Prostate Cancer

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Prostate Cancer

NIH - Medical Encyclopedia Prostate cancer

"The cause of prostate cancer is unknown, although some studies have shown a relationship between high dietary fat intake and increased testosterone levels. … Prostate cancer is the third most common cause of death from cancer in men of all ages and is the most common cause of death from cancer in men over 75 years old. Prostate cancer is rarely found in men younger than 40. … Men at higher risk include black men older than 60, farmers, tire plant workers, painters, and men exposed to cadmium. The lowest incidence occurs in Japanese men and vegetarians. Prostate cancers are classified or staged based on their aggressiveness and how different they are from the surrounding prostate tissue. There are several different ways to stage tumors, a common one being the A-B-C-D staging system, also known as the Whitmore-Jewett system: A: Tumor is not palpable (not felt on physical examination), and is usually detected by accident after prostate surgery done for other reasons. B: Tumor is confined to the prostate and usually detected by physical examination or PSA testing. C: Tumor extends beyond the prostate capsule without spread to lymph nodes. D: Cancer has spread (metastasized) to regional lymph nodes or other parts of the body (bone and lungs, for example)."

Highlighted Articles

Body Mass Index, Weight Change, and Risk of Prostate Cancer in the Cancer Prevention Study II Nutrition Cohort (Cancer Epidemiology Biomarkers & Prevention 2007)

" Conclusion: Obesity increases the risk of more aggressive prostate cancer and may decrease either the occurrence or the likelihood of diagnosis of less-aggressive tumors. Men who lose weight may reduce their risk of prostate cancer."

Meat Consumption among Black and White Men and Risk of Prostate Cancer in the Cancer Prevention Study II Nutrition Cohort (Cancer Epidemiol Biomarkers Prev 2006)

"No measure of meat consumption was associated with risk of prostate cancer among White men. Among Black men, total red meat intake (processed plus unprocessed red meat) was associated with higher risk of prostate cancer … this increase in risk was mainly due to risk associated with consumption of cooked processed meats (sausages, bacon, and hot dogs … This study suggests that high consumption of cooked processed meats may contribute to prostate cancer risk among Black men in the United States."

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Prostate Cancer

Diagnosis, Imaging, and Screening

NEWS:

Adjusting PSA Scores For Obese Men Or Cancers May Be Missed ""Obese men have more blood circulating throughout their bodies than normal weight men, and as a result, the concentration of prostate-specific antigen, or PSA, in the blood -- the gold standard for detecting prostate cancer -- can become diluted," said Stephen Freedland, M.D., a Duke urologist and senior researcher on the study."

Late in Life, Prostate Cancer Screening May Do More Harm than Good "The potential benefits of PSA testing are unclear, but experts agree that a man would probably have to live more than a decade to experience them. This is because the forms of prostate cancer that are detected by PSA testing late in life often progress slowly, as opposed to the more aggressive and often fatal forms of the disease that may occur earlier. The potential harms of PSA testing, on the other hand, can occur immediately and are often substantial. These include additional testing, psychological distress, and side effects from treating a disease that might never have caused any harm. "

New study backs less frequent prostate tests "High PSA levels can mean cancer or just an enlarged prostate; only a biopsy can tell. Moreover, prostate cancer usually is slow-growing and there’s little way to predict which early-stage tumors will threaten life. Since treatment can cause incontinence or impotence, PSA testing may do more harm than good for some men. … More frequent testing spotted more tumors overall — but didn’t reduce diagnosis of aggressive tumors that formed between visits, researchers report Wednesday in the Journal of the National Cancer Institute."

PSA at middle age indicates long-term prostate cancer risk "A single PSA value measured in men between 44 and 50 years of age is highly predictive of the development of clinically diagnosed prostate cancer up to 25 years later … The researchers also reported that men whose total PSA (tPSA) was 1.0 ng/mL and higher were at increased risk for developing prostate cancer by age 75 compared to the median risk of the general population. However, that increased risk was harbored by less than 20% of these men."

PSA Value Is a Poor Predictor of Prostate Cancer Outcome "A study shows that while prostate-specific antigen (PSA) measurement remains an important monitoring tool, it performs poorly in distinguishing those who will develop lethal prostate cancer from those at low or no risk of disease progression."

ARTICLES:

Prostate cancer screening: Should you get a PSA test?

