Prostate Cancer Screening FAQ

Screening – or testing to find a disease in people without symptoms – can help find some types of cancer early, when it’s more easily treated. But for some men, the risks of prostate cancer screening may outweigh the benefits. Asking questions is an important step in deciding whether to be screened.
Q: What are the screening tests for prostate cancer?
A: There are 2 main screening tests for prostate cancer:

• The PSA test is a blood test to check the level of prostate-specific antigen in your blood. Most healthy men have levels under 4 nanograms per milliliter of blood. But everybody is different, and a lower PSA level doesn’t guarantee a man is free of cancer, just like a higher level doesn’t mean he has cancer.
• For the digital rectal exam (DRE), a doctor inserts a gloved, lubricated finger into the rectum to feel for any bumps or hard areas on the prostate that may need to be tested for cancer. This test may be done with the PSA or the PSA may be done alone.

Q: What if the results are not normal?
A: If the results of the PSA and/or DRE suggest that you might have prostate cancer, your doctor will do a prostate biopsy to find out. A sample of prostate tissue is removed using a needle and sent to a lab, where a specialist will look at it under a microscope to see if it contains cancer cells.
Q: At what age should I have my first screening test?
A: The American Cancer Society recommends men learn as much as they can about prostate cancer screening risks and benefits and discuss the information with their doctor before deciding whether to be tested at all. Men at average risk of prostate cancer should have this discussion starting at age 50. Men at higher than average risk should have the discussion starting at age 40 or 45.
Q: Who is at higher than average risk for prostate cancer?
A: African American men and men who have a father, brother, or son who were diagnosed with prostate cancer when they were younger than 65 are at high risk. Men with more than one of these close relatives diagnosed before age 65 are at even higher risk.
Q: Why shouldn’t all men be screened for prostate cancer?
A: It seems like it makes sense to check everyone to find out if they have cancer. But screening isn’t perfect. Sometimes screening misses cancer, and sometimes it finds something suspicious that turns out to be harmless. Also, there aren’t reliable tests yet to tell the difference between prostate cancer that’s going to grow so slowly it will never cause a man any problems, and dangerous cancer that will grow quickly. In addition, studies have not been able to show that annual PSA screening helps men live longer. However, most men who find out they have cancer want to treat it. Treatments for prostate cancer can have urinary, bowel, and sexual side effects that may seriously affect a man’s quality of life. So, testing really is a decision that men should make after they have all the information.

http://www.cancer.org/cancer/news/features/prostate-cancer-screening-faq

Prostate Cancer - Other Treatment

Radiation therapy

Radiation therapy may be used alone or combined with hormone treatment or surgery to treat prostate cancer. Like surgery, it is most effective in treating cancer that has not spread outside the prostate. When combined with surgery, radiation is used to destroy any cancer cells that might be left behind and to relieve pain when the cancer has spread.

There are two main types of radiation treatment for prostate cancer:

• External beam radiation, in which a machine aims high-energy X-rays or protons at the cancer from outside the body. External radiation also includes conformal radiotherapy, intensity-modulated radiation therapy, and proton therapy.
  • Conformal radiotherapy (3D-CRT) uses a three-dimensional planning system to target a strong dose of radiation to the prostate cancer. This helps to protect healthy tissue from radiation.
  • Intensity-modulated radiation therapy (IMRT) uses a carefully adjusted amount of radiation. This provides even more protection for healthy tissue than conformal radiotherapy.
  • Proton therapy uses a different type of energy (protons) rather than X-rays. This allows a higher amount of specifically directed radiation, which offers the most protection possible to nearby healthy tissue, especially the rectum.¹³ Sometimes proton therapy is combined with X-ray therapy.
• Brachytherapy, in which tiny seeds containing radioactive material are injected directly into or near the cancer and left there. In time, the material loses its radioactivity and the seeds can remain where they are.

Side effects

Radiation treatment may cause erection problems and bladder problems. It sometimes causes diarrhea. The ability to have an erection sometimes returns or at least improves over time. So does the ability to control urination.

