Prostate Cancer
- Diagnosis, Imaging, Screening
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- Internet Sites
- Risk Factors
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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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Notes
View Treatment Guidelines from previous years. Go to Treatment for each year.
Prostate Cancer
Daily Treatment Report
Cognitive Therapy-CBT-Psychotherapy
Device Therapy
Drug Side-Effects and Interactions
Higher Risk For Heart Disease And Diabetes Associated With Androgen Deprivation Therapy
Impact of Androgen Deprivation Therapy on Cardiovascular Disease and Diabetes (Journal of Clinical Oncology 2009) “Conclusion: Continuous ADT use for at least 6 months in older men is associated with an increased risk of diabetes and fragility fracture but not AMI or sudden cardiac death.”
Drugs
Role of maximum androgen blockade in advanced prostate cancer. (Indian J Urol. 2009)
Longer is better for treating prostate cancer “ "In our study, the difference in the effect of short-term and long-term androgen suppression on five-year mortality was modest, but we believe that the advantage of long-term suppression is likely to be maintained at 10 years," the team wrote in their report. "When used early in the course of the disease, androgen-deprivation therapy can improve survival, but the researchers also found that to achieve this effect therapy must be provided for at least three full years," Dr. Peter Albertsen of the University of Connecticut Health Center in Farmington wrote in a commentary. Long-term therapy had some significant drawbacks, producing more hot flashes, lower libido and reduced sexual activity. However, both groups reported the same overall quality of life. It is not clear whether the treatment is also best for smaller, localized prostate cancers, the kind most often diagnosed today thanks to better screening, said Albertsen. Until further tests are done on men with that stage of cancer, he said, long-term treatment combined with radiation should be limited to patients with advanced localized disease who are receiving radiation, or to men whose disease has spread.“
Exercise
General Information
Evidence-Based Medicine, Conscience-Based Medicine, and the Management of Low-Risk Prostate Cancer
Outcomes With "Watchful Waiting" in Prostate Cancer in US Now So Good, Active Treatment May Not Be Better “Outcomes have greatly improved in recent years for men diagnosed with localized prostate cancer who opt for "watchful waiting" or "active surveillance," and are now so good that this option of conservative management should be considered as a reasonable alternative to immediate treatment. This is the conclusion from the largest study to be conducted in the United States since the advent of prostate-specific antigen (PSA) screening. The results appear in the September 16 issue of the Journal of the American Medical Association. “
Researcher claims disease overtreated “It did not make sense to do something which would increase peoples risk "if you are offering something which has a considerable hazard, you have really added to their problems". The difficulty was that the commonly used prostate specific antigen test (PSA) led to over-diagnosis of cancers and over treatment. About 30% of men over 50 had a small tumour on their prostate which, when studied under a microscope was indistinguishable from cancer. A vast majority of these tumours did not appear to become a clinical disease or even cause symptoms. Research into randomised trials using PSA for screening showed that the over-diagnosis of cancers could be as high as 50%. Men were undergoing radical prostatectomy or radiotherapy which could result in chronic incontinence (urinary or faecal), impotence, or in some instances, death, he said. Dr Cox estimates that about 2000 cases of prostate cancer are detected by PSA testing a year in New Zealand and about half of them would never become clinically relevant. “
Overused: Androgen-Deprivation Therapy in Prostate Cancer “The overuse of ADT has been driven, in part, by clinicians in the United States overestimating the effectiveness of ADT, suggests Dr. Albertsen. "If it's good for advanced disease, there's a good chance it will work for localized disease — that's probably been the thinking," he explained. Money has also been a driver. "Overuse was probably worse a few years ago when clinicians were making a lot of money off of it," Dr. Albertsen said about the administration of ADT and related follow-up care. The desire to take action is another driver, said Dr. Dale. "There is a propensity to 'do something' about cancer that leads to starting a therapy that is not justified. This is particularly true for older men," he told Medscape Oncology. Dr. Dale cited 2 "do something" settings in which data don't support the use of ADT. "Starting it early when PSA [prostate-specific antigen] first rises following surgery or radiation — versus waiting until later to start it — has not been shown to extend life. It is also being used increasingly in older men as primary therapy rather than surgery or radiation therapy," he noted.”
'Watchful Waiting' Safe With Low-Risk Prostate Cancers “Refusing immediate treatment can be safe for men with low-risk prostate cancer if they're closely monitored, new research finds. The multi-center study of American and Canadian patients was conducted between 1991 and 2007. "When or if to treat men with low-risk prostate cancer has always been a challenging question that faces patients and urologists," study author Dr. Scott Eggener, an assistant professor of surgery at the University of Chicago Medial Center, said in a news release from the university. "Some men may be rushing into treatment that won't necessarily benefit them, prevent problems or prolong life. Close observation in certain patients may provide and maintain quality of life without increasing the chances of the cancer spreading." Between 20 percent and 50 percent of American men diagnosed with prostate cancer will eventually die from a cause other than their prostate cancer, he noted. This shows that a large number of patients don't benefit from treatment for their prostate cancer. … "Active surveillance is not a total disregard for patients with prostate cancer. Instead, it identifies men unlikely to be affected by their cancer and encourages frequent monitoring, and then starting therapy at a later appropriate time if needed. Cure rates appear to be identical when these men choose immediate treatment or delayed treatment when prompted by new information about their condition," Eggener said.”
