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The Early
Detection of Prostrate Cancer |
Early Detection of
Prostate Cancer
Early detection is
especially important in prostate cancer,
because when this form of cancer is
diagnosed early, the chances for a cure are
greatly increased.
The digital rectal
examination is a simple procedure where the
physician inserts a lubricated gloved finger
into the man�s rectum. This examination can
help the doctor detect a mass. To confirm
the presence of cancer, the urologist will
perform a biopsy, which involves obtaining a
small sample of the prostate to determine
whether it contains cancer cells. In order
to tell if the cancer has spread outside the
prostate, several tests are useful for
detecting and staging prostate cancer. Not
all of these tests are needed in all men.
The prostate-specific
antigen (PSA) test is a blood test that can
indicate the presence of prostate cancer.
However, the PSA test is sometimes difficult
to interpret because PSA is produced by both
normal and cancerous prostate cells.In
general, the higher the PSA level, the
greater the chance that the cancer has
spread beyond the prostate.
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Transrectal ultrasonography is a
safe and easy way to "see" the
prostate gland. |
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Ultrasound provides an
image of the prostate that the doctor can
use to measure the size of the prostate,
look for cancerous tissue, and calculate the
PSA density (the PSA level divided by the
size of the prostate). A needle biopsy of
the prostate is usually performed under
ultrasound guidance.
A prostate biopsy
analysis of the tissue gives important
information about the cancer. The tumor
grade is determined by examining the tissue
under a microscope to measure the amount of
disorganization of cells. A Gleason grade,
which ranges from 2 to 10, is one scale that
can be used to estimate the tumor's growth
rate. Generally, the lower the grade, the
slower the cancer grows. Most localized
cancers of the prostate are of an
intermediate grade, (Gleason grades 4, 5 or
6). The Gleason grades for the two most
prominent groups of cells is called the
Gleason Score.
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The Five Gleason Grades
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Grade 1
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Cancer is well differentiated
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Grade 2 |
Cancer is still well
differentiated, but is arranged
more loosely and is more
irregular in shape |
Grade 3 |
Most
common grade of prostate cancer.
Cancer is moderately
differentiated, varying in size
from small to large |
Grade 4 |
Cancer is poorly differentiated,
unable to form separate units,
highly irregular, and has
distorted shapes; progressive
invasion of neighboring tissue |
Grade 5 |
Cancer is undifferentiated and
bears no resemblance to normal
cells. |
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It is important to understand that at least
two physicians work with you through the
diagnosis phase, one who will analyze your
prostate disease (the pathologist) and one
who will detect and treat it (usually a
urologist and/or radiation oncologist). At
present, the only definitive method for
determining the presence or absence of
cancer in a prostate gland is by the
analysis and interpretation of tissue
samples by a pathologist. The interpretation
of tissue samples is a result of the
pathologist�s medical judgment, and
legitimate differences of opinion can exist.
A second opinion might be valuable in
certain circumstances.
A bone scan produces a
nuclear image of the bones. this test, which
may detect the spread of cancer to the
bones, may not be necessary in all patients,
especially those with small cancers, low PSA
levels and low Gleason grades.
Computed tomographic
scan (CT scan) is an X-ray procedure that
produces cross-sectional images of the body.
The CT scan may help detect lymph nodes in
the pelvis that are enlarged because of
cancer. Generally, a CT scan is used only if
the cancer is large, of a high grade, or
associated with a very high PSA level.
The lymph nodes in the
pelvis usually are the first place that
cancer spreads from the prostate. The doctor
can make a rough estimate of how likely it
is that cancer has spread to the lymph
nodes. This estimate is based on the
cancer's size in the prostate and on results
of the biopsy. A high PSA level also may
indicate that the cancer has entered the
lymph nodes. However, cancer in the pelvic
lymph nodes often is microscopic. If there
is a high risk that the cancer has spread to
the lymph nodes, the doctor may recommend
that they be surgically removed and examined
under a microscope. Because there are many
lymph nodes elsewhere in the body, the loss
of some of the pelvic lymph nodes does not
usually cause problems.
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Radio-labeled
Antibody Scans
An antibody that binds to
the prostate specific membrane antigen (PSMA)
may be able to detect cancer that has spread
beyond the prostate and into soft tissue.
Many prostate cancer cells produce the PSMA
protein, which stays attached to the cancer
cells. During the scan an antibody, with
radioactive material attached, is injected
into a vein. The antibody then circulates
throughout the body, but only binds where it
finds the PSMA protein. After four or five
days, the antibody that does not bind to the
PSMA is cleared from the body. Ideally, most
of the remaining antibody will be bound to
the prostate cells bearing the PSMA. In
disease recurrence following prostatectomy,
this type of test may indicate whether the
cancer is limited to the prostate and may be
useful in identifying patients most likely
to benefit from salvage local therapy.
Unfortunately, there are limitations to this
type of scan, because it may be difficult to
interpret. Currently, the only commercially
available scan of this type is ProstaScint.
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Florida Prostate Cancer Network is a
Florida non-profit organization
Federal Tax ID 59-3545266
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Disclaimer
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"The information that FPCN
provides is general and
informative.
FPCN's information should not
take the place of the advice
from your doctor."
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