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This page is about: Prostate Cancer Early  Detection, Prevention, Treatment and Cures About Prostate Cancer
 Prostate Cancer Early Detection, Prevention, Treatment and Cures About Prostate Cancer

Prostate cancer is the most commonly diagnosed non-skin cancer in the United States. One in six American men will develop prostate cancer in the course of his lifetime. A little-known fact is that a man is 33% more likely to develop prostate cancer than an American woman is to get breast cancer.

These and other sobering facts are the driving forces of the Prostate Cancer Foundation, whose mission is to support research into better treatments and a cure for recurrent prostate cancer. The PCF is the world's largest source of philanthropic support for prostate cancer research. The PCF has raised more than $230 million to fund over 1,200 research projects, all with the goal of finding better treatments and a cure as soon as possible.

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You can find this site again  by typing in the  Google search engine  the unique word " 1etatsoprP "  which is  OR " Prostate1 " backwards.

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 Page Title, Keywords  Description Metas, BB  
 This page is about: Prostate Cancer Early  Detection, Prevention, Treatment and Cures About Prostate Cancer

Prostate cancer is the most commonly diagnosed non-skin cancer in the United States. One in six American men will develop prostate cancer in the course of his lifetime. A little-known fact is that a man is 33% more likely to develop prostate cancer than an American woman is to get breast cancer.

These and other sobering facts are the driving forces of the Prostate Cancer Foundation, whose mission is to support research into better treatments and a cure for recurrent prostate cancer. The PCF is the world's largest source of philanthropic support for prostate cancer research. The PCF has raised more than $230 million to fund over 1,200 research projects, all with the goal of finding better treatments and a cure as soon as possible.

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PSA Test Might Not Save Lives
Study found screening for prostate cancer
 made no difference in survival rates
 

MONDAY, Jan. 9 (HealthDay News) -- Screening men for prostate cancer with the prostate-specific antigen (PSA) test may not reduce their risk of death from the disease, new research suggests.

The finding appears in the Jan. 9 issue of the Archives of Internal Medicine.

Researchers looked at 501 men aged 50 and older who were diagnosed with prostate cancer between 1991 and 1995, and who had died by the end of 1999. They compared those men to a control group of 501 men diagnosed with prostate cancer who were still alive.

The study found that 14 percent of the men who died of prostate cancer and 13 percent of the men in the  control group had been screened for prostate cancer with the prostate specific antigen (PSA) test. According to the researchers, if prostate cancer screening prevented death, fewer men who died would have received screening than those who were still alive.

The researchers, from the Veterans Affairs Connecticut Healthcare System and Yale University, also concluded  that screening did not reduce prostate cancer death risk among men who were younger or healthier, or when digital rectal exams were used with PSA testing.

While screening can increase detection of prostate cancer, even at earlier stages, it doesn't necessarily prolong survival, the study authors concluded.

"Optimal clinical strategies for diagnosing and treating prostate cancer remain uncertain, and in need of   additional investigation," the authors wrote. "Based on available evidence, including the present study, recommendations regarding screening for prostate cancer should not endorse routine testing of asymptomatic men to reduce mortality. Rather, the uncertainty of screening should be explained to patients in a process of 'verbal informed consent,' promoting informed decision-making."

 

The National Prostate Cancer Coalition called the study "invalid" because it didn't "take needed facts into consideration," such as the types of treatments offered the men.

"You need to look at what kind of treatments these men went through and change in PSA velocity over time," Dr. Richard N. Atkins, chief executive officer of the coalition, said in a prepared statement. "We're not examining genetically engineered mice where you have roughly the same DNA blueprint. These are men, and every man reacts differently to different treatments."

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Prostate Cancer Detected in 21% of Men with PSA Between 2.0 and 3.9 ng/mL    Results from an Austrian screening study raise questions about a PSA cut-off for disease detection

WEDNESDAY, Jan. 4 (CancerConsultants.com) -- In a population of men undergoing prostate cancer screening in Austria, prostate cancer was detected in 21% of men with a prostate-specific antigen (PSA) level between 2.0 and 3.9 ng/mL and 30% of men with PSA between 4.0 and 10.0 ng/mL. In men with PSA levels between 2.0 and 10.0 ng/mL, 37% of detected prostate cancers occurred in men with PSA less than 4.0 ng/mL. These results were published in the journal Urology.

Men with a PSA level greater than 4.0 ng/mL often undergo a prostate biopsy in order to determine whether prostate cancer is present; the optimal PSA cut-point, however, continues to be debated. Lowering the threshold for a prostate biopsy would detect more prostate cancers, but would also increase the number of cancer-free men who undergo prostate biopsies.

Because the frequency of prostate cancer in men with a PSA level of less than 4.0 ng/mL has not been well described, researchers evaluated information from a prostate cancer screening program in Austria. They collected information from about 3446 men with a PSA level between 2.0 and 10.0 ng/mL. All men had prostate biopsies after PSA testing. The cancer detection rate in men with PSA between 2.0 and 3.9 ng/mL was compared to the cancer detection rate in men with PSA between 4.0 and 10.0 ng/mL.

  • Prostate cancer was detected by biopsy in 21% of the men with PSA between 2.0 and 3.9 ng/mL and in 30% of men with PSA between 4.0 and 10.0 ng/mL.
  • 37% of the prostate cancers detected in this population occurred in men with PSA between 2.0 and 3.9 ng/mL.
  • A Gleason score of 7 or higher (indicating faster-growing cancer) was reported for 24% of the men with prostate cancer and low PSA and 33% of the men with prostate cancer and higher PSA.
  • Compared to men with prostate cancer and higher PSA, men with prostate cancer and lower PSA tended to be younger and to have smaller prostate volume.

The researchers conclude that prostate cancer is not uncommon in men with PSA values less than 4.0 ng/mL. Men with prostate cancer and low PSA tend to be younger and to have a smaller prostate volume. These men are likely to be good candidates for potentially curative treatments such as surgery or radiation therapy.

Reference: Pelzer AE, Tewari A, Bektic J et al. Detection Rates and Biologic Significance of Prostate Cancer with PSA less than 4.0 ng/mL: Observation and Clinical Implications from Tyrol Screening Project. Urology . 2005;66:1029-1033.

-- produced by CancerConsultants.com
Asian Men More Likely to Survive Prostate Cancer
The reasons behind the better survival rates still unclear

By Anthony J. Brown, MD

TUESDAY, September 4 (Reuters Health) - In a study of prostate cancer patients living in California, most Asian men with the disease survived longer than their white counterparts. The exception was men from South Asia; their survival was worse than that of white men.

In an interview with Reuters Health, Dr. Anthony S. Robbins, from the California Cancer Registry in Sacramento, said that few studies have compared prostate cancer risk factors and survival between Asians and whites. He added that "there are zero that looked at Koreans, Vietnamese, and South Asians."

He said that his group was surprised at "how much better nearly all the Asian groups fared compared to whites."

The study involved an analysis of data for 108,076 whites and 8840 Asians who were diagnosed with prostate cancer from 1995 to 2004. The cohort included six of the largest ethnic subgroups of Asians: Chinese, Filipino, Japanese, Korean, South Asian, and Vietnamese. South Asians included men from southern India, Pakistan, Bangladesh, Sri Lanka, Nepal, Bhutan and Sikkim.

The overall 10-year prostate cancer-specific death rate was 11.9 percent, according to the report in the medical journal Cancer. The researchers were surprised by "how much variation there was across the Asian groups, all the way from an 8 percent risk of death over 10 years in Japanese men to a 16 percent risk in South Asian men."

All of the Asian groups had worse risk factor profiles than whites, yet only in South Asian men did the profile correspond with poorer survival. "For the groups with better survival, it was paradoxical," said Robbins, "because their risk factor profiles were all going in the wrong direction ... you would have thought they would do worse than whites."

Nonetheless, "The take-home message is that for five out of six Asian groups, 'being Asian' was a favorable prognostic factor for prostate cancer survival," Robbins noted.

"Obviously, the main question we are still trying to explain is why these five Asian groups had better survival. What is behind the 'Asian edge' in prostate cancer? Diet? Lower comorbidity? Less overweight/obesity?"
Study Adds to Debate Over Prostate Cancer Testing 
More frequent screening did not cut number of cases of aggressive tumors

By Will Dunham

THURSDAY, August 30 (Reuters) - More frequent screening for prostate cancer, as expected, found more tumors, but failed to cut the number of aggressive tumors detected in between scheduled screenings, European researchers said on Tuesday.

The findings, published in the Journal of the National Cancer Institute, added to the controversy over the value of screening tests for this common cancer among men and how frequently they should be performed.

Dutch and Swedish researchers tracked about 4,000 men who every two years were given a prostate-specific antigen, or PSA, blood test for prostate cancer in Gothenburg, Sweden, and another 13,000 men tested every four years in Rotterdam. They were 55 to 65 years old at the time of the first screening.

Over a 10-year period ending in December 2005, detection of any form of prostate cancer was higher among the Swedish men who were screened more frequently - 13 percent - compared to the Dutch men who were screened less often - 8 percent.

But there was no statistically significant difference in the two groups in the number of aggressive tumors that appeared between the times when the tests were conducted. This showed that more frequent screening did not cut the number of these cancer cases as one might have expected, the researchers said.

'TRICKY QUESTION'

Asked about the implications of the findings on how often men should be screened, study leader Monique Roobol of Erasmus Medical Centre in Rotterdam said, "That's a tricky question."

The researchers wrote that each PSA test may lead to prostate cancer diagnoses among some men who may have "clinically insignificant disease."

"We here in Europe feel that over-diagnosis and over-treatment is certainly something you should avoid," Roobol said in a telephone interview.

Diagnoses of prostate cancer have risen substantially since screening using PSA tests began in the late 1980s. While the death rate has dropped, it is unclear if this is a direct result of this screening, the American Cancer Society said.

The American Cancer Society recommends doctors offer the PSA test or another screening method called digital rectal exam, annually to men beginning at age 50.

The idea behind the screening is that the tests can detect tumors early on when they are easiest to treat. But, Roobol noted, screening also may detect minor tumors that may pose no threat but end up getting unnecessarily aggressive treatment.

Screening generally is less frequent in Europe. Most institutions taking part in a large European study assessing prostate cancer gave the tests to men every four years.

"Although many of us believe that early detection is saving lives, definitive evidence is lacking," Dr. David Crawford of the University of Colorado Health Sciences Center wrote in an editorial accompanying the study.

"Critics of the four-year screening interval have voiced concerns that clinically significant cancers could be missed by such an extended interval," Crawford added, saying he was not convinced that the new study has allayed these fears.

