Prostate Cancer

PROSTATE CANCER

  • About one in seven men will be diagnosed with prostate cancer during his lifetime.
    Other than skin cancer, prostate cancer is the most common cancer in American men.
    It occurs mainly in an older men 65 or older and it is rare before age 40.
  • Estimated number of men with prostate cancer in the USA is 2, 707, 821
    66 is the average age at the time of diagnosis.
  • It is a second leading cause of cancer death in American man, behind only to lung cancer.
  • About one man in 36 will die of prostate cancer
  • More than 192, 000 cases are diagnosed each year
  • Rectal examination and PSA helps in the early detection of cancer 

In Prostate Cancer… knowledge is Power and Survival

–and here is what you need to know.

 

Prostate cancer as a disease that arises in the prostate gland.  The prostate is a walnut-sized that is part of the male reproductive system.  It is located in the pelvic region in front of the rectum and below the bladder.  It surrounds part of the urethra, a tube that empties urine from the bladder; With this part of the prostate keeps growing it is referred as benign prostatic hypertrophy.  Its main function is to help produce semen and nourish sperm.

 

How common is prostatic cancer?

The estimated number of men with prostate cancer in the USA is 2, 707, 821. About one in seven men will be diagnosed with prostate cancer during his lifetime.
66 is the average age at the time of diagnosis.

It occurs mainly in an older men 65 or older and it is rare before age 40.

Other than skin cancer, prostate cancer is the most common cancer in American men.

About one man in 36 will die of prostate cancer. More than 192, 000 cases are diagnosed each year.

The American cancer society’s estimates the number of men with prostate cancer in the United States for 2018 are about 164, 690 new cases of prostate cancer.

About 29, 430 deaths from prostate cancer.

Overall prostate cancer is the seven most common cause of death in the United States.
  

What are the risk factors for Prostate Cancer?

Prostate cancer is a multifactorial complex disease resulting from the combination of several factors including:

Age: Most likely the most important risk factor.  About 2  every  3 prostate cancers are diagnosed in men   older than 65 men

Inherited or genetic factors have been seen in families affected by the disease.  Molecular research has recently found that he inherited DNA changes in certain gains made them more likely to develop prostatic cancer.  These genetic mutations appeared to be responsible for about 10% prostate cancer

Race:  African-American man has twice the risk of developing prostate cancer than Whiteman.  The incidence is less in white  American, Hispanic is, an American Indian man
Obesity

 

Androgens. High levels of androgens, male hormones, may contribute to the prostate cancer risk in some men

Insulin-like growth factor-1 (IGF1), when increase, renders man more prone to develop prostate cancer.

 

What are the symptoms of prostate cancer?

  • A need to urinate frequently, especially at night
  • Difficulty starting urination or holding back urine
  • Weak or interrupted flow of urine
  • Painful or burning urination
  • Difficulty in having an erection
  • Painful ejaculation
  • Bloody urine or semen
  • Frequent pain or stiffness in the lower back, hips or upper tightness

 

 How is prostate cancer diagnosed?

The diagnosis of prostate cancer is made through multiple procedures and tests which include the following:

  • Digital rectal exam (DRE). During a DRE, your doctor inserts a gloved, lubricated finger into your rectum to examine your prostate, which is adjacent to the rectum. If your doctor finds any abnormalities in the texture, shape or size of the gland, you may need further tests.
  • Prostate-specific antigen (PSA) test. A blood sample is drawn from a vein in your arm and analyzed for PSA, a substance that’s naturally produced by your prostate gland. It’s normal for a small amount of PSA to be in your bloodstream. However, if a higher than normal level is found, it may indicate prostate infection, inflammation, enlargement or cancer.

PSA testing combined with DRE helps identify prostate cancers at their earliest stages. Hence, debate continues surrounding prostate cancer screening. screening for prostate cancer is controversial.  Whether to screen a healthy man with no symptoms of prostate cancer is been a long debate.  Even the experts in prostate cancer do not have an agreement.  There is a debate on whether screening and whether it deliveries the benefits advocated in the general medical literature.

Diagnosing prostate cancer

If a DRE or PSA test detects an abnormality, your doctor may recommend further tests to determine whether you have prostate cancer, such as:

  • Ultrasound. If other tests raise concerns, your doctor may use transrectal ultrasound to further evaluate your prostate. A small probe, about the size and shape of a cigar, is inserted into your rectum. The probe uses sound waves to create a picture of your prostate gland.
  • Collecting a sample of prostate tissue. If initial test results suggest prostate cancer, your doctor may recommend a procedure to collect a sample of cells from your prostate (prostate biopsy). Prostate biopsy is often done using a thin needle that’s inserted into the prostate to collect tissue. The tissue sample is analyzed in a lab to determine whether cancer cells are present.
  • MRI fusion. While still being developed worldwide, MRI fusion to assist in prostate biopsy and diagnosis is being used more and more.

