Understanding Prostate Cancer: Insights and Information from Melchiore Buscemi MD

Melchiore Buscemi MD shares information and insights about understanding prostate cancer. The prostate is a small walnut-shaped organ in men. It is located between the base of the penis and the opening of the bladder. The prostate serves two functions. The first function is aiding urine control. Secondly, the prostate produces fluid that nourishes and transports sperm.

Prostate Specific Antigen (PSA) is a protein that helps semen retain its liquid state. This liquid state is necessary to allow continued sperm motility and achieve fertilization. As men age, the prostate gland undergoes several changes. These changes range from the formation of cancer and prostate enlargement without cancer.

Prostate enlargement can cause voiding difficulty. As men age, the percentage having subclinical prostate cancer increases. Seventy percent of men 70 and older will have some prostate cancer, but only a small percentage will need treatment. As subclinical prostate cancer progresses, around 15% will receive the cancer diagnosis, and only 2 – 3% will die from cancer.

Despite the lack of blood tests for early detection of breast cancer, the PSA test has given men a better chance at early detection. Though all men produce PSA, it should only be detected in the semen, not the blood. An increasing PSA doesn’t mean one has cancer, but it does mean something is wrong with the prostate gland, and a Urologic evaluation and workup are necessary. If the PSA level continues to rise, so does the probability that prostate cancer exists.

Over the last several years, PSA testing has undergone further lab evaluation. This study determined a Percent Free Ratio, Prostate Health Index, and urine testing to reduce needless prostate biopsies. X-rays and rectal exams cannot detect tiny tumours, but a biopsy can. This could lead to a false negative biopsy.

CAUSES

It is unknown exactly what produces prostate cancer. There is a six times greater risk if one has a direct family member with prostate cancer, mainly if diagnosed before age 60. If a direct family member is diagnosed at age 80 or later, it is four times greater than without a family history.

PREVENTION

There is no accurate prevention plan for prostate cancer. Statistics show that obesity, the wrong diet, exceptionally high in animal fat, places one at a higher risk. Blood nitrates and animal fat create free radicals. Free radicals may potentially accelerate cancer growth.

SCREENING

The American Cancer Association believes men should have a screening PSA starting at age 50. Many Urologists start PSA screening at age 40, particularly in black men with a family history of prostate cancer or voiding difficulties. Years ago, there was a real push to screen all men after age 50. Over time, data has shown this often led to unnecessary treatment. This unnecessary treatment is particularly proper as one reaches the age of 75. As mean age increases, we have to screen men with a good chance for longevity.

DETECTION

As previously stated, annual PSA levels during testing could start increasing. More than a 0.5% increase in PSA per year is concerning. Some men may develop urinary symptoms, microscopic hematuria (blood In the urine}, or blood In the ejaculate. All men over 40 should have an annual digital rectal exam (DAE). If cancer is suspected, your Urologist may recommend a prostate ultrasound, MAI, and biopsy. Most cancers found are adenocarcinoma because they originate in the prostate gland. Occasionally there can be transitional cell cancer from the urethra that runs through the prostate.

DIAGNOSIS

If one’s DRE and PSA suggest cancer needs to be ruled out, then your Urologist will recommend a Prostate biopsy. You will need a Fleet enema and ore-oo antibiotics to prepare for this procedure. The patient is prone during the surgery—transrectal probe insertion. Under direct eyesight, the probe receives a needle. A particular device is ed to shoot or propel the needle to areas in the prostate that require evaluation. It is inserted 1 – 2 cm into the prostate. The larger the prostate, the more samples are needed to assess all areas. Biopsies usually range from 12 -16 cores. Rectal and urethral bleeding and infections are rare.

TREATMENT

Age, health, tumour grade, stage, and voiding symptoms determine treatment. Several older Gleason, six individuals with small volume cancer, are observed. Younger patients with the presumed organ-confined disease are candidates for definitive therapy with either radical robotic surgery or brachy radiation seed placement. External radiation and cryofreezing are for older patients, those with a higher risk of early metastasis, or those unable to undergo a general anaesthetic procedure.

Metastatic Treatment:

Whether you have advanced disease at the time of diagnosis or post-treatment demonstrating a rising PSA, most patients will have some remission with the removal of testosterone. This is done by either removing the testicles or injecting leuprolide acetate, which will put the testicles to sleep. Many patients will have remission varying in length. Smaller volumes and lower-grade tumours have the best outlook. Hopefully, there will be a prolonged period until the PSA starts to rise. If the PSA rises, your physician can recommend various anti-androgen therapies. Bone radiation can treat metastatic pain, and prednisone can relieve symptoms of pain and malaise when other therapies fail. Testosterone withdrawal will produce andropause ( male menopause.)

PROGNOSIS

Cancer grade and stage determine prognosis—microscopes grade cells. The specimen is graded (1–5), with 5 being the most aggressive malignancy. Grades 1 and 2 are rare (3 – 4.) Prostate cancer can be multifocal, affecting various areas independently, and grading can vary in each area. Prostate cancer is multifocal, therefore Gleason scores define it. Add the two main cancer grades. One biopsy grade doubles the number. Gleason’s scores range from 2 – 10. Few scores are rated at (2 – 5 ), and most are (6 – 8.) Approximately 10% of scores are classified as (9 – 10.) The prostate’s volume and ultrasound, MRI, bone, and CT scans define staging..

If your physician recommends terminating PSA screening because of age, you must actively insist on continued screening if you find it unacceptable. Patients should continue surveillance only if the Gleason score is below eight and the cancer volume is minimal. High-grade tumours with larger cancer volumes do not respond well to any therapies. The patient must communicate with their urologist and understand alternatives and hazards.