Prostate Cancer

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    Metastatic prostate cancer is cancer that has spread from a tumor in the prostate gland outside of the prostate to another part of the body. Outside of the lymph nodes, the most common sites that prostate cancer spreads to, according to the National Cancer Institute are:
    • the adrenal gland
    • the bones
    • the liver
    • the lungs
    Most men who are diagnosed with prostate cancer catch the cancer at an early stage when it is very treatable. In men who have non-metastatic prostate cancer, the five-year survival rate is nearly 100 percent. Once prostate cancer has spread far outside of the prostate gland, the five-year survival rate drops to about 28 percent.
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    Locally advanced prostate cancer is prostate cancer that has spread just beyond the prostate gland to neighboring structures. It is not considered metastatic prostate cancer.

    The prostate is a walnut-sized gland that is part of a man's reproductive system. It is found below a man's bladder, in front of his rectum and encircling his urethra. Prostate cancer cells can spread locally when cancerous cells move through the covering of the prostate to neighboring organs like the bladder or rectum.After spreading, cancer cells may attach to other tissues and grow to form new tumors that may damage those tissues.
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    The U.S. Preventive Services Task Force (USPSTF) concluded there is moderate certainty that the benefits of prostate-specific antigen (PSA) screening for prostate cancer do not outweigh the harms. In the past, a PSA blood test was done as screening for patients between the ages of 50 to 74. This is no longer the recommendation, due to the test's high false-positive results.
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    A Internal Medicine, answered on behalf of
    Men over 50 routinely should have a digital rectal prostate examination as part of a general screening, and it is still considered the most reliable initial test for prostate cancer. The doctor will feel the prostate for hard, lumpy or abnormal areas.

    The digital rectal test takes only a few minutes to complete. It is advised usually because of a man’s age, or if a problem exists such as difficulty in passing urine. Physical exams are usually combined with a thorough medical history to determine possible symptoms and family history.
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    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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    It is thought that increased consumption of fruits and vegetables as well as decreased sugar intake may be helpful in preventing or decreasing risk for prostate cancer. A lack of vegetables in the diet, particularly vegetables in the broccoli family, is linked to aggressive forms of prostate cancer, but not linked to nonaggressive forms. Alcohol consumption is not linked to prostate cancer.
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    A Urology, answered on behalf of
    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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    There are two major screening tools for prostate cancer: the digital rectal exam (DRE) and the prostate specific-antigen (PSA) blood test. The role for PSA screening has been debated in the last few years, and both PSA and DRE need to be done in the context of the patient's family history and risk factors. Prostate cancer can occur in the absence of symptoms, and if it is suspected by screening tests it can be confirmed by biopsy.
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    A Urology, answered on behalf of
    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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    A Urology, answered on behalf of
    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.