The World Health Organization said the results of studies already underway into the effectiveness of prostate cancer screening are needed before making any recommendation.
Red Wine Chemical Guards Mice From Prostate Tumors
Resveratrol-fed mice were nearly eight times less likely than the control mice to develop poorly differentiated prostatic tumors

By Anne Harding

TUESDAY, September 11 (Reuters Health) - Resveratrol, an antioxidant found in grapes and berries, can slow the growth of prostate tumors in mice, a new study shows.

"If we could do this in human beings, this would be a significant achievement," Dr. Coral A. Lamartiniere of the University of Alabama at Birmingham, the study's lead author, pointed out in an interview with Reuters Health. Slowing tumor growth so that a man developed prostate cancer in his 80s rather than in his 60s could mean he wouldn't wind up dying from the disease, Lamartiniere noted.

Red wine and grape juices also are rich sources of resveratrol, which plants produce to protect themselves from bacterial and fungal attacks. Studies in animals have found resveratrol may prevent cancer, protect the heart and even extend life.

To investigate whether resveratrol might be effective in slowing or preventing prostate tumor growth, the researchers fed mice bred to develop such tumors a diet containing the resveratrol equivalent of a bottle of red wine daily, or a control diet.

The resveratrol-fed mice were nearly eight times less likely than the control mice to develop poorly differentiated prostatic tumors, the researchers found. "That's the worst tumors that you can have -- those are the ones that are large, those are the ones that would more likely spread," Lamartiniere explained.

Resveratrol-fed mice also had slower cell growth and division in their prostate glands. Levels of several cellular messengers that inhibit cell growth were increased in the mice given resveratrol compared to the control mice, while levels of some tumor-linked chemicals such as insulin-like growth factor 1 were reduced.

Lamartiniere and his team are now investigating whether lower concentrations of resveratrol will have the same anti-tumor effects. "Maybe we could get this down to two glasses of wine a night rather than a bottle," he said.
Low-Fat, Vegetarian Diet May Stall Prostate Cancer 
Fiber and other nutrients found in plant-based diets may affect prostate cancer by altering levels of certain hormones that can feed tumor development

TUESDAY, September 11 (Reuters Health) - Low-fat, plant-based diets may help prevent or slow the progression of prostate cancer, according to a new research review.

A number of studies, though not all, have suggested that eating plenty of fruits and vegetables may help ward off prostate cancer, while "Western"-style diets heavy in animal fat and dairy products may increase a man's risk of developing the disease.

In the current study, researchers reviewed 25 previously published studies that examined the effects of plant-based diets on prostate cancer development or progression.

Overall, the evidence suggests that diets high in fiber, fruits and vegetables, and low in meat and dairy, can help battle the disease, they report in the journal Nutrition Reviews.

For example, several studies of men with prostate cancer have linked high saturated fat intake to faster disease progression and a higher risk of death. Saturated fat is found mainly in animal products.

In contrast, some small trials have found that a high-fiber, low-fat vegetarian diet may slow the growth and spread of early-stage prostate tumors. Some other studies have suggested that components of plant-based foods -- like certain antioxidants or soy isoflavones -- might be beneficial.

"For men diagnosed with prostate cancer, the key to improving the odds of survival is avoiding high-fat fare and instead choosing fruits, vegetables, beans and other cancer-fighting vegetarian foods," lead study author Dr. Susan Berkow said in a statement.

Berkow is with George Mason University in Alexandria, Virginia, and serves as a consultant to Physicians Committee for Responsible Medicine, a group that advocates vegetarian and vegan diets.

Berkow and her colleagues speculate that the fiber and other nutrients found in plant-based diets may affect prostate cancer by altering levels of certain hormones that can feed tumor development, including testosterone and insulin.

The balance of fats in a man's diet may also be key, the researchers point out. Some studies have found that omega-3 fatty acids may help stall prostate cancer progression. Omega-3 fats are found largely in oily fish, but also in some vegetable sources, like flaxseeds and canola oil.
Veggies May Lower Aggressive Prostate Cancer Risk
Broccoli and cauliflower appeared to have the biggest impact

FRIDAY, August 31 (Reuters Health) - Men may be able to halve their risk of aggressive prostate cancer by adding large amounts of broccoli and cauliflower to their menu. However, the overall risk of prostate cancer was not changed.

In a study of nearly 30,000 men, Dr. Richard B. Hayes of the National Cancer Institute in Bethesda, Maryland and colleagues found that men who ate more than a serving of either vegetable each week had roughly half the risk of developing advanced-stage prostate cancer -- that had spread beyond the prostate gland -- compared with their peers who ate these vegetables less than once a month.

A number of studies have linked high fruit and vegetable diets with lower prostate cancer risk, but these results have been mixed. Few investigators have looked at advanced disease, Hayes and his team note in the Journal of the National Cancer Institute. Hayes and his colleagues looked at 29,361 men who were being followed as part of the Prostate, Lung, Colorectal and Ovarian Cancer Screening Trial.

During more than 4 years of follow-up, 1,338 of the men developed prostate cancer. While there was no overall link between fruit and vegetable intake and prostate cancer risk, men who ate the most veggies had a 49-percent lower risk of being diagnosed with prostate cancer that had advanced to stage III or IV (on a scale of I to IV), the researchers found.

Most of the effect appeared to be due to cruciferous vegetables, which include Brussels sprouts, cabbage, broccoli and cauliflower; larger amounts of any vegetables in this family cut risk by 40 percent.

Broccoli and cauliflower appeared to have the biggest impact. Men who ate broccoli more than once a week had a 45 percent lower risk of advanced prostate cancer than those who ate the vegetable less than once a month, while eating cauliflower this often cut risk by 52 percent.

There was also a tendency toward reduced risk of aggressive disease among men who ate raw or cooked spinach at least twice weekly, compared to those who ate the vegetable less than once a month.

Cruciferous vegetables are rich in glucosinolates, note Hayes and his team, which can produce other chemicals with anti-carcinogenic effects. The vegetables also are powerful antioxidants.

If it is ultimately found that these vegetables directly lower the risk of aggressive prostate cancer, "a possible means to reduce the burden of this disease may be primary prevention through increased consumption of broccoli, cauliflower, and possibly spinach," they conclude.
'Lumpectomy' Possible for Some Prostate Tumors
Focal ablative therapy may be an effective and less invasive approach for a considerable minority of men with early prostate cancer that is confined to the prostate

By David Douglas

THURSDAY, September 13 (Reuters Health) - Treating or removing just the part of the prostate that is cancerous may be an effective and less invasive approach for a considerable minority of men with early prostate cancer that is confined to the prostate, according to doctors in Durham, North Carolina.

Focal ablative therapy for prostate cancer "may become similar to breast-conserving lumpectomy in women for the treatment of breast cancer," senior investigator Dr. Thomas J. Polascik told Reuters Health.

Based on pathology findings of men who had surgery for prostate cancer at Duke University, perhaps 1 in 5 men have completely one-sided prostate cancers, Polascik said, "and as such could potentially be candidates for unilateral ablation of the cancerous side of the prostate rather than whole-gland radiation or surgical removal."

As they report in the medical journal Cancer, Polascik and colleagues examined tissue samples from the removed prostates of 1,184 men with prostate cancer that was confined to the prostate.

In all, 227 (19.2 percent) had completely one-sided cancers, and 164 of them (72.2 percent) had minimal tumor involvement of 5 percent or less. Only 14 (6.2 percent) had involvement beyond 15 percent.

In such patients, Polascik said, "the contralateral, non-cancerous side of the prostate would be spared, and therefore there exists the potential to better preserve quality of life, such as erectile and sexual function and urinary continence in men undergoing prostate cancer treatment."
Family Organizes Memorial Golf Tournaments to Raise Funds for the PCF    The Redmond family holds golf tournaments to raise funds in honor of a father who lost his battle with prostate cancer

With their 3rd annual tournament on September 8th, the Redmond Family has raised over $150,000 for the Prostate Cancer Foundation.

It's been over two years year since Kristie Redmond lost her father to prostate cancer, but she's still fighting hard for a cure.

Mark Redmond's prostate cancer came as a huge shock. At age 50, the devoted father, husband, and businessman had just been in for a check-up and received a clean bill of health.

Then the leg pains began, and an X-ray revealed what his PSA had not: a tumor. The cancer was advanced and aggressive, and none of the available treatments worked. A year later, Mark lost his battle with prostate cancer.

But even up to the end, he never lost hope.

"My dad was the most optimistic out of all of us," says Kristie, now 26. "He wasn't going to give up. I know he'd be really proud of our fundraising efforts if he were here."

The idea for a memorial golf tournament came from one of Mark's friends – and the family immediately jumped on board. So did the rest of the community.

"Hundreds of people show up," marvels Kristie’s mother, Kay. "And I got four phones calls from men who were tested after the golf outing and found out they had prostate cancer."

For the Redmonds, making that kind of difference for others is the best way to keep Mark's legacy alive. That's why Kristie’s brother, Ryan, has worked to oversee construction of a hospice in Peru in his father’s memory – and why the family plans to continue supporting the PCF in any way they can.

"People think 'I'm healthy, it can't happen to me,'" Kristie explains. "But as my dad proves, it can happen to anyone. The more money we have for research, the better chance we have of finding treatments and a cure."
 
 
 
 
Prostate Cancer Treatment Causes Bone Loss


 Men treated with hormonal therapy may need bone-boosting meds, too

THURSDAY, Dec. 22 (HealthDay News) -- Many men diagnosed with advanced prostate cancer receive testosterone-reducing therapy, because the hormone is thought to spur tumor growth.

But a new study suggests this hormonal treatment may also have an unwelcome side effect: it triggers a decline in patients' bone mass.

Researchers at the University of Pittsburgh compared the bone health of 152 men with prostate cancer to that of healthy men, for one year. About half the cancer patients had not received hormonal therapy, 30 had received it for less than six months, while 50 had received it for six months or more.

Healthy men and cancer patients who had not undergone hormonal treatment showed no bone loss, the researchers report in the December issue of the Journal of Clinical Endocrinology and Metabolism.

But those who had recently started hormonal therapy showed a loss of bone mineral density ranging from 1 percent to 4 percent.

"Men with prostate cancer who are initiating androgen deprivation therapy have a 5- to 10-fold increased loss of bone density at multiple skeletal sites," compared to men not on this therapy, the researchers concluded.

Based on the findings, they suggested that patients receiving this type of hormonal therapy also receive concurrent treatment aimed at slowing or stopping bone loss, especially in the first year after such therapy begins. 

