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Prostate Cancer
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Prostate cancer is the second-most common cancer in men. However, the condition has very few symptoms until it's advanced. Regular screenings like blood tests and rectal exams help find prostate cancer early when it's most treatable. Survival rates continue to rise with improved screening, detection, and treatment.
The prostate gland is located at the base of the bladder, near the front of the rectum. The gland secretes some of the fluids that are present in semen. It also helps control bladder function. Prostate cancer starts when cells in this gland grow out of control.
Diagnosing prostate cancer commonly involves a few different tests, including a full physical exam, blood work, and an ultrasound or an MRI. Once cancer is suspected, your doctor may order a biopsy of the tissue to look for cancer cells under the microscope.
No two patients or their treatment plans are alike. This is particularly true for prostate cancer, where care may range from active monitoring only to aggressive treatment, depending on the cancer's biology and the patient's overall health. This is why, at Middlesex Health, we take a highly personalized approach to your prostate cancer care.
Early-stage prostate cancer usually does not cause noticeable symptoms. This makes early detection - which is key to successful treatment - more difficult. Therefore, prostate cancer screening is very important.
At Middlesex Health, we recommend that men begin prostate cancer screening at the following ages:
There are many different recommendations for prostate cancer screening from organizations such as the American Cancer Society, American Medical Association, American Urological Association, and the National Comprehensive Cancer Network. There is also debate over the benefits of screening. The most important step you can take is to discuss screening with your doctors and determine the best plan based on your health and risk level.
Most people with prostate cancer do not have symptoms until the disease is in its later stages. Symptoms may include:
Many diseases of the male urinary tract have similar symptoms. If you are experiencing any of the above, please contact your doctor.
Early detection of cancer can be key to successful treatment, so it is important to understand what increases your risk of prostate cancer. Current research has shown that key risk factors include:
Prostate cancer screening and diagnosis takes place using a combination of tests, including:
A prostate MRI is a noninvasive imaging test that uses a powerful magnetic field, radiofrequency pulses, and a computer to create detailed pictures of your prostate gland and surrounding tissues. One of the primary uses of a prostate MRI is to assess the extent and aggressiveness of prostate cancer and determine whether it has spread beyond the prostate gland.
This scan uses a special camera to take PET and CT scans. The scan uses a radioactive tracer called Pylarify, which helps cancer cells show up more clearly in the images.
There are many ways prostate cancer can be treated, and the evidence-based plan your doctors choose is based on a number of factors: type of cancer, grade and stage of the cancer, your overall health, and your treatment preferences.
If your prostate cancer is determined to be low-risk, the best course of action may be to postpone treatment and watch carefully to see if the disease progresses.
A low-risk prostate cancer either grows very slowly or not at all. It is not an aggressive form of prostate cancer.
In cases of low-risk cancer, treatment may be postponed in order to avoid over-treatment. Some patients can avoid surgery or radiation altogether.
Your doctor will closely monitor your cancer. If there are changes, which would show up in repeat PSA testing, DRE testing, or biopsies, your doctor will develop an appropriate treatment plan.
Yes, the American Urological Association and the National Comprehensive Cancer Network recommend active surveillance in carefully selected cases.
Over the last several years, there have been significant advances in the use of medical oncology for Prostate Cancer. Medical therapies are often used in conjunction with other treatments, like radiation and surgery, to ensure the best possibilities for remission and recovery.
Medical therapies we offer for prostate cancer include:
This treatment interferes with the effects of testosterone. Testosterone helps prostate cancer cells grow, so interfering with testosterone production helps kill the tumor.
The use of drugs to kill or slow the growth of rapidly multiplying cancer cells.
Immunotherapy for prostate cancer works by helping a patient's own immune system fight back against cancer cells. For example, one immune therapy approved by the FDA is a vaccine called sipuleucel-T (Provenge), which spurs a patient's immune system to attack prostate cancer cells.
After a patient is diagnosed with prostate cancer, doctors will try to figure out if it has spread and, if so, how far. This process is called staging. The stage of prostate cancer describes how much cancer is in the body. It helps determine how severe the cancer is and how best to treat it. Doctors also use a cancer's stage when talking about survival statistics.
Doctors consider several factors when determining the stage of your prostate cancer, but there are two key measurements.
PSA Level: Prostate-specific antigen (PSA) is a protein made by both normal cells and cancer cells in the prostate gland. Most men without prostate cancer have PSA levels under 4 ng/mL of blood. When prostate cancer develops, the PSA level often goes above 4. Men with a PSA level between 4 and 10 have a 1 in 4 chance of prostate cancer. If the PSA is more than 10, the chance of having prostate cancer is over 50%.
Gleason Score: This score is based on how much the cancer looks like healthy tissue when viewed under a microscope. Tumors with a Gleason score of 6 or less are less aggressive and generally look more like healthy tissue. Tumors with a Gleason score of 8 or more are more aggressive and are likely to grow and spread to other parts of the body. They look less like healthy tissue.
Once prostate cancer has been identified, our team will further sort your cancer into one of five risk categories based on your Gleason score, PSA level, and other factors. Your recommended treatment plan may differ based on the risk category assigned to your cancer.
Very low: These prostate cancers are small, not felt on exam, can only be found in a small area of the prostate, and have not grown outside the prostate. They usually grow very slowly and are unlikely ever to cause any symptoms or other health problems.
Low: Prostate cancers in this group have not yet grown outside of the prostate but are slightly larger than very-low-risk cancers.
Intermediate: This group of prostate cancers can be felt on an exam or seen on an imaging test. The cancer might be found in more than half of one side of the prostate or on both sides of the prostate. Additional classifications split the intermediate-risk group into favorable and unfavorable categories.
High: Prostate cancers in this group have grown outside the prostate. They have a Gleason score of 8 to 10 or a PSA level of over 20.
Very high: These prostate cancers have a high risk of the tumor growing, returning, or spreading to the nearby lymph nodes.
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