The media and prostate cancer screening. "A particular characteristic of this debate has been the polarisation of views for and against screening to the point where, at times, constructive debate has been constrained. However, it is important to differentiate between prostate-specific antigen (PSA) screening, with indiscriminate testing of all men (between prescribed ages), and testing after informed consent, as recommended by peak Australian cancer control and health agencies.3-6 Apart from the fact that PSA is not a test for prostate cancer and has no threshold level providing a high sensitivity and specificity, but rather has a continuum of prostate cancer risk at all values,7 a raised PSA level often commits men to the invasive procedure of transrectal ultrasound (TRUS) guided biopsies. Most men presenting for TRUS biopsies have serum PSA levels of 4–10 ng/mL and do not have prostate cancer detected with extended numbers of biopsy cores."

JOURNAL ARTICLES:

Are prostatic biopsies necessary in men aged > or =80 years? (BJU Int. 2007) "CONCLUSIONS: In men aged > or = 80 years with a PSA level of > or = 30 ng/mL, at least 97% had prostate cancer, >90% of whom had high-grade disease, and nearly all with cancer received active pharmacological treatment. In the vast majority of these men prostate biopsies did not alter their cancer management. The value of prostatic biopsy in this age group, with a PSA level of > or = 30 ng/mL, is questionable."

Body mass index influences prostate-specific antigen in men younger than 60 years of age. (Int J Urol. 2007)

Diagnosis of prostate cancer. (Recent Results Cancer Res. 2007) "Currently, the lifetime risk of a diagnosis of prostate cancer for North American men is 16%, compared to the lifetime risk of death from prostate cancer, which is 3% (Carter 2004). The advent of prostate-specific antigen (PSA) screening and transrectal ultrasonography (TRUS) has significantly impacted the detection of prostate cancer over the last 20 years. The mean age at diagnosis has decreased (Hankey et al. 1999; Stamey et al. 2004) and the most common stage at diagnosis is now localized disease (Newcomer et al. 1997; Stamey et al. 2004). The goal of prostate cancer screening is to detect only those men at risk for death from the disease at an early curable phase."

Diagnosis of prostate cancer in patients with an elevated prostate-specific antigen level: role of endorectal MRI and MR spectroscopic imaging. (AJR Am J Roentgenol. 2007) "CONCLUSION: Endorectal MRI and MRSI are reasonably accurate for the diagnosis of prostate cancer in patients with an elevated serum PSA level, but the remaining limitations suggest that MRI and MRSI should be used as a supplement rather than a replacement for biopsy using the current technology and diagnostic criteria."

How Adequate is Digital Rectal Exam for Prostate Cancer Screening at Colonoscopy? Can Adequacy be Improved? (Dig Dis Sci. 2007)

MR imaging in local staging of prostate cancer. (Eur J Radiol. 2007) "Clinical staging to differentiate between localized and advanced disease stage appear to be unreliable. Curative therapy can only be performed in patients with localized prostate cancer. Accurate staging is therefore especially important for proper disease management. Since 1984 magnetic resonance (MR) imaging has been applied for this purpose. However, the role of MR imaging of the prostate is debated extensively in the literature."

[MRI of prostate cancer.] (Presse Med. 2007)

Obesity Is Negatively Associated with Prostate-Specific Antigen in U.S. Men, 2001-2004 (Cancer Epidemiology Biomarkers & Prevention 2007)

Prostate cancer mortality in relation to screening by prostate-specific antigen testing and digital rectal examination: a population-based study in middle-aged men. (Cancer Causes Control. 2007) "CONCLUSIONS: Results of this study suggest a reduction in prostate cancer-specific mortality associated with PSA and/or DRE screening in middle-aged men. Findings should be interpreted cautiously, however, as results are based on observational data. Further, the study was not able to separate the relative efficacy of PSA versus DRE screening."

Prostate cancer screening. (Recent Results Cancer Res. 2007)

Prostate cancer: the new evidence base for diagnosis and treatment. (Pathology. 2007) "There is now compelling evidence to show that: Cancers diagnosed by screening are more likely to be early stage, when most can be cured by a number of different treatment options. The maximum benefits of screening are for men aged 50-70 years. Older men have a greater chance of a clinically insignificant cancer being diagnosed for which treatment is not necessary. The familial risks of PC are well recognised. In particular, men with one or more first-degree relatives already diagnosed with the disease should be actively encouraged to undergo screening."