SOURCE: Journal of Clinical Endocrinology and Metabolism, abstract, December 2005

-- E.J. Mundell
Obesity Hinders Prostate Cancer Detection
Finding highlights need for rigorous screening in heavier patients
 WEDNESDAY, Jan. 11 (HealthDay News) -- Doctors may have more difficulty in detecting prostate cancer in obese men, which could lead to delayed diagnosis and increased risk of death, researchers say.

A study led by experts at Duke University Medical Center found that doctors may be 20 percent to 25 percent less likely to identify prostate cancer in obese men. Doctors need to be aware of this and be especially thorough when examining obese men for prostate cancer, the study authors recommended
."Diagnosing prostate cancer is a bit like finding a needle in a haystack. The bigger the haystack you have, the harder it is to find the needle, and in this case, we may be missing cancers in obese men," principal investigator Dr. Stephen Freedland, an assistant professor in Duke's department of surgery-urology, said in a prepared statement.
 

He and his colleagues reviewed the medical records of 1,400 men who had their prostrates removed after being diagnosed with prostate cancer. The average weight of obese men's prostate glands was 40 grams, compared to a normal weight of 20 to 30 grams. An enlarged prostate increases the risk that a biopsy will fail to detect cancer, the experts say.

In addition, they note that it is more difficult to perform digital rectal exams on obese men compared with thinner men.

The study appears in the February issue of the Journal of Urology.

 

 

The prostate is made up of a number of small glands
 surrounded by a layer of tissue called the stroma.

The    small glands in the prostate produce the fluid secretions. The stroma contains some muscle cells which contract during ejaculation to help move fluid into the urethra.

The prostate gland produces a milky, slightly acidic fluid that is secreted through several openings into the urethra. Although the functions of the substances in prostatic fluid are not entirely known, they may help keep sperm alive and may also protect sperm when in the female reproductive tract. The prostate produces approximately 40% of the fluid that is ejaculated.

The prostate gland slowly increases in size from birth until puberty, and after that it grows more quickly.

The close location of the prostate around the urethra means that any enlargement of the gland can narrow the outflow from the bladder. If the prostate grows too large, it may slow or even stop the flow of urine.

The outflow of urine from the bladder is controlled by a ring of muscle called the internal sphincter which is located at the base of the bladder. When the internal sphincter is closed, it stops urine and semen leaving the body through the urethra at the same time. At orgasm, this muscle ring closes tightly to stop semen flowing 'backwards' into the bladder. This muscle ring cannot be consciously controlled and is referred to as an involuntary muscle.

The outflow of urine from the penis is controlled by a different muscle layer (external muscle sphincter) that sits underneath the prostate gland in the region referred to as the pelvic floor. Men can voluntarily control the flow of urine by the control of this muscle layer in the pelvic floor. This muscle layer is referred to as a voluntary muscle because it can be consciously controlled.
Growth of the prostate with age

 

The growth of the prostate gland is controlled by substances called androgens. Androgens are the sex steroids or hormones that are responsible for the development of male characteristics such as hair and beard growth.

The most important androgen in men is testosterone. Testosterone is produced mainly in the testes by Leydig cells which lie between the sperm producing tubes (seminiferous tubules). Small amounts of testosterone are also made by the adrenal glands which are walnut sized glands that sit on top of the kidneys. Testosterone is carried in the blood stream to other parts of the body to act on a number of other organs. Only those parts of the body which have sensors that detect androgens (androgen receptors) will respond to testosterone. Testosterone is changed to another androgen called dihydrotestosterone (DHT) which is the androgen that stimulates prostate growth.

Testosterone is not produced until puberty and therefore the prostate gland remains small before puberty. The rising levels of testosterone at puberty causes the prostate gland to increase in size and continues to grow during adult life and in ageing men. If testosterone levels are lowered by removal of the testes, the prostate shrinks in size. Without testosterone, the prostate will also stop producing fluid because the prostate cells depend on testosterone for this function.

Prostate Cancer Early  Detection, Prevention, Treatment and Cures

 About Prostate Cancer

Prostate cancer is the most commonly diagnosed non-skin cancer in the United States. One in six American men will develop prostate cancer in the course of his lifetime. A little-known fact is that a man is 33% more likely to develop prostate cancer than an American woman is to get breast cancer.

These and other sobering facts are the driving forces of the Prostate Cancer Foundation, whose mission is to support research into better treatments and a cure for recurrent prostate cancer. The PCF is the world's largest source of philanthropic support for prostate cancer research. The PCF has raised more than $230 million to fund over 1,200 research projects, all with the goal of finding better treatments and a cure as soon as possible.

Prostate Cancer And You
 Every man diagnosed with prostate cancer begins a deeply personal journey for himself and his loved ones in determining the appropriate therapy for the disease. Receiving a diagnosis of cancer is always very difficult. Prostate cancer is particularly complicated due to the variety of treatment options and the lack of knowledge, in certain cases, as to the most appropriate treatment. However, learning more about the disease, understanding the treatment options and their risks and benefits, and discovering the diet and lifestyle changes that may improve the prognosis all can help empower patients. It lets them participate more actively in their care and helps in making informed choices about treatment options.

This website presents information about prostate cancer that anyone concerned about or diagnosed with prostate cancer should know. It is impossible, however, to present all the information that might be relevant to a particular diagnosis. Therefore, in the "Prostate Cancer Useful Resources" section, there are links to additional sources of information and support.  And, of course, patients should consult with their health care provider regarding their individual situation.
 
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What Is The Prostate?

The prostate is a walnut-sized gland located between the bladder and the penis and in front of the rectum. The urethra, the tube which carries urine from the bladder and out of the body through the penis, passes through the center of the prostate. The microscopic nerves that control erection are attached to both sides of the prostate as they extend to the penis.  The prostate is not a vital organ; however, it is surrounded with lots of small and sensitive nerves and blood vessels that can be damaged as a result of the disease and its treatment. In some ways, it functions as "Grand Central Station" for the male reproductive and urinary systems where urine and semen must pass through the prostate to leave the body. Its importance is less related to what it does than to the problems that it creates when something goes awry.

The Prostate's Role In Reproduction

 

The primary function of the prostate is the production of seminal fluid, a milky substance that nourishes sperm (seminal vesicles, attached to the prostate, contribute nutrients as well). Sperm passes to the prostate by traveling through the vas deferens, tubes originating from the testes. The semen, a mixture of seminal fluid and sperm, is ejaculated during orgasm through a connection to the urethra called the ejaculatory ducts.

Anatomy Of The Prostate
The prostate is divided into five zones: (1) the peripheral zone, which is located in the rear part of the prostate near the rectum and which contains three-fourths of the glands in the prostate and is where most prostate cancer occurs; (2)  the central zone, which is involved in the connection of the seminal vesicles to the prostate, and which contains most of the rest of the organ's glands; (3) the anterior zone, which is primarily smooth muscle tissue, is located in the front part of the prostate; (4) the transition zone, the zone that enlarges with "benign prostatic hyperplasia" (BPH), a noncancerous enlargement of the prostate; and (5), the pre-prostatic tissue, which contains muscles that help prevent semen from flowing backward into the bladder during ejaculation.
What Is Prostate Cancer?

Prostate cancer occurs when cells within the prostate grow uncontrollably, creating small tumors.  The term “cancer” refers to a condition in which the regulation of cell growth is lost and cells grow uncontrollably.  Most cells in the body are constantly dividing, maturing and then dying in a tightly controlled process.  Unlike normal cells, the growth of cancer cells is no longer well-regulated.  Instead of dying as they should, cancer cells outlive normal cells and continue to form new, abnormal cells.

Abnormal cell growths are called tumors.  The term “primary tumor” refers to the original tumor; secondary tumors are caused when the original cancer spreads to other locations in the body.  Prostate cancer typically is comprised of multiple very small, primary tumors within the prostate.  At this stage, the disease is often curable (rates of 90% or better) with standard interventions such as surgery or radiation that aim to remove or kill all cancerous cells in the prostate.  Unfortunately, at this stage the cancer produces few or no symptoms and can be difficult to detect.

About Metastatic Prostate Cancer
If untreated and allowed to grow, the cells from these tumors can spread in a process called metastasis.  In this process, prostate cancer cells are transported through the lymphatic system and the bloodstream to other parts of the body, where they lodge and grow secondary tumors.  Once the cancer has spread beyond the prostate, cure rates drop dramatically.

In most cases, prostate cancer is a relatively slow-growing cancer, which means that it typically takes a number of years for the disease to become large enough to be detectable, and even longer to spread beyond the prostate.  This is good news. However, a small percentage of patients experience more rapidly growing, aggressive forms of prostate cancer.  Unfortunately, it is difficult to know for sure which prostate cancers will grow slowly and which will grow aggressively – complicating treatment decisions.

The spread of cancer outside the prostate can be detected by the presence of prostate cancer cells in areas surrounding the prostate such as the seminal vesicle, lymph nodes in the groin area, the rectum and bones.  When prostate cancer spreads to another site, such as bone, the new tumor is still considered to be prostate cancer, not bone cancer.
Screening & Diagnosis

Screening for prostate cancer can be performed quickly and easily in a physician’s office using two simple tests: the prostate specific antigen (PSA) blood test, and the digital rectal exam (DRE).

About The PSA Test
PSA is an enzyme produced in the prostate that is found in the seminal fluid and the bloodstream.  An elevated PSA level in the bloodstream does not necessarily indicate prostate cancer, since PSA can also be raised by infection or other prostate conditions such as BPH.  Many men with an elevated PSA do not have prostate cancer.

Nonetheless, a PSA level greater than 4.0 nanograms per milliliter of serum was established initially as the cutoff where the sensitivity for detecting prostate cancer was the highest and the specificity for detecting non-cancerous conditions was the lowest. A PSA level above 4.0 ng per milliliter of serum may trigger a prostate biopsy to search for cancer.  Recently, experts have argued that men with a PSA level greater than 2.5 should obtain biopsies to increase the likelihood that prostate cancer might be detected earlier in a more curable form of the disease.  This issue is not yet scientifically resolved, and the topic remains controversial.

It is important to note that the PSA test is an imperfect screening tool.  A man can have prostate cancer and still have a PSA level in the “normal” range.  Approximately 25% of men who are diagnosed with prostate cancer have a PSA level below 4.0.  In addition, only 25% of men with a PSA level of 4–10 are found to have prostate cancer.  With a PSA level exceeding 10, this rate jumps to approximately 65%.

