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Prostate Cancer

Aid & Information

Site provided by a patient with Stage IV Prostate Cancer

 

Understanding Prostate Cancer

An informed patient can make a better decision.

The Cancer

Prostate cancer is a malignancy of one of the major male sex glands. Along with the testicles and the seminal vesicles, the prostate secretes the fluid that makes up semen. The prostate is about the size of a walnut and lies just behind the urinary bladder. A tumor in the prostate interferes with proper control of the bladder and normal sexual functioning. Often the first symptom of prostate cancer is difficulty in urinating. However, because a very common, non-cancerous condition of the prostate, benign prostatic hyperplasia (BPH), also causes the same problem, difficulty in urination is not necessarily due to cancer.

Cancerous cells within the prostate itself are generally not deadly on their own. However, as the tumor grows, some of the cells break off and spread to other parts of the body through the lymph or the blood, a process known as metastasis. The most common sites for prostate cancer to metastasize are the seminal vesicles, the lymph nodes, the lungs, and various bones around the hips and the pelvic region. The effects of these new tumors are what can cause death.

Prostate cancer affects almost a quarter million men each year in the United States. After skin cancer, prostate cancer is the second most common cancer in American men and is second only to lung cancer as a cause of cancer deaths. The good news is that reliable diagnostic tests and numerous treatment options are available, and death rates from prostate cancer are on the decline.

With proper screening, prostate cancer can be detected early. Prostate cancer is curable when detected early. Yet the early stages of prostate cancer are often asymptomatic, so the disease often goes undetected until the patient has a routine physical examination. Diagnosis of prostate cancer can be made using some or all of these tests:

  • Digital rectal examination (DRE)
  • Blood tests
  • Transrectal ultrasound
  • Prostate biopsy
  • X rays and imaging techniques
  • Noticeable symptoms can occur with prostate cancer as it grows larger in the prostate. But these symptoms can also be caused by other prostate problems:

  • Delayed or slowed start of urinary stream
  • Dribbling or leakage of urine, most often after urinating
  • Slow urinary stream
  • Straining when urinating, or not being able to empty all of the urine
  • Blood in the urine or semen
  • When the cancer has spread, there may be bone pain or tenderness, most often in the lower back and pelvic bones
  • An abnormal digital rectal exam may be the only sign of prostate cancer. A biopsy is needed to tell if you have prostate cancer. A biopsy is a procedure to remove a sample of tissue from the prostate. The sample is sent to a lab for examination. It will be done in your doctor's office.

    Your doctor may recommend a biopsy if:

  • You have a high PSA level
  • A digital rectal exam reveals a hard or uneven surface
  • Prostate-specific antigen (PSA) test

    The epithelial cells in the prostate gland produce a protein called PSA (prostate-specific antigen). The PSA helps keep the semen in its liquid state. Some of the PSA escapes into the bloodstream. We can measure a man's PSA levels by checking his blood. If a man's levels of PSA are high, it might be an indication of either prostate cancer or some kind of prostate condition. PSA levels may also be high in men who have an infection or inflammation of the prostate or BPH (an enlarged, but noncancerous, prostate).

    Gleason Score

    Physicians use the term "grade" to describe the appearance of thin slices of cancer tissue when it is observed under a microscope. In the case of prostate cancer tissue, the most common system used in the USA to grade the appearance of this tissue is called the Gleason grading system, after the physician who first described this system.

  • Gleason Grades 1 and 2: These two grades closely resemble normal prostate. They are the least important grades because they seldom occur in the general population and because they confer a prognostic benefit which is only slightly better than grade 3.
  • Gleason Grade 3: This is the most common grade by far and is also considered well differentiated (like grades 1 and 2).
  • Gleason Grade 4: This is probably the most important grade because it is fairly common and because of the fact that if a lot of it is present, patient prognosis is usually (but not always) worsened by a considerable degree.
  • Gleason Grade 5: Gleason grade 5 is an important grade because it usually predicts another significant step towards poor prognosis. Its overall importance for the general population is reduced by the fact that it is less common than grade 4, and it is seldom seen in men whose prostate cancer is diagnosed early in its development.
  • When a pathologist looks at prostate cancer specimens under the microscope and gives them a Gleason grade, he or she in fact will always try to identify two architectural patterns and assign a Gleason grade to each one. There may be a primary or most common pattern and then a secondary or second most common pattern which the pathologist will seek to describe for each specimen; alternatively, there may often be only a single pure grade.