Side effects are common. Some men develop long-term problems that may have a big impact on the quality of their lives. Long-term problems that can be caused by radiation treatment include:

• An irritated rectum that can cause an urgent need to pass stool. This is called proctitis.
• An inflamed bladder and urination problems. This is called cystitis.
• An inflamed intestine and diarrhea. This is called enteritis.
• Being unable to have an erection. This is called impotence.
• Being unable to control urination. This is called incontinence.
• Painful urination. This is called dysuria.

Immunotherapy

Researchers also are testing many new ways to treat prostate cancer using the body's immune system to destroy the cancer cells. This type of treatment is called immunotherapy . Much has been learned in the past 20 years about the body's ability to attack prostate cancer cells with help from the outside, and research is still being done in this area. This type of treatment either stimulates your immune system or adds to it, for example, by giving you immune cells from another person.

Complementary therapy

Complementary therapies, such as acupuncture, herbs, biofeedback, meditation, yoga, and vitamins, are sometimes used along with medical treatment. Some people feel that they benefit from some of these therapies.

Before you try a complementary therapy, talk to your doctor about its possible value and side effects. Let your doctor know if you are already using any such therapies. Complementary therapies are not meant to take the place of standard medical treatment, but they may improve your quality of life and help you deal with the stress and side effects of cancer treatment.

Clinical trials

Clinical trials are being run to find ways to prevent, detect, diagnose, and treat prostate cancer. For example, researchers are studying whether vitamin E and selenium, which is a mineral found in certain foods, can prevent prostate cancer.

Prostate Cancer - Prevention

You can take steps that may lower your chances of getting prostate cancer.¹¹

Eat more low-fat, high-fiber foods, or foods with omega-3 fatty acids, such as:

• Soy products, like tofu and soy beans.
• Tomatoes and foods that contain tomato sauce.
• Vegetables like broccoli, cauliflower, and cabbage.
• Fish, like salmon, albacore tuna, and sardines.
• Walnuts and flaxseed, and their oils.

Researchers are looking into other things that may help prevent prostate cancer. These include:

• Medicines, such as finasteride or nonsteroidal anti-inflammatory drugs (NSAIDs).
• Drinking red wine or green tea.
• Supplements, such as vitamins D and E, and selenium.

Prostate Cancer,Advanced or Metastatic - Topic Overview

Is this topic for you?

This topic is about prostate cancer that has spread or come back after treatment. For information on early cancer of the prostate gland, see the topic Prostate Cancer.

What is prostate cancer?

Prostate cancer is a group of cells that grows faster than normal in a man's prostate gland. It can spread into other areas and kill normal tissue.
The prostate gland sits just below a man's bladder. It makes part of the fluid for semen. In young men, the prostate is about the size of a walnut. It usually grows larger as you grow older.
The cancer may be one of these types:

• Locally advanced prostate cancer. This is cancer that has grown through the outer rim of the prostate and into nearby tissue.
• Metastatic prostate cancer. This is cancer that has spread, or metastasized, to the lymph nodes or other parts of the body.
• Recurrent prostate cancer. This is cancer that has come back after it was treated. The cancer can come back in the prostate, near the prostate, or in another part of the body. If it comes back in another part of the body-often the bones-it is still called prostate cancer, because it started in the prostate.

What causes prostate cancer?
Experts don't know what causes prostate cancer. But they believe that getting older and having a family history of prostate cancer raise your chance of getting it.
What are the symptoms?
Sometimes there are no symptoms of either locally advanced or metastatic prostate cancer.
When they do appear, symptoms of locally advanced prostate cancer include:

• Waking up many times during the night to urinate.
• Having trouble starting your urine stream, having a weaker-than-normal stream, or not being able to urinate at all.
• Having pain or a burning feeling when you urinate.
• Having blood in your urine.
• Having a deep pain or stiffness in your lower back, upper thighs, or hips.

Symptoms of metastatic prostate cancer may include:

• Bone pain.
• Weight loss.
• Swelling in your legs and feet.