More sophisticated forms of the PSA blood test can be used to further improve the precision of the test. It should be noted that the standard PSA test remains the most widely used screening assay for prostate cancer and that the newer methods are just starting to be adopted by the medical community. Learn more about additional diagnostic tests.

About The Digital Rectal Exam
 The digital rectal exam should be performed along with the PSA test.  The DRE is performed by a physician who will insert a gloved finger into the rectum to feel the peripheral zone of the prostate where most prostate cancers occur.  The physician will be checking for hardness of the prostate or for irregular shapes or bumps extending from the prostate – all of which may indicate a problem.  The DRE is particularly useful because the PSA test may miss up to 25% of cancers, and the DRE may catch some of these.

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Evidence of the benefits of nutritional approaches to cancer prevention is rapidly mounting. Day after day, the effects of dietary and lifestyle changes on the development and progression of prostate cancer are being discussed and explored by leading researchers in the field, and nutritional strategies for improving outcomes in prostate cancer patient are taking ever more prominent places in treatment protocols.

Which foods and nutrients have been shown to be beneficial for patients with prostate cancer? How reliable are the data for nutritional strategies in prostate cancer? Are there foods or nutrients that might prevent prostate cancer -- or even prevent or delay a recurrence of the disease? How do you get the most benefit from each vitamin and mineral? What should you do now?

The Nutrition and Prostate Cancer guide summarizes the “best of the best” data and information available in the research arena today, and is designed to help everyone affected by or at risk for prostate cancer understand how key nutritional strategies can be incorporated into everyday life.

Culling the data from the published literature, Dr. Peter Gann of Northwestern University and Dr. Edward Giovannucci of the Harvard School of Public Health offer a comprehensive, yet concise overview of where we are today in the search for nutritional approaches to prostate cancer -- and remind us how much more we have yet to learn.

The Nutrition and Prostate Cancer guide will help you navigate through the information available about various nutritional approaches so that you can create a strategy that’s right for you.

Remember: if the cancer is detected at the earliest stages, over half of men diagnosed will live for more than 15 years. In other words, your diagnosis of prostate cancer is just the beginning of your journey, not the end. And there might be some relatively simple things that you can do to maximize your body’s ability to fight this disease.    

If you would like to receive a paper copy of the complete guide when it is available, please complete the Nutrition and Prostate Cancer registration form.

 
Detection Methods

Screening for prostate cancer can detect the disease when no symptoms are present and can help catch it at an early stage when treatment is thought to be more effective and potentially has fewer side effects.  As noted previously, the most widely used screening tests for prostate cancer include the digital rectal examination (DRE) and the prostate specific antigen (PSA) test.  The DRE and PSA test cannot confirm whether or not cancer is present, but they can suggest the need for further tests.  If the DRE and PSA test suggest the presence of prostate cancer, a transrectal ultrasound (TRUS)–guided biopsy is typically recommended.

Digital Rectal Exam (DRE)
During a digital rectal examination the physician feels the back portion of the prostate for size and any irregular or abnormally firm areas. For this test, the physician inserts a gloved and lubricated finger into the rectum.

Prostate Specific Antigen Test (PSA)
PSA is a substance produced by cells from the prostate.  Under normal circumstances, PSA is secreted by the prostate into semen to help with reproduction by preventing the coagulation of semen.  However, small amounts of PSA naturally leak out into the bloodstream as well.  When prostate cancer is present, the prostate ducts that normally secrete PSA into the urethra get clogged and more PSA leaks out of the prostate into the bloodstream.

During the PSA test, a small amount of blood is drawn from the arm, and PSA levels are measured.  PSA blood test results are reported as nanograms per milliliter (ng/ml).  Results under 4 ng/ml are usually considered normal (however, some experts have recently argued that 2.5 ng/ml should be established as the upper limit of “normal”).  Results over 10 ng/ml are high, and results between 4 and 10 are considered intermediate.  The higher the PSA level, the more likely a patient has prostate cancer.  However, many factors can affect PSA levels, and for some people, a high PSA level is normal and does not indicate a problem.  The test can also be influenced by certain medical procedures and the presence of an infection.  It may be abnormally high (though usually not as high) in men with non-cancerous enlargement of the prostate (benign prostatic hyperplasia or BPH).  Also, some medications and herbal preparations can cause an inaccurate reading of blood PSA levels.

Some helpful hints for obtaining a maximally accurate PSA test include: (1) Don’t ejaculate for 2 days prior to having a PSA test as this can raise PSA levels, and (2) tell your doctor if you are taking Proscar, Avodart or Propecia. These drugs, used to treat BPH and baldness, will likely lower your PSA levels.  Also, (3) be sure that the DRE is performed after drawing blood for the PSA test, as the DRE can artificially raise PSA levels. Herbal supplements can also affect PSA levels.  Be sure to tell your physician about any supplements that you are taking before the PSA test.

Percent Free PSA
This test measures how much PSA circulates freely in the blood and how much is bound with other proteins. The more free PSA that is present the better (or the more likely a man is to be “free” of cancer). So, if a man has an elevated total PSA, but most of it is “free PSA,” then it is most likely coming from BPH rather than cancer.  Conversely if most of the total PSA is coming from PSA that is bound to proteins, it is more likely that the patient will have cancer.  In one study, researchers used a free-PSA cutoff range of 19% in men with total PSA levels between 3 and 4 and detected 90% of all cancers.  In another study of men with total PSA levels between 4 and 10, biopsies were performed only in men with free PSA of less than 25% of the total PSA.  They detected 95% of the cancers and reduced unnecessary biopsies by 20%.

PSA Density (PSAD)
PSA density is the value of the PSA divided by the size of the prostate, which can be determined by a transrectal ultrasound (TRUS). The likelihood of prostate cancer is increased when the PSAD value is high.  In other words, if you have a relatively small prostate that is producing large amounts of PSA, there is a greater likelihood that cancer is present.  If the prostate is large relative to the PSA score, there is a greater chance that BPH is to blame.

PSA Velocity
Calculating the PSA velocity tracks changes in the PSA blood level over time - for example, how quickly the PSA level rises over the course of several months.  PSA velocity may aid the interpretation of borderline PSA results by measuring whether the PSA levels are increasing over a short period of time. The test is used as a tool to keep track of how PSA levels change, but it is not used to diagnose prostate cancer.  If PSA increases dramatically in a short period, it may be one indicator that prostate cancer has progressed.

Transrectal Ultrasound (TRUS)
The Transrectal Ultrasound (TRUS) procedure uses sound waves to create an image of the prostate to help guide the biopsy needles.  It has been shown that TRUS alone is of limited, if any, value in the diagnosis of prostate cancer and is now used primarily to guide biopsy needles.

Prostate Biopsy
 The DRE and PSA tests cannot diagnose prostate cancer; they merely indicate that further testing is needed.  Abnormal findings in either the DRE or PSA may indicate the need for a biopsy.  During a biopsy, a TRUS is used to view and guide a needle (or multiple needles) into the prostate to take small samples of tissue.  Typically, a prostate cancer biopsy employs a multi-needle device that is able to take six or more tissue samples simultaneously from different parts of the prostate to be sure that cancerous tissue is not missed.  This procedure is typically performed using local anesthesia.

Some physicians will take 12 or more tissue samples or “cores” during a biopsy.  These tissues are then examined for the presence of cancer.  This generates a value known as a Gleason Grade (Click here for more information), which is used to diagnose the grade of the disease or how far it may have progressed.

 A biopsy is the only way to confirm or diagnose the presence of prostate cancer.  The biopsy procedure may cause some discomfort or pain, but the procedure is short, and it can usually be performed without an overnight hospital stay, on an outpatient basis.  After a biopsy, blood may be present in the urine, semen and/or bowel movements, but these symptoms generally disappear after a few weeks.

Some men worry that a biopsy might help spread the cancer cells either throughout the prostate or beyond.  There is no evidence that cancer biopsies of any kind result in the spread of cancer.

While biopsies are the most accurate means of detecting the presence of cancer in the prostate, it is possible to miss a significant cancer during a biopsy – or receive a false-negative result.  Prostate cancer does not typically grow as one single tumor or grouping of cancer cells.  Rather, prostate cancer is usually comprised of many different small tumors or cancer cell groupings in different areas of the prostate.  For this reason, the exact location of these various small tumors can be difficult to pinpoint with the biopsy needles.  The needles are directed to the locations in the prostate that are most likely to contain prostate cancer.  However, the biopsy is only a sampling of tissue from various parts of the prostate. If very strong signs of cancer were present prior to the biopsy, such as a prostate lump felt during the DRE, a very high PSA and/or an elevated PSA with a very low percentage of free PSA, but no cancer was found, the patient should discuss repeating the biopsy with his physician.
 
Screening

How Often Should I Be Screened?
If detected at an early stage, when the cancerous cells are still confined within the prostate, prostate cancer may be cured through surgery or radiation.  This fact alone makes the strongest case for aggressive, early screening for prostate cancer.

The American Cancer Society suggests that prostate cancer screening (PSA blood test and DRE) should be offered annually, beginning at age 50, to men expected to live for at least 10 years.  Men who may be at high risk, such as those with a father or brother with prostate cancer diagnosed at an early age, should begin testing at age 45.  Men at even higher risk (because they have several first-degree relatives who had prostate cancer at an early age) or African-American men could begin testing at age 40.

However, there is no unanimous opinion in the medical and scientific communities regarding prostate cancer screening. The U.S. Preventive Services Task Force, a group of experts that develops recommendations for clinical preventive services, concluded that evidence is insufficient to recommend for or against routine screening for prostate cancer using prostate specific antigen (PSA) testing or digital rectal examination (DRE).

 Issues and Controversies in Screening
Large studies are underway to determine the extent to which prostate cancer screening saves lives, balancing this against the results of unnecessary treatment for men whose cancer would not become clinically meaningful in their lifetimes.  These studies will help determine whether a man who is screened regularly is less likely to die from prostate cancer than a man who does not get screened.  Results are expected within 5-10 years and should help clarify the extent to which screening for prostate cancer decreases the risk of death from prostate cancer.

Those who encourage regular screening believe that finding and treating prostate cancer early, when treatment might be more effective, saves lives and provides patients with more treatment options and potentially less significant side effects.  They agree with the recommendation that all men who have a life expectancy of at least 10 years should be offered the PSA test and DRE annually beginning at age 50.  Some also recommend screening tests even earlier for high-risk groups, such as African-American men and those with close family relatives with prostate cancer.

