What Is Carcinoma Of Prostate

What Are Additional Tests For Detecting Prostate Problems

If the DRE or the PSA blood test indicates a problem may exist, the health care provider may order additional tests, including urinalysis, urodynamic tests, cystoscopy, abdominal ultrasound, transrectal ultrasound with prostate biopsy, and imaging studies such as magnetic resonance imaging or computerized tomography scan.

Filed in Testing & Diagnosis

In this article, Id like to discuss a new non-invasive test for prostate cancer that more and more of our patients are requesting. It promises to be much more accurate in highlighting the possibility of prostate cancer than a PSA test, and avoids some of the uncomfortable aspects of a prostate biopsy. It is called the SelectMDX test.

To start with, and to help new patients who are unaccustomed to the prostate cancer diagnosis process, lets discuss the PSA blood test. This is usually the very first test that patients have that leads them down the path of diagnosis. Contrary to what you might have read in your newspaper, doctors never use the PSA blood test to actually diagnose prostate cancer as it is not entirely specific or sensitive . It is, however, extremely useful in identifying men who need further investigation and the largest screening study done to date has shown that a man aged 55-69 years who undergoes PSA testing will have his risk of dying from prostate cancer reduced by 29%. This is important when you consider how common and important prostate cancer is: 35,000 new cases and 11,000 deaths each year in the UK.

What Does It Mean If My Biopsy Report Also Mentions Atrophy Adenosis Or Atypical Adenomatous Hyperplasia

All of these are terms for things the pathologist might see under the microscope that are benign , but that sometimes can look like cancer.

Atrophy is a term used to describe shrinkage of prostate tissue . When it affects the entire prostate gland it is called diffuse atrophy. This is most often caused by hormones or radiation therapy to the prostate. When atrophy only affects certain areas of the prostate, it is called focal atrophy. Focal atrophy can sometimes look like prostate cancer under the microscope.

Atypical adenomatous hyperplasia is another benign condition that can sometimes be seen on a prostate biopsy.

Finding any of these is not important if prostate cancer is also present.

Identification Of Candidates For Observation

Prostate cancer is in most cases a slowly progressive disease. However, early localized disease is curable whereas metastatic disease is not. Thus, a continued debate among clinicians is whether to treat early to prevent disseminated disease, or observe and delay treatment until there is evidence of progression. The former risks harm from overtreatment of an indolent disease whereas the latter risks missing an opportunity for cure among those destined to experience progression. An unmet need is to identify the relatively small proportion of men with a lethal phenotype in whom death can be prevented by curative intervention, while avoiding treatment of the large pool of indolent disease that can be detected with screening.

Selection of patients for active surveillance depends upon patient and tumor metrics, as well as a patient’s personal preferences. The age, comorbidities, and estimated life expectancy of the patient are important to consider given that prostate cancer can be a slowly progressive disease that may not have time to progress in those whose remaining years of life are limited. In this respect, tools for estimating life expectancy can be useful in decision making.

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History Of Untreated Prostate Cancer

The course of prostate cancer in the absence of treatment has been evaluated both in observational studies and randomized trials. Most of the evidence on the outcomes of men that are not treated for prostate cancer comes from those diagnosed in the era prior to when the disease was diagnosed at a more advanced state.

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.

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What Does It Mean To Have A Gleason Score Of 6 7 8 Or 9

Because grades 1 and 2 are not often used for biopsies, the lowest Gleason score of a cancer found on a prostate biopsy is 6. These cancers may be called well differentiated or low-grade and are likely to be less aggressive that is, they tend to grow and spread slowly.

Cancers with Gleason scores of 8 to 10 may be called poorly differentiated or high-grade. These cancers are likely to grow and spread more quickly, although a cancer with a Gleason score of 9-10 is twice as likely to grow and spread quickly as a cancer with a Gleason score of 8.

Cancers with a Gleason score of 7 can either be Gleason score 3+4=7 or Gleason score 4+3=7:

• Gleason score 3+4=7 tumors still have a good prognosis , although not as good as a Gleason score 6 tumor.
• A Gleason score 4+3=7 tumor is more likely to grow and spread than a 3+4=7 tumor, yet not as likely as a Gleason score 8 tumor.

What Does It Mean If My Biopsy Mentions That There Is Perineural Invasion

Perineural invasion means that cancer cells were seen surrounding or tracking along a nerve fiber within the prostate. When this is found on a biopsy, it means that there is a higher chance that the cancer has spread outside the prostate. Still, perineural invasion doesnt mean that the cancer has spread, and other factors, such as the Gleason score and amount of cancer in the cores, are more important. In some cases, finding perineural invasion may affect treatment, so if your report mentions perineural invasion, you should discuss it with your doctor.

