Understanding Prostate Cancer: Guidelines and Information from Melchiore Buscemi MD

According to Melchiore Buscemi MD, men have small organ that looks like a walnut. It is between the bottom of the penis and where the bladder opens. The prostate has two jobs to do. The first thing it does is help control urine. Second, the prostate makes fluid that helps sperm grow and move.

PSA, a "Prostate Specific Antigen," is a protein that helps the semen stay liquid. This liquid state is needed for sperm to move and for fertilization. As a man gets older, his prostate gland goes through several changes. Changes include the growth of cancer and the growth of the prostate without cancer.

Prostate enlargement can cause voiding difficulty. As men age, more have prostate cancer that hasn't spread yet. Seventy percent of men 70 or older will have some prostate cancer, but only a small number will need treatment. As subclinical prostate cancer worsens, about 15% of men will find out they have cancer, but only 2% to 3% will die from it.

Even though there aren't any blood tests to find breast cancer early, the PSA test has given men a better chance of finding it early. All men make PSA, but it should only be found in the sperm, not the blood. If your PSA is going up, it doesn't mean you have cancer, but it does mean something is wrong with your prostate gland, and you need to see a urologist. If the PSA level keeps increasing, the chances of having prostate cancer also increase.

PSA testing has been looked at in the lab more in the last few years. Through this evaluation, a Percent Free Ratio and a Prostate Health Index were found, along with different urine tests, to help reduce the need for prostate biopsies that aren't necessary. Even though a biopsy is needed to prove cancer, it is possible to have a small tumor that can't be felt and seen on an X-ray. This could cause the biopsy to be wrongly negative.

CAUSES

No one knows for sure what causes prostate cancer. If someone in your immediate family has prostate cancer, especially if diagnosed before age 60, your risk is six times higher. If a close relative is diagnosed at age 80 or later, the risk is four times higher than if there wasn't a family history of the disease.

PREVENTION

There is no good way to keep from getting prostate cancer. Statistics show that a person's risk increases if they are overweight, eat the wrong foods, or eat a lot of animal fat. Free radicals are made in the blood when nitrates and animal fat are broken down. It is also thought that these free radicals could make cancer grow faster if it is already there.

SCREENING

The American Cancer Society thinks PSA tests should be done on men at age 50. Many Urologists start PSA testing at age 40, especially for black men with a family history of prostate cancer or trouble going to the bathroom. A long time ago, a big push was to test all men over 50. Over time, data have shown that this often led to treatment that wasn't necessary. When a person is 75, treating them in this unnecessary way is especially suitable. As the average age increases, we must look for men with a good chance of living longer.

DETECTION

As was already said, PSA levels during testing could increase yearly. Concerns arise when PSA goes up by more than 0.5% per year. Some men may have urinary symptoms, microscopic hematuria (blood in the urine), or blood in the ejaculate. All men over 40 should have a digital rectal exam (DAE) every year. If your Urologist thinks you might have cancer, they may suggest a prostate ultrasound, MRI, and biopsy. Adenocarcinoma is the most common type of cancer because it starts in the prostate gland. Occasionally, the urethra that runs through the prostate can give rise to transitional cell cancer.

DIAGNOSIS

If your DRE and PSA test results show that cancer needs to be ruled out, your Urologist will suggest a Prostate biopsy. You will need a Fleet enema and ore-oo antibiotics to get ready for this. The patient is put on their side for the procedure. Transrectally, a probe is put in. Under direct view, a needle is put through the probe. A unique tool is used to shoot or move the needle to the parts of the prostate that need to be looked at. It is put into the prostate about 1 to 2 cm deep. More samples are needed to look at all parts of a larger prostate. Most biopsies have between 12 and 16 cores. Bleeding and infections in the urethra and rectal area are rare.

TREATMENT

Treatment options depend on the person's age, health, size, stage, and grade of the tumor, as well as their symptoms when they urinate. Many older people with a Gleason score of 6 and a small amount of cancer are allowed to be watched. Younger people with a disease that is thought to be limited to one organ may be able to get a definitive treatment with either radical robotic surgery or brachy radiation seed placement. External radiation and cryofreezing are used on older patients, those at a higher risk of early metastasis, or those who can't have a procedure with general anesthesia.

Treatment for Metastases: Even if your cancer is already in an advanced stage when you are diagnosed, or your PSA is going up after treatment, testosterone removal will help most people get better. This can be done by taking the testicles out or injecting leuprolide acetate, which puts the testicles to sleep. Many people will go into remission for varying amounts of time. The best prognosis is for tumors with smaller volumes and lower grades. We hope it will be long before the PSA starts to go up. If the PSA goes up, your doctor may suggest different anti-androgen treatments. Pain that has spread to other body parts can be treated with bone radiation, and prednisone can help with pain and fatigue when other treatments don't work. Andropause will happen when the body stops making testosterone ( male menopause.)

PROGNOSIS

One's prognosis is based on how the grade and stage of their cancer compared to those of other people. Cells are looked at under a microscope to figure out the grades. The sample will be given a grade between 1 and 5, with 5 being the most dangerous type of cancer. It's rare to see 1st and 2nd grades; most kids get 3rd and 4th (3 - 4.) Prostate cancer can be multifocal, which means it can affect different parts of the body at the same time. Grading can be different in each part. Because prostate cancer has many symptoms, a Gleason score was made to classify it. This is worked out by adding the two most essential cancer grades. If a biopsy shows only one grade, the number increases by two. Scores for Gleason range from 2 to 10. Only a few scores are from 2 to 5, and most are (6 - 8.) About 10% of scores are considered to be (9 - 10.) The stage is based on how much cancer is in one or both lobes of the prostate, and ultrasound, MRI, bone, and CT scans are used to determine how far cancer has spread outside the gland.

If your doctor tells you to stop getting PSA tests because of your age, you must insist on keeping them if you don't like the idea. I think it's okay for a patient to stay under observation as long as the Gleason score is less than eight and there's only a tiny amount of cancer. No treatment works well on high-grade tumors with large amounts of cancer. The patient needs to talk to their Urologist and make sure they understand their options and risks.