The Prostate Cancer Foundation advises that men age 50 or older discuss prostate cancer screening with their physicians.  African-American men and all men with a close relative with prostate cancer should consider prostate cancer screening after age 40.
Risks of Over-Detection
 Medical experts who recommend against regular screening believe that prostate cancer, if present at all, may never affect a man’s health and treating it could cause side effects like impotence (inability to keep an erection) and incontinence (inability to control the urine flow).   Therefore, they believe the known side effects of treatment may outweigh the potential benefits of screening.   Thus, men should be given information regarding the pros and cons of screening so they can make their own decisions.

Issues that men should understand before screening include the likelihood that prostate cancer (that may or may not become symptomatic) will be diagnosed; the likelihood of false negative and false positive results; anxiety associated with a positive test; the discomfort of additional testing; and the uncertainty regarding whether screening reduces the risk of death from prostate cancer.
Gleason Grade

The Gleason Grade refers to the degree of aggressiveness of a particular tumor based on the appearance of the tissue under a microscope.   The Gleason grading system assigns a numerical score to each of the two largest areas of cancer in the tissue samples.    The lowest possible combined Gleason Grade is 2, and the highest possible Gleason Grade is 10.

This image shows what the various prostate cancer cells might look like under a microscope – relative to the Gleason Grade.   Note that Gleason Grade “1” cells look round and defined, whereas the Gleason Grade “5” cells are clumped together like islands of cancer cells with little or no individual cell boundaries (www.prostateinfo.com).

How Is It Determined/Calculated?
 The Gleason grading process assigns a number ranging from 1–5 based on the degree of “cell differentiation” within the tissue sample from very well differentiated (i.e., least cancerous, most normal looking [grade 1] to very poorly differentiated and most cancerous [grade 5]). 

Gleason Grades 1 and 2 closely resemble normal prostate tissue – in which the cells appear round, orderly and with defined borders. In grade 2, the cells are more loosely aggregated.

In Gleason Grade 3 cells are beginning to lose their defined borders and are starting to group together into clumps.

Gleason Grade 4 is identified by loss of normal cell structure and a more pronounced clumping together of cancerous cells.

Gleason Grade 5 means that the cells have lost most or all of their normal characteristics are very poorly differentiated and have essentially merged together into cancerous islands of cells.

The Combined Gleason Grade or Gleason Sum
The final Gleason Grade is the combination of two numbers, derived from adding the two highest grades assigned to two tissue areas extracted during the biopsy.  The pathologist will assign patterns to each section of tissue samples, a most common pattern in one sample and a second most common pattern in another specimen.

Assigning a combined grade to the two most common patterns allows for a better prediction about the prognosis.  The lowest possible Gleason Grade is 2 (1 + 1), where both the primary and secondary patterns have a Gleason Grade of 1.  A typical Gleason Grade might be 5 (2 + 3), where the primary pattern has a Gleason Grade of 2 and the secondary pattern has a grade of 3.  Another typical Gleason Grade might be 7    (4 + 3), where the primary pattern has a Gleason Grade of 4 and the secondary pattern has a grade of 3.  The highest possible Gleason Grade is 10 (5 + 5), when the primary and secondary patterns both have the most disordered Gleason Grades of 5.

Risk Relative to Gleason Grade
The Gleason Grade can help a physician to determine a man's stage of cancer.  In general, the Gleason can be an indicator of how aggressive the cancer is or will behave in the future.  However, the Gleason Grade does not determine how far the cancer has spread, whether it is confined to the prostate or to which part of the body the cancer may have spread.

Nonetheless, a high Gleason Grade (8–10) indicates a greater chance that the cancer has spread beyond the prostate and is a more aggressive form of cancer.  A very high Gleason Grade (i.e., 10) is strongly predictive for aggressive cancer that has likely grown outside of the prostate.  Conversely, a lower Gleason Grade indicates a better prognosis.

Some scientists believe that very low Gleason Grades (i.e. 2–4) may be misleading.  When prostates removed from patients with low Gleason Grades are evaluated by pathologists, the Gleason Grade is often restated because higher-grade cancers are found within the prostate that were not pinpointed with the original biopsy.

Prostate cancer is a very complex disease, and the Gleason Grade alone cannot predict the future course of disease.  Some men with low Gleason Grades have been known to do poorly, while some other men with high Gleason Grades have been known to do well.

By combining the patient's Gleason Grade with the PSA level and the clinical stage, it is possible to use prognostic tools such as the “Partin coefficient tables” to estimate the likelihood that that patient has localized or locally advanced prostate cancer of different types. (Click here for more information about Partin tables.) This factor – whether the cancer has spread – is an important consideration in determining the optimal treatment.

 Staging & Prognosis

Staging determines the extent of prostate cancer and provides an idea of how the cancer should be treated.  The best-case scenario is that the cancer is identified at an early stage, when the tumors are very small and confined within the prostate.  Staging is based on where the cancer is in the body and where it may have spread if it has grown beyond the prostate.  Physicians use a variety of techniques to accomplish this, including feeling the prostate itself via a digital rectal exam (DRE), magnetic resonance imaging (MRI) and other techniques to visualize what is going on within the body.

Terminology you may hear: Cancer may be described as “indolent” or “aggressive.”  “Indolent" means that the cancer is expected to grow slowly and not progress rapidly.  “Aggressive” indicates that the prostate cancer is likely to grow rapidly.  Prostate cancer is a heterogenic disease, in that some prostate cancers progress very rapidly while some grow slowly.  The aggressiveness of tumors appears to correlate directly with the proportion of higher Gleason Grade cells, but it may still be difficult to determine the prognosis and the best treatment and how responsive a particular cancer might be to treatment.

Other terminology:  “Localized” prostate cancer means that the cancer is confined within the prostate.  “Locally advanced” prostate cancer means that most of the cancer is confined within the prostate; however, some of the cancer has penetrated the capsule of the prostate or has escaped into the seminal vesicle (but not the lymph nodes).

The following describes some of the tests and procedures that may be used by a physician to determine the extent of the prostate cancer.

Imaging & Staging Methods

Transrectal Ultrasound (TRUS)
The TRUS (also described in the “Detection Methods” section) is used to help image the prostate and help guide the placement of biopsy needles. It has been shown that the TRUS alone is of limited, if any, value in the diagnosis of prostate cancer and is now used primarily to guide biopsy needles.

Lymph Node Biopsy (Lymphadenectomy)
As noted previously, the best way to determine whether the cancer has spread beyond the prostate is to remove tissue from areas where prostate cancer is known to spread.  When prostate cancer is suspected to have spread, a lymph node biopsy is commonly taken.  Lymph nodes are often assessed during surgery when the prostate is removed.

Bone Scan  
A bone scan, which is similar to an X-ray, is used to determine if prostate cancer has spread to the bones.  In this procedure, a physician will first inject a harmless radioactive substance (“radioisotope”), which is attracted specifically to bones.  Normal bones absorb the radioactive substance at a lower rate than bone that is in a process of regeneration – such as in a bone fracture or when cancer is present.  Thus, if cancer is present in the bone, the radioisotope accumulates in those locations and shows up as a “hot spot” on the X-ray-like image taken during the bone scan.

It is important to note that bone scans are not perfect tools for identifying whether prostate cancer has spread to the bone.  There may be microscopic deposits of prostate cancer cells in bones that do not show up on the bone scan image – giving a “false negative” test result.  Conversely, any type of bone problems such as a current (or old) bone fractures, arthritis and infections can show up as hot spots on a bone scan – giving a “false positive” test result.  However, regular X-rays can help separate these other bone problems from suspicious sites of cancer in the bone.

Magnetic Resonance Imaging (MRI)
MRI uses a high-powered magnetic field to create an image of the prostate.  The MRI can show whether the cancer has spread outside the gland into the lymph nodes or other areas around the prostate.  However, because prostate cancer tumors can be so small, MRI may miss some small or microscopic tumors that are either extending from the wall of the prostate or are in surrounding areas.

Computed Tomography (CT)
CT forms a picture out of multiple cross-sectional X-ray images put together by a computer.  It is similar to an MRI, but with less clarity.  It shows the prostate and other nearby parts of the body.  The drawbacks to CT are similar to MRI in that micro-metastases may easily be missed by CT images.

Chest X-ray
A chest X-ray image can show whether cancer has spread to the lungs or other parts of the chest.  However, chest X-rays are not commonly used since the lungs are not a common site of early prostate cancer metastases.

Intravenous Pyelogram (IVP)
An X-ray of the kidneys, ureters and bladder taken after the patient has been injected with a dye that can be seen by X-ray.

ProstaScint Scan
This test uses antibodies with radioactive molecules attached to detect the presence of prostate cells throughout the body.  The radioactive antibodies are designed to attach to prostate cancer cells themselves so that they can be imaged through an X-ray-like process.  If the test detects the cells outside of the prostate, it indicates that the prostate cancer has spread.

The ProstaScint scan has not gained wide use because reading and interpreting the test results are challenging and very dependent on the skills of the physician reading the scan.  In other words, the test results are highly subjective or open to interpretation.  This makes decision-making based upon the test results challenging.  Efforts are underway to improve the accuracy and interpretability of the ProstaScint scan technology through improvements in imaging technology. These results are highly encouraging, especially for determining if the cancer has locally progressed.

While none of the techniques described above has emerged as the “gold standard” for determining the extent or location of prostate cancer tumors in the body, physicians commonly use one or more of them to determine the stage of the cancer – which helps to define recommended treatment approaches.  After a series of diagnostic approaches that may include biopsies, surgery and/or imaging procedures, the physician will typically assign a “stage” to the cancer that will describe the extent and location of the cancer in the body.

Traditional Cancer Staging

TNM Staging
A widely used staging system is called the TNM System. It is also known as the Staging System of the American Joint Committee on Cancer (AJCC).

• T refers to the extent of the primary tumor (T stage) within the prostate.
• N refers to whether the cancer has spread to the lymph nodes.
• M refers to the absence or presence of metastasis.

T Stages
Four categories, ranging from T1 to T4, are used to describe the stage of the cancer within the prostate itself.

• T1 No tumor can be felt upon DRE or seen with an imaging technique such as TRUS.
• T1a: The cancer is found incidentally during a transurethral resection (TURP), a procedure used to reduce pressure on the urethra due to benign prostatic enlargement.  Cancer is present in less than 5% of the tissue removed.
• T1b: Cancer is found after TURP and is present in more than 5% of the tissue removed.
• T1c: The cancer is found by needle biopsy that was done because of an elevated PSA.
• T2: The cancer can be felt upon DRE, but it is still confined to the prostate.
• T2a: The cancer is in one-half or less of only one side (left or right) of the prostate.
• T2b: The cancer is in more than half of only one side (left or right) of your prostate.
• T2c: The cancer is in both sides of the prostate.
• T3: The cancer has begun to spread outside the prostate and may involve the seminal vesicles.
• T3a: The cancer extends outside the prostate but not to the seminal vesicles.
• T3b: The cancer has spread to the seminal vesicles.
• T4: The cancer has spread to tissues next to the prostate such as the bladder's sphincter (muscles that help control urination), the rectum and/or the pelvic wall.