How is prostate cancer diagnosed?
Your doctor will do a digital rectal exam, in which he or she puts a gloved, lubricated finger in your rectum to feel your prostate. You may also have a blood test called a prostate-specific antigen (PSA) test. These tests will help find out if you have prostate cancer or if your prostate cancer has come back.
Your doctor also may do a biopsy. In this test, your doctor takes a sample of tissue from your prostate gland or from the area where the cancer may have spread and sends the sample to a lab for testing. A biopsy is the only way to know for sure that you have prostate cancer.

If you have had prostate cancer before, your doctor may also order a bone scan, CT scan, or MRI to see if it has come back or spread.

Finding out that you have cancer can be scary. It may help to talk with your doctor or with other people who have had cancer. Your local American Cancer Society chapter can help you find a support group.

How is it treated?

Choosing treatment for prostate cancer can be confusing. Your choices depend on your overall health, how fast the cancer is growing, and how far it has spread.

Locally advanced prostate cancer may be treated with surgery, radiation therapy, or hormone therapy.

Treatment of metastatic cancer focuses on slowing the spread of the cancer and relieving symptoms, such as bone pain. It also can help you feel better and live longer. Treatment may include hormone therapy, radiation therapy, or chemotherapy.

Prostate Cancer Vaccine Meets Goal

Provenge, an experimental treatment vaccine for advanced prostate cancer, met researchers' goal in a key trial needed for FDA approval.

That news comes from Dendreon, the company that makes Provenge.

"We believe this is truly a breakthrough for the prostate cancer community and a testament to the promise of the field of cancer immunotherapies," Dendreon's president and chief executive officer Mitchell Gold, MD, said in a conference call today.

Provenge is a biologic drug given by infusion to spur the immune system to fight advanced prostate cancer that doesn't respond to anti-androgen treatment.

In 2007, an FDA advisory panel recommended that the FDA approve Provenge. But instead, the FDA requested more information about whether Provenge prolongs survival.

That request led to a new study of 512 men with advanced prostate cancer. Those men had metastatic, androgen-independent prostate cancer, meaning their cancer had spread and wasn't responding to anti-androgen treatment.

In that study, overall survival was significantly better for men taking Provenge than those taking a placebo.

The study's results were "unambiguous" and "very consistent" with previous Provenge trials, Gold says.

Dendreon plans to submit the study's results to the FDA in the fourth quarter of 2009; after that, the FDA will have six months to review the material, Gold says.

"This data supports Provenge being used as front-line treatment in men with metastatic, androgen-independent prostate cancer," says Gold, who notes that no new side effects from Provenge stood out in the study. In previous trials, the most common side effects in men taking Provenge were chills, fever, headache, fatigue, shortness of breath, vomiting, and tremor, mainly at a low level and for one to two days following infusion.

Gold says that those men would first have surgery or some form of local therapy, then anti-androgen therapy if their cancer recurred, and if their PSA levels rose after that, "Provenge would come into play as a potential treatment option for them."

In men with prostate cancer, PSA (prostate-specific androgen) levels are used to gauge the success of prostate cancer treatment.

Dendreon isn't releasing any further details of the study until April 28, when the findings will be presented at the American Urological Association's annual meeting in Chicago.

The technology used to make Provenge may also prove useful against other forms of cancer, Gold says.

American Cancer Society Responds

The American Cancer Society released a statement about today's Provenge news. The statement comes from Otis W. Brawley, MD, chief medical officer at the American Cancer Society.

Dendreon's announcement about the new Provenge study "is reason for optimism about a vaccine that has generated controversy for several years," Brawley says. "We have to respect the scientific process, an important part of which is a full disclosure and careful review and discussion of the data, which the company says will not be released until an upcoming medical meeting."

"One of the most important questions we'll be looking at will be the magnitude of the survival advantage; how much longer the men taking the vaccine lived compared to those on standard therapy," Brawley continues. "As with any new therapy, it will take a detailed analysis to fully understand the impact of this potential new treatment for patients with advanced prostate cancer. We look forward to the presentation of the study at the upcoming meeting."