Prostate Cancer
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Prostate Cancer
NHS - Prostate cancer “Diagnosing prostate cancer Prostate-specific antigen (PSA) testing The main test for prostate cancer is the PSA (prostate-specific antigen) test, which looks for raised levels of PSA in the blood. Prostate cancer increases the production of PSA, so the test may be able to detect prostate cancer in its early stages. However, the test is problematic: • Up to 20% of men who do have prostate cancer will not have a raised PSA level; • Over 65% of men with a raised PSA level will not have cancer. PSA levels tend to rise in all men as they get older. Digital rectal examination The next step to confirming a diagnosis of prostate cancer is a digital rectal examination (DRE). This can be done by your GP. During a DRE, your GP will insert a finger into your rectum (back passage). The rectum is close to your prostate gland, so your GP is able to check to see if the surface of the gland has changed. This will feel a little uncomfortable but it should not cause you pain. Prostate cancer can cause the gland to become hard and bumpy. However, in some cases, the cancer causes no changes to the gland and a DRE may not be able to detect the cancer. DRE is also useful in ruling out benign prostatic hyperplasia, as this causes the gland to feel firm and smooth. Biopsy Your GP will assess the risk of you possibly having prostate cancer based on a number of factors, including your PSA levels, the results of your DRE and associated risk factors such as age, family history and ethnic group. If it is felt that the risk is significant you will be referred to a hospital to discuss the options of further tests. The most commonly used test is known as a transrectal ultrasound-guided biopsy (TRUS). During a TRUS biopsy, an ultrasound scanner (a machine that uses sound waves to build up a picture of the inside of your body) is used to study your prostate. This also allows the doctor to guide a needle through your rectum which is then used to take small samples of tissue from your prostate (biopsy). The procedure can be uncomfortable and sometimes painful. You may be given a local anaesthetic to minimize any discomfort. The biopsy may also cause complications such as bleeding and infection. Although it is much more reliable than a PSA test, a biopsy may miss up to 20% of cancers. Therefore, you may need to undergo another biopsy if your symptoms persist, or your PSA level continues to rise. Gleason score The samples of tissue from the biopsy are then studied in a laboratory. If cancerous cells are found, they can be studied further to see how quickly the cancer will spread. This is done by giving the samples a grade, known as a Gleason score. The lower the score, the less likely the cancer will spread. • a Gleason score of 6 or less means the cancer is unlikely to spread, • a Gleason score of 7 means that there is a moderate chance of the cancer spreading, and • a Gleason score of 8 or above means that there is a significant chance that the cancer will spread. Further testing If it is felt that there is a significant chance that the cancer has spread from your prostate to other parts of the body, further tests may be recommended. Two tests that are commonly used are: • A magnetic resonance imaging (MRI ) scan - which uses magnetic waves to build up a detailed picture of the inside of your body. A MRI scan can tell if the cancer has spread beyond the prostate to the surrounding tissue. • An isotope bone scan - this test uses radiation to detect any abnormalities in your bones. An isotope bone scan can tell if the cancer has spread to your bones. “
NIH - Prostate cancer (Medical Encyclopedia) "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
Doctors Urged Not to Screen Elderly Men for Prostate Cancer (2008) “In a move that could lead to significant changes in medical care for older men, a national task force on Monday recommended that doctors stop screening men ages 75 and older for prostate cancer because the search for the disease in this group is causing more harm than good.”
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:
More Evidence Prostate Tests Overdiagnose Cancer
Prostate Cancer Overdiagnosis in the United States: The Dimensions Revealed “More than 1 million additional men have been diagnosed with and treated for prostate cancer since the introduction of prostate-specific antigen (PSA) screening in the 1980s. And the "vast majority of these additional 1 million men did not benefit from early detection," write the authors of a new study published online August 31 in the Journal of the National Cancer Institute. "Prostate cancer screening has resulted in substantial overdiagnosis and in unnecessary treatment," Otis W. Brawley, MD, medical director of the American Cancer Society, writes in an editorial that accompanies the new study. These new findings once again question the benefits of prostate cancer screening, says Dr. Brawley.”