N stages:

• N0: The cancer has not spread to the lymph nodes.
• N1: The cancer has spread to one or more nearby lymph nodes.

M stages

• M0: The cancer has not spread beyond the regional nodes.
• M1: The cancer has spread beyond the regional nodes.
• M1a: The cancer has spread to distant lymph nodes outside of the pelvis.
• M1b: The cancer has spread to the bones.
• M1c: The cancer has spread to other organs such as lungs, liver, or brain (with or without bone disease).

Stage Groupings
The TNM score can be combined, along with the Gleason Grade, in a process called stage grouping.  The overall stage can then be expressed in Roman numerals from I (the least advanced) to IV (the most advanced).  This is done to determine the prognosis for survival or cure.

The stage groups that combine TNM score and Gleason Grade are:

Stage I

T1a, N0, M0, low Gleason Grade (2 to 4)
The cancer is still localized to the prostate and has not spread to lymph nodes or anywhere else.  It was found during a transurethral resection, had a low Gleason Grade (2 to 4), and less than 5% of the tissue was cancerous.

Stage II

T1a, N0, M0, intermediate or high Gleason Grade (5 to 10)
T1b, N0, M0, any Gleason Grade (2 to 10)
T1c, N0, M0, any Gleason Grade (2 to 10)
T2, N0, M0, any Gleason Grade (2 to 10)

The cancer is still localized to the prostate and has not spread to the lymph nodes or elsewhere, and

• It was found during a transurethral resection.
• It had an intermediate or high Gleason Grade (5 or higher), or more than 5% of the tissue contained cancerIt was discovered because of a high PSA level, cannot be felt on DRE or seen on TRUS, and was diagnosed by needle biopsy
• Or, it can be felt on DRE or seen on TRUS

Stage III

T3, N0, M0, any Gleason Grade (2 to 10)

Cancer has begun to spread outside the prostate and may have spread to the seminal vesicles, but it has not spread to the lymph nodes or anywhere else.

Stage IV

T4, N0, M0, any Gleason Grade (2 to 10)
Any T, N1, M0, any Gleason Grade (2 to 10)
Any T, any N, M1, any Gleason Grade (2 to 10)

 One or more of the following apply:

• The cancer has spread to tissues next to the prostate (other than the seminal vesicles), including the bladder's external sphincter (muscles that help control urination), the rectum, and/or the pelvic wall
• It has spread to the lymph nodes
• It has spread to other, more distant sites

Prognostic Tools
Scientists have developed tools that are used by clinicians to predict the prognosis (or outcome) of a particular man’s prostate cancer based on the various information that is accumulated during the diagnosis and staging process. The ultimate goal is to predict the probability that the recently diagnosed primary prostate cancer is localized and treatable by surgical or radiation procedures or is advanced and will require systemic (whole body) treatment.

Partin Coefficient Tables
This prognostic tool was originally developed by a group of urologists at The Johns Hopkins University. The Partin coefficient tables combine data on the PSA value, Gleason Grade and clinical stage of a specific patient in order to try to predict the specific risk for that patient.  They are used to estimate four different outcomes that are important in deciding how a man with prostate cancer should be treated.

• The probability that the patient has disease completely confined to the organ.
• The probability that the patient has established capsular penetration (prostate cancer has extended into and perhaps through the capsule of the prostate).
• The probability that the patient has extension of prostate cancer into the seminal vesicles.
• The probability that the patient has prostate cancer that has spread into the lymph nodes.


Note: While these tables are clinically useful, their ability to predict outcome for large numbers of patients has not been evaluated, and they cannot predict the prognosis of any particular patient with any known degree of accuracy.

An example of how to use Partin tables is shown below.  As indicated, the table uses three measurements: Gleason Grade, Stage and PSA.  The table below presents only one of several Partin tables that show the probability of having organ-confined disease based on these three variables.  For example, using this table, a man who, at diagnosis, has a Gleason Grade of 7 (4+3), a PSA of 5.0 and no palpable tumor during the DRE has a 52% probability of having totally organ-confined disease, a 42% probability of having extra prostatic extension of the tumor, and a small (3%) probability of the cancer having spread to the seminal vesicle and/or lymph nodes.


 

 

The complete set of Partin tables and an online Partin table calculator is available on the Johns Hopkins University website which you can access by clicking on this link:  http://urology.jhu.edu/Partin_tables/

There is a similar online calculator that utilizes the same information as the Partin tables but uses artificial intelligence to compare your information with that of a database of other patients with similar numbers to predict future disease outcomes. This calculator may be found at:  www.prostatecalculator.org.

Nomograms
Nomograms are a fairly recent computerized addition to the decision-making process. These mathematical algorithms, developed by Memorial Sloan-Kettering Cancer Center researchers, are used to assess the probability of cure or transition to the next stage, based on current understanding of the best predictive factors.  For patients with localized disease, predictive factors include the extent of the tumor on DRE, the Gleason Grade of the tumor, and baseline or pretreatment PSA.  Nomograms have also been developed for radical prostatectomy, external-beam radiation therapy and brachytherapy (seed implantation), and for patients whose cancer has progressed after hormone therapy.

This tool may be accessed by clicking the following link: 
http://www.mskcc.org/mskcc/html/10088.cfm
Treatment

Over the years, a wide array of treatments for prostate cancer have been developed including surgery, radiation, hormone deprivation therapy, chemotherapy, dietary changes and the use of various herbal supplements.  Deciding which of these treatments to select is a difficult decision.  Prostate cancer is a complex heterogeneous disease that acts differently in different men. Fortunately, for most men, most prostate cancer grows very slowly.  The slow rate of growth, however, coupled with the widely varied presentation, has made it difficult, if not impossible, to determine scientifically which treatment is best for which man. 

Which Treatment Is Right For You?
 Since there is no “one size fits all” treatment, each man must learn as much as he can about various treatment options and, in conjunction with his physician, make his own decision about what is best for him.  It may be reassuring to know that 86% of all prostate cancers are diagnosed in the local and regional stages and that the 5-year relative survival rate for men whose prostate cancer is diagnosed at this early stage is nearly 100%.   Additionally, according to the most recent data, the relative 10-year survival rate is 86%, and the 15-year survival rate is 56% (ACS Cancer Facts & Figures, 2004).  A variety of factors that must be considered and evaluated before deciding on a treatment plan (or no treatment at all) include the stage of the prostate cancer, age, other health issues and the patient's willingness to undergo certain procedures or therapies – some of which may have side effects.

At this time, it is virtually impossible to know how rapidly or slowly a particular man’s prostate cancer will grow – because at the time of diagnosis it is not known how long the prostate cancer cells have been developing.  If the cancer has been found to be contained within the prostate, it could take years for a tumor to double in size.  In fact, the cancer might stay within the confines of the prostate indefinitely and never cause problems.  Alternatively, the cancer might be growing very rapidly and might spread to other parts of the body quickly.

The Gleason Grade discussed in the “Screening & Diagnosis” section of this website, helps to provide some basis for determining how slowly or rapidly the prostate cancer cells might grow.  However, it is an imperfect means of predicting the future behavior of the cancer cells.  This uncertainty creates challenges for men diagnosed with prostate cancer in deciding how aggressively to treat the cancer.

The key is to collect as much information as possible before making a final decision – and if you are being encouraged to pursue one particular treatment by your physician, it may be valuable to get a second or third opinion, just to be sure that you have received a balanced view of your particular situation.  Keep in mind that second and third opinions can sometimes be confusing because you may receive conflicting advice or opinions.  That is why it is important to gather as much information about your particular cancer and the various treatment options as possible, so you can make an informed decision about which treatment is best for you.

Making a decision regarding treatment can be helped by talking with a spouse, friends, family and other men who have prostate cancer.  When speaking with other men with prostate cancer, however, it is important to remember that their circumstances (including the grade and stage of their cancer) may be very different from yours.  The treatment decisions that they have made may not be appropriate for you.

Because dealing with a prostate cancer diagnosis can be very stressful, attending to your psychological and spiritual well-being is also important.  Reaching out and including those close to you may be crucial to helping you deal with this stress.  Some people have trouble asking for and accepting support, even from family members, but a diagnosis of prostate cancer may require that you consider reaching out to others, even if you don’t normally do so.
Things to Consider

Most of the other sections in this “About Prostate Cancer” area of the website have been focused on facts and information so that you can be as informed as possible about prostate cancer, its causes, its effects on the body and available treatment options.

In this section, we aim to propose some things to consider and be aware of which may be relevant to your particular situation and which are not so information intensive. Rather we raise some questions for you to consider – particularly questions that you may wish to raise with your physician(s).  We hope to help you gain an added perspective on some of the concerns you may have or issues with which you may be dealing.
 
Prostate Cancer Symptoms

Often, early stages of prostate cancer do not cause symptoms.  But, in some cases, men with prostate cancer may experience any of these problems:

- 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;
- Blood in urine or semen; or
- Frequent pain or stiffness in the lower back, hips, or upper thighs.

You should speak with your doctor immediately if you have experienced any of the above symptoms or if you are a man over 50 who has not had a recent prostate cancer screening.  If you have a family history of prostate cancer, or are an African-American male, you should consider screening at age 45.
 Prostate Cancer Disease States

Prostate cancer can be thought of as having four distinct phases of progression.  These phases are: (1) localized disease, in which the prostate cancer is confined within the capsule of the prostate itself and has not spread into other parts of the body; (2) recurrent disease, where after localized therapy, there are signs – typically of rising PSA – indicating that the cancer has returned, but it can’t be detected in bone scans or other tests; (3) metastatic disease, in which the prostate cancer is growing outside the prostate and surrounding areas; and (4) hormone refractory disease, in which prostate cancer continues to grow despite the suppression of male hormones (androgens/testosterone) that fuel the growth of prostate cancer cells.

Not all men with prostate cancer will progress through these phases.  In fact, prostate cancer can remain within the prostate indefinitely and never grow quickly enough to become a problem within a man’s lifetime.  The goal is to diagnose the cancer early when it is truly contained within the prostate and, in most cases, to try to eliminate the cancer with localized treatments such as surgery or radiation.  Tens of thousands of men each year have their prostate cancer completely eliminated by local treatment.  However, the unfortunate reality is that prostate cancer may come back after local treatment, and it is impossible to predict with certainty which cancers will return.  Sometimes the cancer is not even diagnosed until it is already in an advanced stage and has spread outside the prostate.