Prostate Volume Is Strongest Predictor of Cancer Diagnosis at Transrectal Ultrasound-Guided Prostate Biopsy with Prostate-Specific Antigen Values Between 2.0 and 9.0 ng/mL. (Urology. 2007) "OBJECTIVES: Data have suggested benign prostatic hyperplasia, and not cancer, as the major reason for elevated prostate-specific antigen (PSA) values between 2.0 and 9.0 ng/mL. If this hypothesis were correct, within these ranges, a smaller prostate volume would be a stronger predictor of cancer than the PSA level itself (the relative contribution from cancer is greater in smaller glands. … CONCLUSIONS: When the PSA level is in the 2.0 to 9.0 ng/mL range, a smaller prostate volume is the strongest predictor of cancer detection. These data support previous studies suggesting the amount of benign prostatic hyperplasia, and not cancer, as the major factor responsible for elevated PSA."

Prostate-specific antigen in the early detection of prostate cancer. (CMAJ. 2007) "Throughout Canada, the United States and much of Europe, prostate-specific antigen (PSA) screening for prostate cancer has proliferated over the past 2 decades, leading to dramatic increases in detection rates of prostate cancer. Although it has unquestionably led to increased detection of cancer and a migration to lower-stage and -volume tumours, it is still unknown whether PSA screening significantly reduces mortality from prostate cancer. Often thought to be dichotomous (i.e., either normal or elevated), PSA measurements actually reflect cancer risk, with the risks of cancer and of aggressive cancer increasing with the level of PSA."

Prostate-specific antigen levels as a predictor of lethal prostate cancer. (J Natl Cancer Inst. 2007) "CONCLUSIONS: Although baseline PSA value and rate of PSA change are prognostic factors for lethal prostate cancer, they are poor predictors of lethal prostate cancer among patients with localized prostate cancer who are managed by watchful waiting."

Prostate-specific antigen (PSA) and PSA velocity for prostate cancer detection in men aged <50 years. (BJU Int. 2007) " CONCLUSIONS In men aged <50 years the operating characteristics of PSA are more sensitive and specific than in older men. Diagnostic PSA levels in men aged <50 years are significantly lower than suggested by guidelines. Using a 2.0-2.5 ng/mL PSA level threshold for biopsy in men aged <50 years and a PSAV threshold lower than the traditional 0.75 ng/mL/year is reasonable in contemporary practice. Further studies are warranted to validate these thresholds."

PSA reduction (after antibiotics) permits to avoid or postpone prostate biopsy in selected patients. (Prostate Cancer Prostatic Dis. 2007)

Screening for prostate cancer. (Am Fam Physician. 2007)

Screening for prostate cancer in Dutch hereditary prostate cancer families. (Int J Cancer. 2007) "A more aggressive screening policy in HPC families does not seem to be justified."

Screening for prostate cancer: A Cochrane systematic review. (Cancer Causes Control. 2007) " CONCLUSIONS: Given that only two randomised controlled trials were included, and the high risk of bias of both trials, there is insufficient evidence to either support or refute the routine use of screening compared to no screening for reducing prostate cancer mortality. Currently, no robust evidence from randomised controlled trials is available regarding the impact of screening on quality of life, harms of screening, or its economic value. Results from two ongoing large scale multi-center randomised controlled trials, which will be available in the upcoming few years, will assist patients and health professionals in making an evidence-based decision regarding the effectiveness of screening for prostate cancer."

[Screening for prostate cancer. What does the evidence show?] (Ugeskr Laeger. 2007) "The review concludes that there is insufficient evidence to either support or refute the routine use of mass, selective or opportunistic screening compared to no screening in order to reduce prostate cancer mortality. Until ongoing large, randomised screening trials mature and produce results that may prove otherwise, the Danish policy of not recommending PSA-based screening should be upheld."

The continuing importance of transrectal ultrasound identification of prostatic lesions. (J Urol. 2007)

“The news is [not] all good”: misrepresentations and inaccuracies in Australian news media reports on prostate cancer screening (The Medical Journal of Australia 2007) "Conclusions: Despite near universal lack of support for prostate cancer screening of asymptomatic men by leading international and Australian cancer control agencies, Australians are exposed to an unbalanced stream of encouragement to seek testing. This coverage includes inaccurate information which ignores scientific evidence and the general lack of expert agency support. "

[Transrectal ultrasound: an applicable diagnostic approach to chronic prostatitis] (Zhonghua Nan Ke Xue. 2007)

Ultrasound of prostate cancer: recent advances. (Eur Radiol. 2007)

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