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Blood And Lymphatic Vessels

The prostate receives blood through the inferior vesical artery, internal pudendal artery, and middle rectal arteries. These vessels enter the prostate on its outer posterior surface where it meets the bladder, and travel forward to the apex of the prostate. Both the inferior vesical and the middle rectal arteries often arise together directly from the internal iliac arteries. On entering the bladder, the inferior vesical artery splits into a urethral branch, supplying the urethral prostate and a capsular branch, which travels around the capsule and has smaller branches which perforate into the prostate.

The veins of the prostate form a network the prostatic venous plexus, primarily around its front and outer surface. This network also receives blood from the deep dorsal vein of the penis, and is connected via branches to the vesical plexus and internal pudendal veins. Veins drain into the vesical and then internal iliac veins.

The lymphatic drainage of the prostate depends on the positioning of the area. Vessels surrounding the vas deferens, some of the vessels in the seminal vesicle, and a vessel from the posterior surface of the prostate drain into the external iliac lymph nodes. Some of the seminal vesicle vessels, prostatic vessels, and vessels from the anterior prostate drain into internal iliac lymph nodes. Vessels of the prostate itself also drain into the obturator and sacral lymph nodes.

• Microscopic glands of the prostate

E Common Pitfalls And Side

The most common side-effects of both radical prostatectomy and radiation therapy are erectile dysfunction and bladder incontinence. Additional side effects from radiation therapy include diarrhea and rectal irritation, though newer techniques of radiation have reduced the side effect profile while increasing radiation dosages to the target site. Advances in surgical technique, such as nerve-sparring and robot assistance, have decreased the incidence of erectile dysfunction.

Metastatic prostate cancer is commonly complicated by involvement of the bone, including pathological fractures, bone pain, hypercalcemia, and spinal cord compression. Common side effects of zoledronic acid and denosumab are fatigue, myalgias, fever, anemia, elevated serum creatinine, hypocalcemia, hypophosphatemia and osteonecrosis of the jaw. Most metastatic prostate cancer will become castration resistant within 2 years and is invariably fatal.

Though most patients do not received chemotherapy, ADT is not completely benign. Patients can expect flushing, night sweats, fatigue, weakness, decreased libido, erectile dysfunction, and weight gain. Over time, patients may develop hypertension, dyslipidemia, insulin resistance, metabolic syndrome, osteopenia/osteoporosis, and are at increased risk for clinical bone fractures, cardiovascular events, and cerebrovascular events.

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What Tests Check For Prostate Cancer

Common tests to check for prostate cancer include:

• Digital rectal exam: Your doctor inserts a finger into your rectum and touches your prostate gland. The doctor feels the shape of the prostate gland and checks for any hard spots.
• PSA blood test: This blood test tells how much PSA is in your blood. Many men with prostate cancer have PSA levels that are higher than normal or that have gotten higher over time.
• A high PSA level does not always mean a man has prostate cancer. As men get older, their prostate gland may grow larger over time. This growth, and other health conditions, can cause a high PSA level in men who do not have prostate cancer.

If the test results are not normal, your doctor may recommend more tests, such as a biopsy. During a biopsy, the doctor uses a needle to take out a tiny piece or pieces of the prostate gland. An ultrasound probe may be used to guide the needle. Another doctor called a pathologist looks at the tissue under a microscope to check for cancer cells.

Note

What Are The Symptoms Of Prostate Cancer

In most cases, prostate cancer causes no symptoms.

In rare cases, men may experience certain symptoms when they have advanced prostate cancer. However, these symptoms are also present in many men who do not have cancer, so it is best to discuss them with a doctor before jumping to any conclusions. Some of these symptoms can include difficulty emptying the bladder, blood in the urine, and bone pains.

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C Laboratory Tests To Monitor Response To And Adjustments In Management

No laboratory tests are recommended for prostate cancer and the acute response to therapy. During active surveillance or after surgery or radiation, serum PSA is monitored every 6-12 months and DRE every year to monitor remission and recurrence. If rising PSA is noted, a CT of the abdomen/pelvis should be obtained. If patient has new bone pain a bone scan should be performed.

In the setting of malignant hypercalcemia, serial calcium levels should be obtained to monitor adequate response to therapy.

Detecting And Diagnosing Prostate Cancer

Prostate cancer is often detected during the course of a routine prostate exam and/or the PSA blood test, but diagnosing it may require other procedures.

PSA test: PSA is a protein found in prostate cells that helps to keep semen liquified. Most cases of prostate cancer develop in these cells, so an elevated PSA count may be a sign of prostate cancer. However, PSA results are more of an indicator than a firm diagnostic tooltheres not a certain PSA score that means a man has prostate cancer. Instead, there are various ranges that are considered average for different age groups. If the PSA score is elevated for your age, further testing may be recommended.

PSA levels are measured as ng/mL. According to the ACS:

• Men with a PSA level between 4 and 10 have about a 25 percent chance of having prostate cancer.
• Men with a PSA level higher than 10 have more than a 50 percent chance of having prostate cancer.

