Download prostate ca - Chesterfield Urology

6055 harbour park drive
midlothian, va. 23112
chesterfield
urology
web:
e-mail:
phone: 804.639.7777
fax:
804.739.1021
www.chesterfieldurology.com
[email protected]
Prostate Cancer
Prostate cancer is the second most common type of cancer among men in the United States. Only skin
cancer is more common. Every year more than 248,900 American men are diagnosed with prostate
cancer, and 33,720 die from the disease, according to the National Cancer Institute.
It's important to know the facts about prostate cancer so you and your family can make informed
choices about screening and treatment.
What is the prostate:
The prostate is a gland that is part of the male reproductive system. A healthy prostate is roughly the
size of a walnut, and it helps produce seminal fluid-the fluid in which sperm are carried out of the body
as part of semen. The prostate gland encircles the urethra-the tube that carries urine away from the
bladder.
What is prostate cancer:
As men age, they are at greater risk for developing prostate problems. Growth of prostate cells is
relatively common in men over age 50. While many of these growths are benign (non-cancerous),
many others are malignant (cancerous).
Prostate cancer is typically slow-growing, but if left untreated it can spread to other parts of the body
and can be fatal. It's crucial to find prostate cancer early and treat it before it has a chance to spread.
What are the causes and risk factors associated with prostate cancer?
Scientists are still trying to determine what causes prostate cancer. What they do know is that there are
probably many reasons the disease occurs-and that by examining common risk factors, they can better
determine who is likeliest to develop it. These risk factors include:




Age: The diagnosis of prostate cancer is rare in men younger than 40. As men age, they are
increasingly more likely to develop it. 1 in 6 men will be diagnosed in their lifetimes.
Family history: If your father, grandfather, brother, son or other closely related family member
has had prostate cancer, you are at an increased risk yourself.
Race: African-American men are 60% more likely to develop prostate cancer than Caucasian or
Hispanic men. The disease is rarer among Asian-American and American Indian men.
Diet: Some studies suggest that men with diets high in fat may be at higher risk. Other research
suggests that nutritional factors, like greater intake of vitamin D, lycopene and selenium, may
lower a man's risk of developing prostate cancer.
What are the symptoms of prostate cancer?
It's important to understand that by the time prostate cancer symptoms usually appear, the cancer is
likely in a later stage and is generally not curable. The disease needs to be found and cured before
symptoms develop, which is why prostate cancer screenings are recommended starting at age 40.
Men with early-stage prostate cancer may not have symptoms at all. In fact, it could be 10 years before
symptoms become noticeable. Some older men may never even know that they have prostate cancer
since it may have not progressed or caused symptoms in their lifetime. And other forms of the disease
may be small and grow so slowly that they don't require treatment at all.
Some symptoms of prostate cancer may include:







Difficulty urinating and/or difficulty starting and stopping urine flow
Needing to urinate frequently, especially at night
Pain or burning during urination
Dull lower pelvic pain
Blood in the urine or semen
Painful ejaculation
Pain in the lower back, hips or thighs
How is Prostate Cancer Diagnosed?
Diagnosis of prostate cancer is a 4-step process. If the PSA levels in your blood test suggest the possibility that
you may have prostate cancer, your physician will order a biopsy. If there is cancer present in the biopsy
samples, it will be given a Gleason score and stage-two numbers that indicate the extent and aggressiveness of
the cancer.
Step 1: Testing for elevated PSA levels
Your prostate cancer screening includes a test to measure the levels of prostate-specific antigen (PSA) in your
blood. Elevated PSA levels are often an early indication of prostate cancer as well as other prostate disorders.
PSA is a protein produced by the prostate that helps keep semen liquid outside the body. When the prostate is
healthy, a very small amount of PSA escapes from the prostate and enters the bloodstream. When the prostate
is unhealthy-if it is inflamed, enlarged or contains cancerous cells-larger amounts of PSA leak into the
bloodstream.
PSA levels of 4ng/ml and above are considered elevated, however there is no specific level that indicates
cancer. Results from regular PSA screenings will show whether your PSA levels have changed year to year,
and whether that change is cause for concern.
Step 2: Prostate Biopsy
While the PSA test helps assess risk of prostate cancer, the prostate biopsy is the only way to make an accurate
diagnosis. If either your digital rectal exam or blood test had an abnormal result, your physician will often order a
biopsy.
What to expect during a prostate biopsy:
Your biopsy will be performed by a urologist in our office. The entire procedure usually takes about 15 minutes
or less. While lying on your side, an ultrasound probe will be inserted into the rectum. This probe provides a
clear visual of the prostate and allows the physician to guide the very fine biopsy needle into the prostate.
Using the needle, the physician will take tiny tissue samples-called cores-from different areas of the prostate.
These cores are the width of only 4 threads. The samples are sent to a uropathologist, who determines if there
is cancer present. If cancer is present, the uropathologist gives the cancer a Gleason score.
Step 3: Assessing your Gleason score
The Gleason score is a number given by the pathologist who examines the cancerous tissue samples. under a
microscope. The Gleason score refers to how different the prostate cancer cells/glands appear in comparison to
normal prostate cells/glands. The pathologist provides two grades, or numbers, based on the pattern of cancer
cells/glands that appear under the microscope. Each grade is based on a scale of 1 to 5. The two grades are
added together for your Gleason Score. With today's biopsy methods/grading recommendations, almost all
prostate cancer patients have a Gleason Score of 6 or above. These scores are then rated into low-risk (≤6),
intermediate (7) and high-risk (8, 9 or 10) categories.
Gleason Pattern Scale
New Gleason chart
Step 4: Staging the prostate cancer
Prostate cancer is also assigned a stage, based on how advanced the disease is. Both your Gleason score and
stage are critical deciding factors in what types of prostate cancer treatment may be recommended. See
treatment options for early stage prostate cancer or treatment options for advanced stage prostate cancer.
The clinical stages of prostate cancer:
T1: The earliest stage is divided into three types: T1a, T1b and T1c.
T1a is when prostate cancer is found during a surgery performed on the prostate for an unrelated condition. It is
microscopic and found in less than 5 percent of the prostate tissue.
T1b is found similarly to T1a, but the cancer is more extensive, involving more than 5 percent of the tissue.
T1c is the most frequently found prostate cancer. It is detected by a prostate biopsy, which was done because of
information provided by PSA testing.
T2: The cancer is still entirely within the prostate, but T2 cancer can be felt during a digital rectal exam.
T3: The cancer has begun to spread locally beyond the prostate but has not reached the lymph nodes.
T4: The cancer has spread and may have reached the bladder, the rectum or other nearby areas of the body,
including the lymph nodes and/or the bones.
Treatment Options Prostate Cancer
The following prostate cancer treatment options are available for men with Prostate Cancer. Your doctor will
discuss with you the pros and cons of each approach. You and your family will have time to ask any questions
you may have. Please feel free to contact our office if any other questions arise as you weigh your options.
Active Surveillance for Prostate Cancer
Active surveillance, also known as watchful waiting, is an approach to prostate cancer treatment that involves
monitoring the disease and watching for progression, rather than undergoing surgery or radiation treatment right
away. It requires close monitoring of the cancer through frequent physician visits. If the cancer progresses,
treatment may be started immediately.
Radiation Therapy for Prostate Cancer
Radiation therapy is a type of cancer treatment that uses high-energy X-rays or radioactive seeds to directly
target the cancerous cells in the prostate. The two types of radiation therapy are external beam radiation and
brachytherapy.
Choosing to undergo radiation therapy requires a formal consultation with a radiation oncologist to make a
decision regarding your treatment. A radiation oncologist is a physician who is board-certified specifically in the
treatment of cancers utilizing radiation therapy.
Hormone Therapy
Leuprolide is used to treat advanced prostate cancer in men. It is not a cure. Most types of prostate cancer need
the male hormone testosterone to grow and spread. Leuprolide works by reducing the amount of testosterone
that the body makes. This helps slow or stop the growth of cancer cells and helps relieve symptoms such as
painful/difficult urination
Brachytherapy
Also called a seed implant, brachytherapy is a treatment using radioactive seeds placed directly inside of the
prostate gland during a 1 to 1 ½ hour outpatient procedure. This treatment is sometimes used alone for low risk
patients or combined with five weeks of IG-IMRT for patients with higher risk prostate cancers. Most often, a
permanent radioactive seed is used and this is referred to as LDR, or low dose rate brachytherapy. Some
centers also use temporary HDR, or high dose rate brachytherapy, which requires either hospitalization or two
separate procedures
.