Prostate Cancer

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    ABelis Aladag, MD, Family Medicine, answered on behalf of UCLA Health
    A rising prostate-specific antigen (PSA) level after treatment for prostate cancer suggests the recurrence of cancer. Magnetic resonance imaging (MRI) has been shown to detect recurrent cancer both in the surgical bed and radiation therapy field, and also in the bones and lymph nodes. Spectroscopy and perfusion modeling can increase detection. However, the ability of doctors to detect this prostate cancer is relatively low.

    Active surveillance is appropriate for men with low-volume, low-grade disease. MRI has two advantages: it can screen for missed areas that look suspicious for high-grade cancer, and it can also provide an imaging baseline to evaluate for follow-up. There’s a lot of interest in MRI replacing biopsy, but this is currently not standard procedure, and MRI does sometimes miss tumors.
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    AMark Litwin, MD, Urology, answered on behalf of UCLA Health
    Certain elements of the Western diet may have an impact on the development and progression of prostate cancer. In particular, it is thought that a high-fat diet and highly processed foods may accelerate the progression of prostate cancer. Omega-3 fatty acids found in many fish products are thought to be protective. Overall, there's a lot that doctors don't know about diet and prostate cancer.
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    AMark Litwin, MD, Urology, answered on behalf of UCLA Health
    A pathologist will grade cancer taken during a core biopsy on a numerical 10-point scale called the Gleason grading system, which indicates how severe a cancer is. Many cancers are on the lower end of the spectrum and may not need to be treated at all. There is a subset of tumors that are on the higher end of that spectrum, however, and therefore more severe. In those cases, early diagnosis may be key to saving the man’s life.
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    AMark Litwin, MD, Urology, answered on behalf of UCLA Health
    The early detection of prostate cancer is key to its diagnosis, treatment and cure. The only way to make sure it’s diagnosed early is to have regular checkups. The checkup for prostate cancer includes two critical elements. The first is the digital rectal examination (DRE). The other element of early diagnosis is a prostate-specific antigen (PSA) blood test.
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    AMark Litwin, MD, Urology, answered on behalf of UCLA Health
    Unlike slow-growing indolent prostate cancer, a more aggressive type of prostate cancer can spread throughout the body to the lymph nodes; to the bones, where it can cause painful symptoms; and to other areas of the body as well. These are the cases that need to be identified and treated early.
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    AMark Litwin, MD, Urology, answered on behalf of UCLA Health
    As the prostate gland enlarges in older men, it can cause symptoms, but in addition it can also harbor nests of prostate cancer cells. Many prostate cancer cells simply stay within the prostate gland and never spread, progress, or cause any harm to the patient. These are called indolent or slow-growing prostate cancers. Fortunately, they comprise the majority of prostate cancers throughout the world.
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    AChristopher Saigal, MD, Urology, answered on behalf of UCLA Health
    Prostate cancer is usually categorized as low, medium and high risk. This is based on your Gleason score, your prostate-specific antigen (PSA) level and prostate exam result. Low risk means your Gleason score is six or below, your PSA is 10 or below and there is nothing that is palpable on the prostate, or if it's palpable, it's on one-half of the gland. Sometimes, on an initial biopsy, only a part of the tumor is caught on the ultrasound. Before you begin active surveillance, another evaluation with magnetic resonance imaging (MRI) and perhaps a repeat biopsy is indicated to make sure a more aggressive tumor is not being missed.
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    AChristopher Saigal, MD, Urology, answered on behalf of UCLA Health
    In a template-guided biopsy for prostate cancer, doctors systematically take tissue samples across the prostate gland. What can happen, however, is that doctors can miss cancers because they can't see them. Large cancers are often detected, but a small cancer or even a larger cancer can be missed if it happens to lie between biopsy tracts.

    In many studies of people on active surveillance, the repeat template-guided biopsies show no cancer. That may be because the cancer is small and being missed by the systematic approach.
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    AChristopher Saigal, MD, Urology, answered on behalf of UCLA Health
    Family history is very relevant for prostate cancer detection. Men with a first-degree male relative -- a father or a brother -- who was diagnosed with prostate cancer before age 65, are at increased risk for prostate cancer themselves. Their risk of prostate cancer is 1.5 to 2 times greater than the average risk. Because of the use of prostate-specific antigen (PSA) screening, prostate cancer is being found at earlier, more treatable stages.
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    AChristopher Saigal, MD, Urology, answered on behalf of UCLA Health
    Age is a major risk factor for prostate cancer. As a man gets older, his risk of being diagnosed gets higher. In fact, in autopsies on men in their 70s, almost three-quarters of them will have some evidence of prostate cancer. Most of those men, however, will not die of prostate cancer, which is important in considering treatment options.