Prostate Cancer
- Diagnosis, Imaging, Screening
- General Information
- Guidelines
- Internet Sites
- Risk Factors
- Risk Reduction
- Treatment
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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
The 2007 Treatment Guidelines section will contain the 2007 published guidelines. To view Guidelines from previous years, view year 2006 Treatment Guidelines and 2005 InfoMedlinks (Articles section) or our Monthly Online Newsletter (under the Guidelines section).
Prostate Cancer
Daily Treatment Report
Cognitive Therapy-CBT-Psychotherapy
Device Therapy
Drug Side-Effects and Interactions
Prostate Cancer Hormone Treatments May Raise Risk of Colorectal Cancer
Study finds possible heart risk with prostate drug “The study involved 6,700 men with high scores from PSA blood tests but no sign of cancer on biopsy. They were given Avodart or dummy pills and new biopsies four years later. Prostate cancer was found in 25 percent of those on dummy pills and 20 percent of those on Avodart. That's the same risk reduction as other studies have found from a similar drug, finasteride, sold in generic form and as Proscar, made by Merck & Co. Inc. Studies did not find an increased risk of heart failure with Proscar. In the Avodart study, heart failure developed in 30 men on the drug versus only 16 on dummy pills.”
Adverse effects of androgen deprivation therapy: defining the problem and promoting health among men with prostate cancer. (Natl Compr Canc Netw. 2010)
Drugs
Intermittent Androgen Deprivation At Least As Effective As Continuous Androgen Deprivation
Exercise
Kegel Exercises: An Undercover Secret “Kegel exercises consist of repeatedly tightening and releasing the muscles of the “pelvic floor” to strengthen them. These are the muscles that support the bladder and bowel, which help you urinate, move your bowels, and have intercourse. The muscles weaken as you get older and if you are overweight—and this can lead to incontinence and premature ejaculation. Men who have had prostate surgery may also suffer from incontinence. It makes sense to think that exercising these muscles can help these conditions, and much research is encouraging.”
Exercise May Prevent Incontinence From Prostate Surgery “A healthy weight and regular exercise may help protect men from incontinence after prostate cancer surgery, a new study suggests. Researchers found that among 165 men who had radical prostatectomy, those who were not obese and were getting regular exercise before surgery had the lowest prevalence of long-term urinary incontinence. Even among obese men, those who were physically active before surgery were less likely to be incontinent one year after surgery.”
General Information
Multimodal approaches to high-risk prostate cancer (Curr Oncol. 2010)
Androgen deprivation therapy for prostate cancer—review of indications in 2010 (Curr Oncol. 2010)
Untreated prostate cancer no death sentence “After about eight years, 20 percent of the men in the watchful waiting group had died, almost twice as many as in the treatment group. However, the number of deaths was no different than what would be expected in the general population. Less than three percent had actually died from prostate cancer, and those who weren't treated turned out also to be sicker in the first place. The researchers calculated that of those men with low-risk cancer, 2.4 percent would die from the disease within 10 years without treatment. While this number was about three times higher than in men who had had surgery or radiation therapy, it wasn't clear how much of the difference was due to worse general health in the men who didn't get treatment.”
Gone Today, Hair Tomorrow “If you have an enlarged prostate, your doctor may prescribe finasteride (Proscar) at a 5-milligram dose. But at lower dose (1 milligram), the same drug (Propecia) counters male pattern baldness.”
Specialty may bias doctors' prostate cancer advice “New research suggests that the type of specialist a prostate cancer patient sees -- rather than the patient's own preference -- may determine the treatment he receives. This is problematic, the study's authors say, because none of the options now available for treating localized prostate cancer have been shown to be any better than the others. "The different treatments for prostate cancer...entail different side effects, different recovery profiles, and they require different time commitments," Dr. Thomas L. Jang of The Cancer Institute of New Jersey in New Brunswick, one of the study's authors, told Reuters Health. For this reason, he and his colleagues say, it should be the patient's preferences -- rather than the physician's specialty -- that guides treatment decisions.”
Prostate Cancer Survivors: A New Battle
Risk factors associated with transrectal ultrasound guided prostate needle biopsy in patients with prostate cancer. (Med J. 2009)
Physicians Urged to Consider Active Surveillance in Prostate Cancer “Active surveillance—in the past also called “watchful waiting and “expectant management”—refers to a strategy of forgoing immediate treatment after a diagnosis of prostate cancer in favor of regularly scheduled testing and clinical exams to closely monitor the disease. Active surveillance can include prostate-specific antigen (PSA) testing, digital rectal exams (DRE), and prostate biopsies. If, at some point, there are indications that the disease is progressing—such as significant growth in the tumor or a rapid increase in PSA level or higher tumor grade on biopsy—definitive treatments such as surgery or radiation therapy can be pursued.”
Guidelines
NCCN Clinical Practice Guidelines in Oncology™ Prostate Cancer, Version 1.2010 (2010)
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
Soy may stop prostate cancer spread “Genistein, a natural chemical found in soy, is being used in the lab of Raymond Bergan, M.D., the director of experimental therapeutics at the Lurie Cancer Center, to inhibit prostate cancer cells from becoming metastatic and spreading to other parts of the body. So far the cancer therapy drug has worked in preclinical animal studies and now shows benefits in humans with prostate cancer.”
Intakes of meat, fish, poultry, and eggs and risk of prostate cancer progression (Am J Clin Nutr 2009) “Conclusions: Our results suggest that the postdiagnostic consumption of processed or unprocessed red meat, fish, or skinless poultry is not associated with prostate cancer recurrence or progression, whereas consumption of eggs and poultry with skin may increase the risk.”
Rare Study of Diet and Prostate Cancer Progression
Other
Radiation-Chemotherapy
Other Treatments
Experimental
Radiotherapy
External beam radiotherapy for prostate cancer. (Panminerva Med. 2010)
Ten-year outcomes of high-dose, intensity-modulated radiotherapy for localized prostate cancer. (Cancer. 2010)
Radiation therapy in prostate cancer: a risk-adapted strategy. (Curr Oncol. 2010)
Supplements-Vitamins-CAM
A nutrient approach to prostate cancer prevention: The Selenium and Vitamin E Cancer Prevention Trial (SELECT). (Nutr Cancer. 2010) “SELECT data show that neither selenium nor vitamin E, alone or together, in the doses and formulations used, prevented prostate cancer in this heterogeneous population of healthy men.”
Is There a Benefit From Lycopene Supplementation in Men With Prostate Cancer? A Systematic Review (Prostate Cancer Prostatic Dis. 2009)
Surgery
Role of surgery in high-risk localized prostate cancer (Curr Oncol. 2010)
Transplantation
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