    The Gleason score is actually a combination or sum of two numbers. These combined Gleason sums or scores may be determined as follows:

  • The lowest possible Gleason score is 2 (1 + 1), where both the primary and secondary patterns have a Gleason grade of 1 and when added together their combined sum is 2.
  • Very typical Gleason scores might be 5 (2 + 3), where the primary pattern has a Gleason grade of 2 and the secondary pattern has a grade of 3, or 6 (3 + 3), a pure pattern.
  • Another typical Gleason score might be 7 (4 + 3), where the primary pattern has a Gleason grade of 4 and the secondary pattern has a grade of 3.
  • Finally, the highest possible Gleason score is 10 (5 + 5), when the primary and secondary patterns both have the most disordered Gleason grades of 5.
  • The grade of a prostate cancer specimen is very valuable to doctors in helping them to understand how a particular case of prostate cancer can be treated. In general, the time for which a patient is likely to survive following a diagnosis of prostate cancer is related to the Gleason score. The lower the Gleason score, the better the patient is likely to do.

    However, remember that prostate cancer is a very complicated disease. People with low Gleason scores have been known to fare poorly and men with high Gleason scores have been known to do well. General principles do not always apply to individual patients.

    Biopsy

    Transrectal biopsy : The removal of tissue from the prostate by inserting a thin needle through the rectum and into the prostate. This procedure is usually done using transrectal ultrasound to help guide where samples of tissue are taken from. A pathologist views the tissue under a microscope to look for cancer cells. Transperineal biopsy : The removal of tissue from the prostate by inserting a thin needle through the skin between the scrotum and rectum and into the prostate. This procedure is usually done using transrectal ultrasound to help guide where samples of tissue are taken from. A pathologist views the tissue under a microscope to look for cancer cells.

    At Risk

    Prostate cancer is the most common cause of death from cancer in men over age 75. Prostate cancer is rarely found in men younger than 40. People who are at high risk include: African American men, who are also more likely to develop this cancer at every age Men who are older than 60 Men who have a father or brother with prostate cancer Other people at risk include: Men who have been around Agent Orange Men who use too much alcohol Farmers Men who eat a diet high in fat, especially animal fat Obese men Tire plant workers Painters Men who have been around cadmium Prostate cancer is less common in people who do not eat meat (vegetarians).

    Survival Rates

    This is a great deal of information on the web related to prostate cancer. Much of it is older, 4 years or more. So it is important to make sure that whatever you are researching that you know the date of the information. Advances in technology and medicine are never ending, so 4 year old information could be very out dated. So please keep this in mind than educating yourself about prostate cancer.

    This was dated Jan 22, 2014

    By Dr. Ananya Mandal, MD

    Survival rates are estimated and used as a way of explaining to cancer patients what their prognosis is. Survival statistics can help a patient understand how long they may survive after they are diagnosed with cancer.

    While this may give hope to some patients, others may find survival estimates unhelpful and may not even want to hear them.

    When dealing with cancer patients, the 5-year survival rate is often used, which refers to the proportion of people who survive for at least five years after they have been diagnosed with cancer. Many patients who are diagnosed may survive more than five years or may even be cured with treatment.

    Five-year relative survival rates adjust for the fact that people may die from causes unrelated to cancer and are relative to the expected survival rates of people without cancer. Survival rates are often based on outcome data for large numbers of people who were diagnosed with cancer and cannot be used to predict the prognosis for a specific individual.

    Prostate cancer is a relatively slow growing cancer in most individuals and therefore survival rates are usually high. Doctors explain to the patients how well the numbers may apply to them in the context of the various aspects of their disease. According to the most recent survival data on all stages of prostate cancer:

  • The relative 5-year survival rate is between 99% and 100%
  • The 10-year survival rate is 98%
  • The 15-year survival rate is 93%
  • Survival by stage

    Survival rates also vary depending on the stage of the cancer when it was first diagnosed. Patients with cancers that have been detected in the early stages have a longer survival rate compared with those with cancers detected at a later and more advanced stage.

    A database held by the National Cancer Institute provides survival data for different types of cancer that are categorized according to whether they were local, regional or distant at the time of diagnosis. Local refers to cancer confined to the prostate, regional to cancer that has spread to nearby but not distant areas, and distant refers to cancer that has spread to distant lymph nodes, bones or other areas of the body. According to the cancer stage at diagnosis, the 5-year survival rates are:

  • 100% for local stage
  • 100% for regional stage
  • 28% for distant stage
  • The 4 Stages of Prostate Cancer

    Prostate Cancer Stage I

    Prostate cancer is found in the prostate only. Stage I prostate cancer is microscopic; it can’t be felt on a digital rectal exam (DRE), and it isn’t seen on imaging of the prostate.

    Prostate Cancer Stage II

    The tumor has grown inside the prostate but hasn’t extended beyond it.

    Prostate Cancer Stage III

    Prostate cancer has spread outside the prostate, but only barely. Prostate cancer in stage III may involve nearby tissues, like the seminal vesicles.

    Prostate Cancer Stage IV

    The cancer has spread (metastasized) outside the prostate to other tissues. Stage IV prostate cancer commonly spreads to lymph nodes, the bones, liver, or lungs.

    Four stages of prostate cancer