Parsteiner Blog

Posts Tagged ‘Prostate Gland’

Prostate cancer is often treated successfully if it is caught early, but in its very early stages there may not be any visible symptoms. Prostate cancer early symptoms often don’t become apparent until the cancer has progressed enough to put pressure on the urethra. When this happens it may cause symptoms such as pain when urinating and pains in the pelvic area, although these may be caused by something completely different so do not mean you have cancer.

Some of the early prostate cancer symptoms are:

Sudden need to urinate, often at night Painful urination and/or ejaculation Irregular urine flow Blood in urine (in some rare cases) Pain in hip or pelvic area

Again, these symptoms do not mean you have cancer, as they can be caused by many other conditions. However if you do start to have these prostate cancer early symptoms occurring, then you should contact your GP who will be able to advice you whether a test or scan is required. This will be able to determine whether you have cancerous cells in the prostate gland.

If cancerous cells are detected, then depending on your age, health and progression of the tumour (which is rated using the Gleason scale) a treatment program will be recommended by your doctor. The final say in what treatment is performed is always down to the patient however. As prostate cancer is a relatively slow growing cancer that affect predominantly older men, in many cases the man dies of other causes before the prostate cancer takes effect.

Prostate brachytherapy (pronounced bray-kee-ther-uh-pee), the implantation of radioactive seeds into the prostate gland, is one of the standard methods of successfully treating prostate cancer. The tiny radioactive seeds are smaller than grains of rice.

A prostate seed implant may be the only type of radiation therapy needed by a man with low-risk prostate cancer or it may be prescribed in addition to external beam radiation therapy in men with intermediate- and high- risk prostate cancer. The goal is to eradicate cancer cells while preserving healthy, surrounding tissue, such as the bladder, the urethra (the tube that connects the bladder to the penis), and the rectum.

The advantages of prostate seed implants are significant. Fist, the procedure requires only minor surgery, usually causing fewer side effects than other treatments. Also, it is generally a same day, outpatient procedure. Men usually are able to return to work within several days, as long as they feel well enough. In addition, recent reports suggest that the procedure, when performed on properly selected men, is at least as effective as surgery to cure prostate cancer. Radiation exposure to other people is minimal, so restrictions do not apply unless the man is returning to a setting where a young child or pregnant woman is present.

Treatment Planning

Men undergo a pre-implant ultrasound study to determine where the radioactive seeds (and the needles to implant them) should be placed. A transrectal ultrasound, wherein an ultrasound probe is carefully positioned in the rectum to view the entire prostate, is performed. Images of the prostate are taken and are transferred to a special treatment planning computer, which evaluates the position of the prostate and generates a three-dimensional plan that dictates the precise placement of the seeds.

Preparation for the Procedure

Most candidates for prostate brachytherapy undergo blood tests, a chest x-ray and an EKG several days prior to the implant, in order to be approved for anesthesia. On the morning of the procedure, men receive an enema to help optimize the quality of the transrectal ultrasound images. In addition, blood thinners are discontinued several days prior to the procedure to help diminish the risk of bleeding.

Day of the Procedure

Typically, men who are scheduled to undergo seed placement arrive early in the morning. Next, the man is taken to the operating room for the procedure, where he undergoes either general or spinal anesthesia. Then, the radiation oncologist and the urologist work as a team to implant the seeds into the prostate, using transrectal ultrasound to guide the placement.

The Implant Process

Using the treatment plan and fluoroscopy (real-time x-ray), the radiation oncologist places the seeds within the prostate. The entire procedure usually takes less than one hour. After the seed placement, the urologist performs a cystoscopy (a procedure in which a slender, flexible, fiber optic scope is inserted from the penis into the bladder), to look for and remove any seeds that dislodged in the bladder or the urethra. Within the few next days, a CT scan is obtained to verify the placement of the seeds.

Prostate Seed Implants: Recovery

Because prostate implants do not involve major surgery, side effects are rarely severe. The most common side effects reported by men after prostate seed implants are:

o Urinary frequency (60-70%)

o Urinary burning (50%)

o Urinary urgency (50%)

o Erectile dysfunction (30%)

o Blood in the urine (20-30%)

o Increased bowel movements and bowel urgency (5%)

o Fatigue (20%)

o Pelvic pain (20%)

o The need for temporary catheter placement (10-15%)

o Urinary incontinence (less than 1%)

In addition, up to 20 percent of men are found to have seed migration into their lungs. However, no detrimental effects have been reported. Infrequently, men have required trans-urethral resection, the “scraping” of the prostate gland via the penis, to relieve urinary obstruction after the seed placement.

Follow-Up

Men who undergo prostate brachytherapy report for follow-up visits four weeks after the procedure and every three months thereafter. A PSA blood test and a physical exam are performed to assess the status of the prostate.