Report: Prostate cancer screening has yet to prove its worth “The recent release of two large randomized trials suggests that if there is a benefit of screening, it is, at best, small, says a new report in CA: A Cancer Journal for Clinicians. Authored by Otis W. Brawley, M.D. of the American Cancer Society and Donna Ankerst, Ph.D. and Ian M. Thompson, M.D. of the University of Texas Health Science Center at San Antonio, the review says because prostate cancer is virtually ubiquitous in men as they age, it is clear that a goal of "finding more cancers" is not acceptable. Instead, public health principles demand that screening must reduce the risk of death from prostate cancer, reduce the suffering from prostate cancer, or reduce health care costs when compared with a non-screening scenario. The authors suggest prostate cancer screening has yet to reach one of these standards to date. No major medical group, including the American Cancer Society, currently recommends routine prostate cancer screening for men at average risk. In the United States, prostate cancer will affect one man in six men during his lifetime. Since the mid-1980s, screening with the prostate–specific antigen (PSA) blood test has more than doubled the risk of a prostate cancer diagnosis. The review says a decrease in prostate cancer death rates has been observed since that time, but the relative contribution of PSA testing as opposed to other factors, such as improved treatment, has been uncertain.”
U.S. Cancer Screening Trial Shows No Early Mortality Benefit from Annual Prostate Cancer Screening
ARTICLES:
Screening for Prostate Cancer — The Controversy That Refuses to Die
JOURNAL ARTICLES:
A systematic review of the diagnostic accuracy of prostate specific antigen. (BMC Urol. 2009)
Mortality Results from a Randomized Prostate-Cancer Screening Trial (NEJM 2009) “However, we now know that prostate-cancer screening provided no reduction in death rates at 7 years and that no indication of a benefit appeared with 67% of the subjects having completed 10 years of follow-up. Thus, our results support the validity of the recent recommendations of the U.S. Preventive Services Task Force, especially against screening all men over the age of 75 years.”
Proposed quality standards for regional lymph node dissections in patients with melanoma. (Ann Surg. 2009)
Prostate specific antigen for early detection of prostate cancer: longitudinal study (BMJ 2009) “Conclusions Although prostate specific antigen has a relatively high validity for prediction of subsequent prostate cancer, this longitudinal study shows that no cut-off value for prostate specific antigen attains the likelihood ratios formally required for a screening test. However, prostate specific antigen concentrations below 1.0 ng/ml virtually ruled out a diagnosis of prostate cancer during follow-up, and higher prostate specific antigen concentrations expressed a continuum of prostate cancer risk. Taken together, our study and the recent findings from screening trials strongly indicate that in addition to serum concentrations of prostate specific antigen, further biomarkers are needed before population based screening for prostate cancer can be recommended.”
Prostate Specific Antigen Testing Among the Elderly-When To Stop? (J Urol. 2009) “CONCLUSIONS: Men 75 to 80 years old with a prostate specific antigen less than 3 ng/ml are unlikely to die of or experience aggressive prostate cancer during their remaining life, suggesting that prostate specific antigen testing might be safely discontinued for these men.”
Screening and Prostate-Cancer Mortality in a Randomized European Study (NEJM 2009) “Conclusions PSA-based screening reduced the rate of death from prostate cancer by 20% but was associated with a high risk of overdiagnosis. “
Screening for Prostate Cancer (CA Cancer J Clin 2009) “In the United States, prostate cancer will affect 1 man in 6 during his lifetime. Since the mid-1980s, screening with the prostate–specific antigen (PSA) blood test has more than doubled the risk of a prostate cancer diagnosis. A decrease in prostate cancer death rates has been observed since that time, but the relative contribution of PSA testing as opposed to other factors, such as improved treatment, has been uncertain. The recent release of 2 large randomized trials suggests that if there is a benefit of screening, it is, at best, small.”
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