Physicians will recommend distinct treatment approaches (or no treatment) depending on the state of the disease.  In this section, we frame some of the issues related to each of these phases of disease and then link you to the appropriate areas within the “Screening & Diagnosis” and “Treatment” sections of this website.
Causes & Risk Factors

No single cause of prostate cancer has been identified.  There are likely a variety of causes and contributing factors that lead to prostate cancer.  The major known risk factors for prostate cancer are age, race and family history.  Although there are no conclusive data, diet and other environmental factors may play a role as well.

Age
Age is the single most important factor in the development of prostate cancer.  It is extremely rare for a man under the age of 40 to develop detectable prostate cancer.  However, early growth of precancerous or cancerous cells in the prostate may actually begin before that time.  Detectable prostate cancer takes time to develop.   The chance of having prostate cancer increases rapidly after age 50.  In fact, about 80% of all prostate cancers are diagnosed in men over the age of 65.  A man in his mid-to-late seventies is 130 times more likely to develop prostate cancer than a man in his mid-to-late forties.  It is still unclear why prostate cancer rates increase with age; however, the genetic mutations that have been linked to development of cancer occur gradually over time.

 

Surveillance, Epidemiology, and End Results (SEER) Program (www.seer.cancer.gov) SEER*Stat Databases: Incidence - SEER 11 Regs + AK Public-Use, Nov 2003 Sub for Expanded Races (1992-2001) and Incidence - SEER 11 Regs Public-Use, Nov 2003 Sub for Hispanics (1992-2001), National Cancer Institute, DCCPS, Surveillance Research Program, Cancer Statistics Branch, released April 2004, based on the November 2003 submission.


 Race
A wide variation in incidence has been reported among different races and ethnic groups.  While Caucasian-Americans comprise the largest group of men that develop prostate cancer in raw numbers, more African-American men develop prostate cancer than Caucasian-American men.  In fact, African-American men are 65% more likely to develop prostate cancer than Caucasian-American men.  Moreover, African-American men appear to get more severe forms of prostate cancer and are more than twice as likely to die from it as Caucasian-American men.  The reasons for this are unknown.  However, diet, genetics and, possibly, inadequate exposure to vitamin D (see below) may all play a role.

Asian men living in Asia have the lowest incidence; however, their prostate cancer risk appears to rise the longer they live in Western culture.   Prostate cancer is most common in North America and northwestern  Europe.   It is less common in Asia,  Central America and South America.   While genetics may play a role, diet is suspected to be a major factor in these racial differences.

Family History
Approximately 25% of men with prostate cancer have a history of the disease within their family.  However, it is believed that only 9% of all prostate cancers are purely hereditary.  The picture may be more complex for those patients with a family history since family members typically share other risk factors, including race, diet and other environmental factors.  The risk of prostate cancer doubles among men having a first-degree relative with the disease.  With two close relatives, a man's risk increases fivefold, and with three or more close relatives, the risk for developing prostate cancer is alarmingly high – close to 100%.

Diet, Obesity & Nutrition  
Diet and weight may play a role in the development of prostate cancer.  High intake of animal fats, such as those found in red meat, and polyunsaturated fats (corn oil, safflower oil, margarine, etc.) may be associated with higher rates of prostate cancer; however, it is unclear exactly how dietary fat might relate to increased risk.

It is unclear whether animal fats themselves cause the problems or if it is the way red meat is often cooked.   Scientists have shown that charred meats (as in barbecuing) can create potent cancer-promoting chemicals.   Additionally, men with a high dietary fat intake may be less likely to eat fruits and vegetables, and it is unclear whether high fat or low fruit and vegetable intake (or a combination of both) is responsible for increasing risk.

Obesity
Recent studies have shown that men who are overweight or obese are at significantly higher risk for developing prostate cancer.  Moreover, early weight gain in life is negatively correlated with survival for men who go on to develop prostate cancer.  In other words, a man who develops prostate cancer at age 55 who became overweight at age 25 and stayed overweight is likely to have a more aggressive form of prostate cancer and shorter survival than a man who develops prostate cancer at age 55 who has not been overweight.

“Overweight” and “obese” are vague concepts to many people.  However, scientifically, these terms are defined by a person’s Body Mass Index (BMI), which is a calculation based upon both weight and height.  A BMI of 25–29 is considered overweight while a BMI of 30 or above is considered obese.  To calculate your BMI:

1.       Multiply your weight in pounds by 704.
2.       Multiply your height in inches by itself.
3.       Divide the result of step one with the result in step two.

For example, if you weigh 175 pounds: 175 X 704 = 123,200.   If you are 6 feet (or 72 inches) tall: 72 X 72 = 5,184.   123,200 divided by 5,184 equals 23.77.   Thus, your BMI is 23.8 – not overweight.

Nutrition
Nutrition may play an important role in the prevention of prostate cancer.   Fruits and vegetables, especially cooked tomatoes, contain key sources of cancer-fighting agents, such as lycopene, antioxidants and fiber (Prostate Cancer Nutrition).

Researchers supported by the Prostate Cancer Foundation are investigating how a low-fat diet high in soy protein and fiber may reduce the risk of prostate cancer.   (See "Nutrition & Prostate Cancer: The Complete Report" for more information PDF).

Vitamin D & Sunlight
Vitamin D is known to protect the body against cancer.   While vitamin D is contained in milk and some fish, the main source is from the skin, which forms vitamin D when it is exposed to sunlight.   Studies have shown that people living in regions that get less sunlight have higher rates of prostate cancer.   This may also help to explain some of the racial differences in the incidence of prostate cancer.   People with dark skin absorb less sunlight and are known to have lower levels of vitamin D.

Circulating Male Hormone Level
Lifetime risk of prostate cancer may be linked to the amount of the male hormone testosterone circulating in a man's body as early as puberty or even in utero, although direct evidence of this link remains to be shown.  Prostate cancer cell growth may be fueled by the presence of testosterone.  Therefore, one of the most common treatments for prostate cancer, especially if it returns after first-line treatment, is the complete suppression of testosterone production and action in the body.  (Hormone Therapy). It has also been shown that men who have their testicles surgically removed (orchiectomy; castrated) before puberty rarely develop prostate cancer.   However, these observations do not prove that prostate cancer is caused by high levels of testosterone in the body.
Non-Risk Factors

Things That Have Been Shown NOT to Increase
Prostate Cancer Risk

 Other Prostate Conditions
Non-cancerous conditions of the prostate account for a high percentage of prostate-related symptoms and can sometimes cause unnecessary worries about prostate cancer itself.   While some of these symptoms can be similar to those of prostate cancer and should be thoroughly examined by a physician, there is no evidence that having benign prostatic hyperplasia (BPH) or prostatitis increases the risk for developing prostate cancer. 

BPH
BPH refers to the non-cancerous enlargement of the transition zone of the prostate – the area of tissue around the urethra.  BPH causes the inner prostate tissue to press on the urethra, making it more difficult for men to urinate freely.  By age 70, 70% of men have some degree of BPH and 25% of them require treatment.  A number of research studies show that BPH does not make a man any more or less likely to develop prostate cancer.  Today there are a number of good treatments for BPH and most of them have few major side effects.

Prostatitis
 Prostatitis is the most common cause of urinary tract infection for men and 25% of men who see a physician for urological problems have prostatitis.  Symptoms include fever, chills, burning during urination or difficulty urinating.  Some forms of prostatitis are caused by a bacterial infection and can be treated with antibiotics.  However, some of the most common forms do not respond to antibiotics and treatment is aimed at symptomatic relief.  Many men find that a change in diet and lifestyle can help resolve prostatitis symptoms.  Prostatitis is not cancerous and has not been shown to increase or decrease chances of developing prostate cancer.

Vasectomy
 Vasectomy has been rumored to place men at higher risk for prostate cancer.  There is no evidence to support this theory.  The only possible connection between the diagnosis of prostate cancer and vasectomy is that men commonly visit a urologist to have a vasectomy performed.  At that time, a screening for prostate cancer may be performed. This would increase the chance of detecting prostate cancer at an early stage, but would in no way increase the likelihood of getting prostate cancer.

Cigarette Smoking
Although smoking cigarettes significantly increases the chances of developing lung cancer (which accounts for the highest number of cancer-related deaths), it has not been shown to increase the risk of developing prostate cancer.

Sexual Activity
 High levels of sexual activity or frequent ejaculation have been rumored to promote prostate cancer risk.  This is untrue.  In fact, preliminary studies show that frequent ejaculation may, in fact, slightly lower the risk of developing prostate cancer.
Prevention

Ultimately, it is best to prevent prostate cancer from occurring at all.  As the scientific community learns more about the causes and risk factors associated with cancer, the greater the likelihood there is that cancer can be prevented. Most cancers develop progressively over a long period of time – well before they create noticeable symptoms or are easily detected by a physician.  This means that a cancer-healthy lifestyle must be sustained over a long period of time to be of value in preventing cancer from occurring.  Some risk factors – such as race, family history or age -cannot be modified, while others, especially diet and weight, can be controlled.  The Prostate Cancer Foundation suggests that men wanting to reduce their risk of prostate cancer eat fewer red meats and high-fat dairy products, eat five or more servings of vegetables and fruits each day, exercise regularly and maintain a normal weight.

In addition, several large studies testing agents that might prevent prostate cancer are ongoing. Most notable are studies of vitamin E with selenium, and others evaluating the possibility that a class of drugs known as 5-alpha-reductase inhibitors (Proscar or Avodart) might prevent prostate cancer occurrence.
Localized Disease

During the process of diagnosing prostate cancer, physicians will use a variety of tests and procedures to try to determine whether the cancer is contained within the prostate or if it has spread to other parts of the body.  However, even with all of the tools of modern medicine, we are never really 100% certain that prostate cancer cells have not escaped from the prostate and lodged in other parts of the body.

However, the best-case scenario is that the prostate cancer is caught early in the disease process and is found to be contained within the capsule of the prostate gland.  This enables the patient and the physician to discuss and consider treatment strategies aimed at the complete removal or elimination of all of the cancer cells in the body. If successful, the cancer will not return.

Even when the cancer is believed to be completely localized to the prostate, there are a variety of treatment options and consideration that must be carefully evaluated by the patient in consultation with his physician(s) and family (Click here for a detailed overview and discussion of options for localized prostate cancer treatments).
Recurrent Disease (Rising PSA)

After a man receives treatment for localized prostate cancer, there is always a chance that the prostate cancer will come back, or "recur."  This happens because the local treatment did not successfully remove or eliminate all of the prostate cancer.  Often, this occurs because undetected microscopic prostate cancer cells escaped from the prostate before local treatment and spread to nearby lymph nodes or other structures.