The good news is that prostate seed implants are usually successful at controlling prostate cancer within the gland. Such local control of disease correlates with rendering men free from prostate cancer.

Many people will have heard of the prostate specific antigen test (or more commonly PSA test) for prostate cancer, but do you know just what it is and whether or not it is something which you should consider having?

The PSA test was considered a major breakthrough when it was approved for use by the FDA in the mid 1980s and today it remains one of the best tests available for detecting the possible presence of prostate cancer.

PSA testing is quick and easy as it is a simple blood test looking for the presence in the blood of a specific protein produced by the prostate gland. In a normal prostate gland the quantity of this protein produces a level in the blood of about 4 nanograms per milliliter and this is assigned a normal PSA score of 4. As with most things of course this level will vary from one individual to another and so a slightly higher or lower level is not necessarily an indication of a problem and many men will have a normal PSA score of as high as 8 or 9.

In the presence of cancer production of this protein rises and, as the cancer progresses, so the level of the prostate specific protein in the blood increases. Accordingly, once a PSA score reaches 10 your doctor will want to monitor PSA levels carefully as this is an initial indicator of a possible developing problem. If your PSA score continues to rise then additional and more specific tests will normally be recommended. As an indicator, a PSA score of 50 is considered to be very high and the level at which not only is the presence of cancer very likely, but such cancer will probably have already spread beyond the prostate gland itself.

Prostate specific antigens appear in two forms within the blood. In the first form antigens attach themselves to the blood proteins, while in the other the antigens are simply free floating. Today it is possible to test for both by measuring the total amount of PSA in the blood and by measuring only free PSA in the blood. Being able to separate out the two different forms of PSA is thought by many doctors to produce a more accurate test and in a study published in the Journal of the American Medical Association in 1995 it was said that the ability to measure free PSA had led to a twenty percent fall in the number of unnecessary follow-up tests following PSA tests.

Perhaps the biggest controversy today is not over whether men should undergo regular (annual) PSA testing which almost all physicians today recommend, but at what age such testing should begin.

Both The American Cancer Society and The American Urological Association recommend testing for all men over the age of 50 and testing for men in ‘at risk’ categories from the age of 40 onwards. There are several ‘at risk’ categories, the most important of which is men with a family history of prostate cancer.

Unfortunately, these recommendations probably have more to do with resources and cost than with anything else and it is not uncommon for men to develop prostate cancer in their forties, or even in their thirties. So, where do we go from here?

Well, this must of course be a personal decision but an increasing number of men are now asking to be tested at quite young ages (typically when they reach 40) to provide a benchmark and then decide on the frequency of follow-up testing depending on their initial result. For example, if a 40 year old man has a normal initial PSA score of 4 then he may decide to leave further testing for 2 or 3 years. However, if his initial test score comes in at 8, he may decide to have a follow-up after six months and, if it remains the same or has fallen, to then have tests annually.

When you start testing and how often you have follow-up testing is very much a personal decision to be taken in consultation with your physician. What is important is that every man should be tested regularly and you should not put off testing for too long.

Traditionally, the method for early detection of this cancer was the digital rectal examination, in which the doctor introduced a finger into the rectum and could feel the prostate gland to see if there was suspicious nodules. In recent years, it can be a laboratory test: the detection of prostate specific antigen, called PSA. This test was initially introduced as a laboratory test for diagnosing and monitoring prostate problems and subsequently was proposed as early diagnostic test.

The PSA is a protein produced by cells of the prostate gland. Analysis of PSA measures the concentration in the blood. A sample of blood and is measured in the laboratory the amount of PSA that contains the sample. Because PSA is produced by the body and can be used to detect the disease, sometimes called a biological marker or tumor marker.

It is normal for men to have low levels of PSA in their blood, however, benign (not cancerous) may increase the concentration of PSA.

The PSA level alone does not provide enough information so that physicians can distinguish between benign prostate conditions and cancer. However, the doctor will take into account the outcome of this analysis to decide whether to investigate further for signs of prostate cancer.

The elevated PSA (above 4), may indicate a prostate cancer but may also indicate other conditions such as benign prostatic hyperplasia, or infection. Therefore, PSA can be considered a unique indicator of prostate cancer, but it is high, start a diagnostic process.

The recommendations of physicians regarding the screening vary. Some recommend annual screening tests for men over 50 years of age and some advise men who have a higher risk of prostate cancer to begin screening at 40 or 45 years old.

Several risk factors increase the chances that a man is suffering from prostate cancer. These factors may be considered when a doctor recommends screening. Age is the most common risk factor, since nearly 65 percent of prostate cancer cases occur in men 65 years of age or older. Other risk factors for prostate problems include race, family history and possibly diet.