  

What are the types of prostate cancer?

A tissue sample for biopsy is essential in determining the type of cancer in the different prognostic indicators currently use.  The pathologies examined the sample and make a determination of the difference between her cancer cells on the normal cells.  When abnormal cells have a mild resemblance to normal cells it is a low-grade cancer, and when the abnormal cells different from the normal cells this is a high grade cancer.  1 of the most important grading t systems and that is a useful prognostic indicator, is the Gleason score.  Gleason scores and combines 2 numbers and can arrange for 2 (nonaggressive cancer) to 10 (very aggressive cancer).

Most prostate cancers are adenocarcinomas which arise from the epithelial cells lining o the glands of the prostate. 

Survival rates for prostate cancer.

The natural history of the cancer is different from other cancers of the body.  Prostate cancer is a slow-growing cancer that does not necessarily kill the patient.  It is the less common, the aggressive form that normally occurs in younger age groups has a more devastated biological behavior and needs to be detected early to treat it effectively

According to the most recent data, when including all stages of prostate cancer:

  • The 5-year relative survival rate is 99%
  • The 10-year relative survival rate is 98%
  • The 15-year relative survival rate is 96%

Keep in mind that just as 5-year survival rates are based on men diagnosed and first treated more than 5 years ago, 10-year survival rates are based on men diagnosed more than 10 years ago (and 15-year survival rates are based on men diagnosed at least 15 years ago).

Survival rates by stage

  • Local stage means that there is no sign that the cancer has spread outside of the prostate. This includes AJCC stage I, II, and some stage III cancers. About 4 out of 5 prostate cancers are found in this early stage. The relative 5-year survival rate for local stage prostate cancer is nearly 100%.
  • Regional stage means the cancer has spread from the prostate to nearby areas. This includes mainly stage IIIB and IVA cancers. The relative 5-year survival rate for regional stage prostate cancer is nearly 100%.
  • Distant stage includes stage IVB cancers – cancers that have spread to distant lymph nodes, bones, or other organs. The relative 5-year survival rate for distant stage prostate cancer is about 29%.

Remember, these survival rates are only estimates – they can’t predict what will happen to any one man. We understand that these statistics can be confusing and may lead you to have more questions. Talk with your doctor to better understand your situation.

 

How is prostate cancer treated?

 Prostate cancer treatment depends and several factors such as cancer type, Gleason score, tumor spread and finally the over the overall stage of the tumor.

In some centers, men with a low risk prostate cancer, treatment is not started right away.  Instead, what is recommended that is close observation and active surveillance by regular checkups, blood tests, rectal exams and possible biopsies to monitor the progression of the cancer.  If there is a progression of the tumor, the patient may for prostate cancer treatment such as surgery or radiation.  Cancer surveillance, even though is a common modality carries a risk that the cancer may grow and is spread between checkups making cancer less likely to be cured.

Surgery for prostate cancer may involve the removing the prostate gland sounds surrounding tissue and a few lymph nodes there is radical prostatectomy can be performed using a right a robotic-assisted surgery, or making an incision in your abdomen.  The risk associated with these surgeries are mainly urinary incontinence and erectile dysfunction.

Radiation therapy is the alternative modality of treatment, where high-power radiation be used to kill cancer cells.  This radiation therapy can be the liver through an external beam radiation or a small radiated pellets inside your body (brachytherapy).

Hormone therapy.  The ultimate functional hormonal therapy history.  Your body from producing testosterone male hormone.  Prostate cancer cells have a high appetite for testosterone to help thin growth.  By cutting the supplied of testosterone may cause cancer cells to die or tomorrow more slowly.

Hormone therapy normally includes medications or stop your body from producing testosterone such as luteinizing hormone-releasing hormone agonist.  Drugs which are used in these setting include leuprolide (Lupron, Eligard), goserelin (Zoladex), triptorelin (Trelstar) and histrelin (Vantas). Other drugs sometimes used include ketoconazole and abiraterone (Zytiga).

All other hormonal strategies that are commonly used are medications that block testosterone from reaching cancer cells, such as the anti-androgens. Examples include bicalutamide (Casodex), nilutamide (Nilandron) and flutamide. The drug enzalutamide (Xtandi) may be an option when other hormone therapies are no longer effective.

Orchiectomy or the surgical removal of the testicles is another alternative to reduce the level of testosterone in your body.

 

The information in this document does not replace a medical consultation. It is for personal guidance use only. We recommend that patients ask their doctors about what tests or types of treatments are needed for their type and stage of the disease.

Sources:

  • American Cancer Society
  • The National Cancer Institute
  • National Comprehensive Cancer Network
  • American Academy of Gastroenterology
  • National Institute of Health
  • MD Anderson Cancer Center
  • Memorial Sloan Kettering Cancer Center

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