Frequent PSA Tests
The best means of monitoring for a recurrence of prostate cancer is to test PSA levels at least annually.  Some men and/or their physicians decide to check PSA levels every few months - especially after the first couple of years following local therapy.  If PSA levels begin to rise, it means that the prostate cancer has returned.  Because only prostate cells produce PSA, if the prostate tissue has been removed surgically or treated ("killed") with radiation, a rising PSA means that prostate cancer cells are still present somewhere in the body.

After a man undergoes local treatments such as surgery or radiation, PSA levels should drop to virtually undetectable levels if all of the cancer cells have been removed or killed. 

PSA Levels After Radical Prostatectomy
For men who undergo a radical prostatectomy (removal of the entire prostate), the aim is to maintain PSA levels that are either undetectable or under 0.2 nanograms per milliliter of blood.  (Note: PSA levels below 0.1 are considered "undetectable" by most physicians.)

PSA Levels After Radiation Therapy
For radiation, the post-treatment PSA follows a different pattern.  Following radiation therapy, PSA levels decline more gradually as the cumulative power of the repeated radiation treatments kills the prostate cancer cells.  Sometimes it takes as long as 2 to 3 years for PSA levels to hit rock-bottom (the "nadir") following radiation therapy; however, some men reach their post-radiation nadir after only a few months.  The lower the PSA nadir following radiation therapy, the less likely the cancer is to recur.  For example, one study has shown that men receiving radiation therapy who achieved a post-treatment PSA nadir of less than 0.5, 95% were cancer-free at five years, and 84% at ten years.  However, in men whose PSA nadir was not as low (between 0.6-1.0), only 29% were cancer-free at five years.  Generally speaking, the longer the time between local therapy and a rising PSA, the better the prognosis.

There are differences of opinion in the medical community regarding the timing of additional treatment following a rising PSA.  Some physicians believe that additional treatment should be initiated immediately to try to suppress the continued growth of the prostate cancer cells.  Others believe that if symptoms are not present and there is no evidence that the cancer has spread to the bone, delaying additional treatment may be warranted.  No studies have yet shown that there is a survival advantage for immediate versus delayed treatment when the only sign of cancer recurrence is a rising PSA.  However, additional tests such as tracking the rate of rise of the PSA (also known as PSA velocity or doubling time) and a bone scan may help to decide how quickly to intervene with additional treatments - including hormonal therapy.

PSA Velocity or Doubling Time
A rising PSA following local therapy can occur at any point - ranging from months to many years later.  The reasons for this are unclear.  However, the rate at which the PSA is rising is known to correlate with aggressiveness and growth rate of the cancer.  A rapidly rising PSA is correlated with worse patient outcomes and vice-versa.  It is important to work with your physician to understand what is happening to your PSA and to chart your PSA levels and changes over time as an indicator of what is happening.

Checking for Bone Metastases
Because a rising PSA following local treatment means that the cancer is back, it is important to try to determine if the cancer has spread to the bones - one of the most common sites where prostate cancer can spread.  In most cases, this can be determined by performing a bone scan.  The bone scan is the easiest and most reliable (but not a foolproof) way to check for bone metastases.  If the cancer has spread to the bone, there are specific treatments that can be used to try to slow the progression of the disease.

Radiation Therapy for Recurrent Cancer
Some recent studies have shown that external radiation therapy may be beneficial in men who have recurrent prostate cancer.  This approach is called "salvage" radiation therapy.  This involves the administration of external radiation if PSA levels begin to rise at some point following the complete surgical removal or radiation of the prostate - indicating that the prostate cancer has returned.  Many experts believe that men are best treated with salvage radiation while the PSA is still relatively low (i.e., below 2.0) and in cases where the Gleason Grade was 7 or below.  However, salvage radiation has been shown to be useful even when both the recurring PSA and the Gleason are high.
 Metastatic Disease

When prostate cancer has spread outside the prostate and is growing in other parts of the body, a man is considered to have advanced or metastatic prostate cancer.

Some men are found to have advanced prostate cancer when they are initially diagnosed.  They are not candidates for localized therapies aimed at curing the disease when it is still confined to the prostate and must determine how to manage advanced prostate cancer immediately.  For others, prostate cancer may return after localized treatment failed to eliminate all of the cancer.

When prostate cancer has spread outside the prostate, a number of different disease-management issues arise.  In most cases, physicians will want to determine how rapidly the prostate cancer is growing and where in the body the cancer may have spread.  The rate at which the PSA is rising (the “PSA velocity” or “PSA doubling time”) can provide an indication of how quickly the prostate cancer is growing. 

Since prostate cancer almost always grows relatively slowly, even men with metastatic prostate cancer can live for many years with good quality of life, during which time new treatments may become available.

Current Treatment Options
 Patients with metastatic disease have a variety of treatment options including treatments that suppress the hormones that are known to fuel the growth of prostate cancer cells.  Some new treatments may slow the progression of prostate cancer to the bone and, at the very least, can help to manage the pain often associated with bone metastases.  In addition, significant advances are being made in the use of chemotherapy for the treatment of advanced prostate cancer and are being shown to be highly beneficial.  Recent studies have shown that a chemotherapy drug may help to prolong survival in patients with advanced disease.

New Treatments Being Developed
There are also more than 200 new therapies being developed for prostate cancer, most of which are for advanced prostate cancer – because that is where the greatest unmet medical need exists.  There are two places on this website where you can learn more about new treatments under development: first, a brief narrative description of some of the new treatments is in the “Experimental Therapies” section of this website.  Second, the Therapeutics Resource Center has a searchable database of all prostate cancer therapies in development.

Volunteering For A Clinical Trial
A man with advanced prostate cancer may also consider volunteering for a clinical trial that is evaluating an experimental therapeutic approach.  Participation in a clinical trial can be a way to contribute to advances in treatment and potentially gain access to an experimental new therapy before it becomes widely available.  Clinical trials have certain advantages and disadvantages that patients should consider carefully.  The “Clinical Trials FAQs” section of this website may help answer some important questions about clinical trials participation.  You will soon be able to search and find on this website a variety of clinical trials that might be appropriate for you.
Treatment

Over the years, a wide array of treatments for prostate cancer have been developed including surgery, radiation, hormone deprivation therapy, chemotherapy, dietary changes and the use of various herbal supplements.  Deciding which of these treatments to select is a difficult decision.  Prostate cancer is a complex heterogeneous disease that acts differently in different men. Fortunately, for most men, most prostate cancer grows very slowly.  The slow rate of growth, however, coupled with the widely varied presentation, has made it difficult, if not impossible, to determine scientifically which treatment is best for which man. 

Which Treatment Is Right For You?
 Since there is no “one size fits all” treatment, each man must learn as much as he can about various treatment options and, in conjunction with his physician, make his own decision about what is best for him.  It may be reassuring to know that 86% of all prostate cancers are diagnosed in the local and regional stages and that the 5-year relative survival rate for men whose prostate cancer is diagnosed at this early stage is nearly 100%.   Additionally, according to the most recent data, the relative 10-year survival rate is 86%, and the 15-year survival rate is 56% (ACS Cancer Facts & Figures, 2004).  A variety of factors that must be considered and evaluated before deciding on a treatment plan (or no treatment at all) include the stage of the prostate cancer, age, other health issues and the patient's willingness to undergo certain procedures or therapies – some of which may have side effects.

At this time, it is virtually impossible to know how rapidly or slowly a particular man’s prostate cancer will grow – because at the time of diagnosis it is not known how long the prostate cancer cells have been developing.  If the cancer has been found to be contained within the prostate, it could take years for a tumor to double in size.  In fact, the cancer might stay within the confines of the prostate indefinitely and never cause problems.  Alternatively, the cancer might be growing very rapidly and might spread to other parts of the body quickly.

The Gleason Grade discussed in the “Screening & Diagnosis” section of this website, helps to provide some basis for determining how slowly or rapidly the prostate cancer cells might grow.  However, it is an imperfect means of predicting the future behavior of the cancer cells.  This uncertainty creates challenges for men diagnosed with prostate cancer in deciding how aggressively to treat the cancer.

The key is to collect as much information as possible before making a final decision – and if you are being encouraged to pursue one particular treatment by your physician, it may be valuable to get a second or third opinion, just to be sure that you have received a balanced view of your particular situation.  Keep in mind that second and third opinions can sometimes be confusing because you may receive conflicting advice or opinions.  That is why it is important to gather as much information about your particular cancer and the various treatment options as possible, so you can make an informed decision about which treatment is best for you.

Making a decision regarding treatment can be helped by talking with a spouse, friends, family and other men who have prostate cancer.  When speaking with other men with prostate cancer, however, it is important to remember that their circumstances (including the grade and stage of their cancer) may be very different from yours.  The treatment decisions that they have made may not be appropriate for you.

Because dealing with a prostate cancer diagnosis can be very stressful, attending to your psychological and spiritual well-being is also important.  Reaching out and including those close to you may be crucial to helping you deal with this stress.  Some people have trouble asking for and accepting support, even from family members, but a diagnosis of prostate cancer may require that you consider reaching out to others, even if you don’t normally do so.

Prostate Cancer News

 

The Prostate Cancer Foundation provides access to the most recent prostate cancer news articles. To keep up-to-date on all the breaking news about prostate cancer, read today's lead stories and review recent headlines from the news archive.

High-Dose Radiation Cuts Risk of Prostate Cancer Recurrence
But it doesn't influence survival rates, a new study finds
 
Study Questions Progress Against Prostate Cancer
Tougher 'survivability' rates may skew real mortality figures, study suggests
 
Vitamin D and Painkiller Slow Prostate Cancer
Lab tests show combination stopped malignant cells in their tracks
 
Breast Cancer Gene Tied to Non-Breast Tumors in Men
BRCA2 mutations up risks for other malignancies, study finds
 
Chemo-Hormone Combo Curtails Toxic Side Effects
Research with mice offers hope for ovarian, breast and prostate tumors
Personal Stories

The Prostate Cancer Foundation is about more than advancing science. It is about changing the lives of all those touched by prostate cancer. The following portraits show how survivors manage their illness, deal with treatments, stay healthy and work to end the toll of prostate cancer for their children and grandchildren.

Andy Grove

Dr. Ward “Trip” Casscells

William Clapp

Professor Gerald Haslam

Michael Milken

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