weakness
Symptoms like nausea, hot flashes, and pain can usually be relieved with medication. Some people find that complimentary treatments like acupuncture or massage help manage side effects.
Your doctor may also recommend orthopedic surgery to stabilize your bones, relieve pain, and help prevent bone fractures.
What Is Metastatic Prostate Cancer
Sometimes cancer cells will escape the prostate and grow quickly, spreading to nearby tissue, or metastasizing. Nearby lymph nodes are often the first destination for a spreading cancer. If prostate cancer has spread to your lymph nodes when it is diagnosed, it means that there is higher chance that it has spread to other areas of the body as well.
If and when prostate cancer cells gain access to the bloodstream, they can be deposited in various sites throughout the body, most commonly in bones, and more rarely to other organs such as the liver, lung, or brain. Bone metastases are seen in 85% to 90% of metastatic cases.
No matter where a cancer turns up in the body, it is always identified by the tissue type in which it started. Prostate cancer can metastasize to other organs, but it is always prostate cancer, because it consists of mutated prostate cells.
Men diagnosed with metastatic prostate cancer , will often not undergo local treatments of the primary prostate tumor, such as surgery or radiation. Instead, their therapeutic journey might start with hormone therapy, and from there follow a similar path as men who were diagnosed at an earlier stage and had subsequent disease progression.
Want more information about a prostate cancer diagnosis and treatment options? Download or order a print copy of the Prostate Cancer Patient Guide.
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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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How Is Bladder Cancer Treated
Treatment for bladder cancer will depend on the stage and type of cancer you have. Your provider will talk to you about treatment options and which plan of care is best for you.
Superficial Bladder Cancer
Superficial bladder cancer is bladder cancer that has not invaded into the muscle. It is often treated with surgery and intravesicular therapy.
A TURBT is a surgical treatment in which a surgeon removes the bladder tumor using a tool placed into the body through the urethra. The extent of the disease is based mainly on findings during this test. TURBT is the main treatment for superficial disease since all of the tumor is often able to be removed. After a TURBT, you may have intravesicular therapy to prevent the cancer from coming back.
Intravesicular therapy is when chemotherapy or immune therapy is injected directly into the bladder. This treatment destroys any remaining cancer cells. Both immunotherapy and chemotherapy medications can be used in intravesicular therapy.
Bacillus Calmette-Guerin is an immunotherapy medication that is used. BCG is a type of virus that works to stimulate the immune system to destroy any cancer cells in the area. You will likely be given this medication multiple times. After treatment, you will have regular cystoscopies to monitor for any reoccurrence or new tumor development.
Muscle Invading Bladder Cancer
Bladder Preservation Therapy
Radiation and Chemoradiation
What Tests Will I Have If My Doctor Suspects Bladder Cancer Or Another Urinary Problem
Your doctor will want to analyze your urine to determine if an infection could be a cause of your symptoms. A microscopic examination of the urine, called cytology, will look for cancer cells.
A cystoscopy is the main procedure to identify and diagnose bladder cancer. In this procedure, a lighted telescope is inserted into your bladder from the urethra to view the inside of the bladder and, when done under anesthesia, take tissue samples , which are later examined under a microscope for signs of cancer. When this procedure is done in the doctors office, local anesthesia gel is placed into the urethra prior to the procedure to minimize the discomfort.
If the diagnosis of bladder cancer is made, then the next step is to remove the tumor for detailed staging and diagnosis.
Transurethral resection is a procedure done under general or spinal anesthesia in the operating room. A telescope is inserted into the bladder and the tumor is removed by scraping it from the bladder wall , using a special cystoscope . This procedure is diagnostic as well as therapeutic.
This often can be done as an outpatient procedure, with patients discharged from hospital the same day. After removal, the tumor is analyzed by a pathologist, who will determine the type of tumor, the tumor grade and the depth of invasion. The purpose of the procedure is to remove the tumor and obtain important staging information .
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