Guidelines
NCCN Clinical Practice Guidelines in Oncology™ Prostate Cancer (2009)
Immunotherapy
Internet Sites
Treatment Information
NCI - Dictionary of Cancer Terms
NCI - Overview of Nutrition in Cancer Care
NCI - Prostate Cancer (PDQ®): Treatment
Drug-Food-Supplement Information
DrugDigest (drug interactions)
FDA - Drug Interactions: What You Should Know
NIH - Botanical Dietary Supplements: Background Information
NIH - Drug, Supplements, and Herbal Information
NIH - Herbal Supplements: Consider Safety, Too
NIH - Vitamin and Mineral Supplement Fact Sheets
Nutrition
Men Treated For Localized Prostate Cancer Could Benefit From Pomegranate Juice Consumption "This study suggests that pomegranate juice may effectively slow the progression of prostate cancer after unsuccessful treatment," said Christopher Amling, MD, an AUA spokesman. "This finding and other ongoing research might one day reveal that pomegranate juice is an effective prostate cancer preventative agent as well."”
Other
Radiation-Chemotherapy
Other Treatments
Experimental
Radiotherapy
Shorter Radiation Course Stops Cancer Growth In High-Risk Prostate Cancer Patients
Hormone Therapy Ups Survival of Radiation-Treated Men With Prostate Cancer “The use of hormone suppression in combination with radiotherapy cut the risk of biochemical failure by 24% and improved clinical progression-free survival by 19%, the report shows. Cancer-specific survival and overall survival were improved by 24% and 14%, respectively. Treatment with hormone therapy reduced the risks of local and distant relapse by 36% and 28%, respectively. As noted, hormone therapy plus radiotherapy caused no greater toxicity than did radiotherapy alone.”
Does hormone treatment added to radiotherapy improve outcome in locally advanced prostate cancer?: meta-Analysis of Randomized Trials. (Cancer. 2009)
Long-Term Outcomes in Younger Men Following Permanent Prostate Brachytherapy. (J Urol. 2009)
Supplements-Vitamins-CAM
Green Tea: The Next Cancer Therapy? “The study included 26 men, aged 41 to 72 years, diagnosed with prostate cancer and scheduled for radical prostatectomy. Patients consumed four capsules containing Polyphenon E until the day before surgery — four capsules are equivalent to about 12 cups of normally brewed concentrated green tea. The time of study for 25 of the 26 patients ranged from 12 days to 73 days. Findings showed a significant reduction in serum levels of HGF, VEGF and PSA after treatment, with some patients demonstrating reductions in levels of greater than 30 percent, according to the researchers. There were only a few reported side effects associated with this study, and liver function remained normal. Results of a recent year-long clinical trial conduced by researchers in Italy demonstrated that consumption of green tea polyphenols reduced the risk of developing prostate cancer in men with high-grade prostate intraepithelial neoplasia (HGPIN). "These studies are just the beginning and a lot of work remains to be done; however, we think that the use of tea polyphenols alone or in combination with other compounds currently used for cancer therapy should be explored as an approach to prevent cancer progression and recurrence," Cardelli said.”
Selenium intake may worsen prostate cancer in some, study reports “Higher selenium levels in the blood may worsen prostate cancer in some men who already have the disease, according to a study by researchers at Dana-Farber Cancer Institute the University of California, San Francisco. A higher risk of more-aggressive prostate cancer was seen in men with a certain genetic variant found in about 75 percent of the prostate cancer patients in the study. In those subjects, having a high level of selenium in the blood was associated with a two-fold greater risk of poorer outcomes than men with the lowest amounts of selenium. By contrast, the 25 percent of men with a different variant of the same gene and who had high selenium levels were at 40 percent lower risk of aggressive disease. The variants are slightly different forms of a gene that instructs cells to make manganese superoxide dismutase (SOD2), an enzyme that protects the body against harmful oxygen compounds. The research findings suggest that "if you already have prostate cancer, it may be a bad thing to take selenium," … Therefore, they add, it is important to know which type of SOD2 gene a man has when considering the risks and potential benefits of taking selenium supplements. Additionally, the authors say the effects of the interaction between the SOD2 genotype and selenium may help explain apparently conflicting results of previous studies. The results may seem counterintuitive to the public, who have been told for years that antioxidants can help people live longer, healthier lives with a lowered risk of cancer. However, Kantoff says, "There is some precedent to this – research has suggested that antioxidants could be protective if you don't have cancer, but once you do, then antioxidants may be a bad thing."”
Surgery
What Are the Outcomes of Radical Prostatectomy for High-risk Prostate Cancer? (Urology. 2009)
Comparative Effectiveness of Minimally Invasive vs Open Radical Prostatectomy (JAMA 2009)
Impotence, Incontinence Risk Casts Doubt on High-Tech Prostate Surgery “Heightened risks for post-operative incontinence and impotence may outweigh any benefits from minimally invasive "keyhole" surgery for prostate cancer, a new study suggests. The presumed good stemming from the robotic technique are being oversold to a public that is all too willing to believe, said Dr. Jim C. Hu, a genitourinary surgeon at Brigham and Women's Hospital in Boston who led the study. "Given the expense of the procedure and the hype around it, expectations are being raised that are too high," said Hu, whose team published the findings in the Oct. 14 Journal of the American Medical Association. Men who have the prostate-removing surgery, which requires only a small incision and is helped along by robotic technology, do get out of the hospital faster than those who have the older operation, according to the report. Patients who underwent the more high-tech surgery spent an average of two days hospitalized rather than the three-days seen with traditional procedure. They were also less likely to require blood transfusions or suffer respiratory or surgical complications, researchers found.”
Transplantation
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