Not all men with high PSA levels have prostate cancer. High levels may also be caused by a urinary tract infection, prostatitis or benign prostatic hyperplasia, all of which are noncancerous conditions. Conversely, men with a low PSA level may still develop prostate cancer.

PSA tests are not an indication of how aggressive the prostate cancer may be. Many prostate cancers are slow-growing and dont require immediate treatment.

The National Comprehensive Cancer Network suggests these screening guidelines and recommendations for men older than 45:

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Treatment: Prostate Cancer Vaccine

This vaccine is designed to treat, not prevent, prostate cancer by spurring your body’s immune system to attack prostate cancer cells. Immune cells are removed from your blood, activated to fight cancer, and infused back into the blood. Three cycles occur in one month. It’s used for advanced prostate cancer that no longer responds to hormone therapy. Mild side effects can occur such as fatigue, nausea, and fever.

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Advanced Genomic Testing For Prostate Cancer

The most common lab test for prostate cancer is advanced genomic testing, which examines a tumor to look for DNA alterations that may be driving the growth of the cancer. By identifying the mutations that occur in a cancer cells genome, doctors may get a clearer picture of the tumors behavior and be able to tailor a patients treatment based on the findings.

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What Is The Source Of The Information

Researchers funded by the Agency for Healthcare Research and Quality, a Federal Government research agency, reviewed studies on treatments for localized prostate cancer published between January 1, 2007, and March 7, 2014. The report included 52 studies and was reviewed by health care professionals, researchers, experts, and the public.

What Are Prostate Cancer Treatment Side Effects

Some prostate cancer treatments can affect the bladder, erectile nerves and sphincter muscle, which controls urination. Potential problems include:

• Incontinence: Some men experience urinary incontinence. You may leak urine when you cough or laugh, or you may feel an urgent need to use the bathroom even when your bladder isnt full. This problem can improve over the first six to 12 months without treatment.
• Erectile dysfunction : Surgery, radiation and other treatments can damage the erectile nerves and affect your ability to get or maintain an erection. Some men regain erectile function within a year or two . In the meantime, medications like sildenafil or tadalafil can help by increasing blood flow to the penis.
• Infertility: Treatments can affect your ability to produce or ejaculate sperm, resulting in male infertility. If you think you might want children in the future, you can preserve sperm in a sperm bank before you start treatments. After treatments, you may undergo sperm extraction. This procedure involves removing sperm directly from testicular tissue and implanting it into a womans uterus.

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About The Prostate And Prostate Cancer

The prostate gland is part of the male reproductive system and produces fluid that mixes with semen during ejaculation to help sperm travel. The prostate is a walnut-sized, rubbery organ that surrounds the urethrathe urinary duct that carries urine from the bladder out of the bodyand sits directly below the bladder.

The prostate gland, which grows during puberty, is considered an organ and is made up of several dozen lobules or saclike glands, held together with connective prostate tissue and muscle between them. The glands are called exocrine glands, because they secrete liquid to outside the body.

An enlarged prostate, called benign prostatic hyperplasia , is common in men over the age of 40 and may obstruct the urinary tract. The abnormal prostate cell growth in BPH is not cancerous and doesnt increase your risk of getting prostate cancer. However, symptoms for BPH and prostate cancer can be similar.

A condition called prostatic intraepithelial neoplasia , where prostate gland cells look abnormal when examined under a microscope, may be connected to an increased risk of prostate cancer. Prostate cancer is often caught by a doctor performing a digital rectal exam , through a prostate-specific antigen blood test, through a prostate biopsy or with a CT scan.

Another condition, prostatitis, is the inflammation of the prostate. While not cancerous, it may cause higher PSA levels in the blood.

Types Of Prostate Cancer

Almost all prostate cancers are adenocarcinomas. These cancers develop from the gland cells .

Other types of cancer that can start in the prostate include:

• Small cell carcinomas
• Neuroendocrine tumors
• Transitional cell carcinomas
• Sarcomas

These other types of prostate cancer are rare. If you are told you have prostate cancer, it is almost certain to be an adenocarcinoma.

Some prostate cancers grow and spread quickly, but most grow slowly. In fact, autopsy studies show that many older men who died of other causes also had prostate cancer that never affected them during their lives. In many cases, neither they nor their doctors even knew they had it.

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What Are Possible Side Effects Of Treatments For Localized Prostate Cancer

All treatments can cause side effects. The most common side effects are urinary, bowel, and sexual problems. Some problems happen soon after treatment, but others develop over time. Some side effects may get better, but some may last a long time or may never go away. Talk with your doctor if you have any side effects. There may be ways to help manage them.

Table 2. Possible side effects of treatments

Treatment
Weakened bones that may break more easily	Some types of hormone therapy may increase the risk of a heart attack or stroke.