Prostate cancer is the most common cancer among men, about 1 in 9 men will be diagnosed in their lifetime. Below are seven things that you may not know about prostate cancer that can help you detect it earlier and understand this type of cancer better if you have received a diagnosis.
The majority of men survive a prostate cancer diagnosis.
Prostate cancer can affect men of all ages.
Symptoms may be difficult to recognize.
It can be hereditary.
Treatment isn’t always the first option.
Prostate cancer is more common in some races.
Lifestyle may affect your likelihood of getting prostate cancer.
1. The Majority of Men Survive a Prostate Cancer Diagnosis
Though prostate cancer is very common in men, the survival rate is high. Ninety-five percent of all prostate cancer cases are detected while the cancer is still confined to the prostate, and that means it’s easier to monitor and treat. Also, 99% of men who are diagnosed with prostate cancer survive at least 5 years after the diagnosis. Even though early detection and treatment are helping men live longer with a prostate cancer diagnosis, it’s still a serious disease that every man must watch out for. If not treated, it can spread to other parts of the body.
2. Prostate Cancer Can Affect Men of All Ages
Age is one of the biggest risk factors for prostate cancer. The average age of diagnosis is 66 years old but younger men can also receive a diagnosis. Prostate cancer in young men is often more aggressive and more dangerous. These aggressive cancers can possibly spread to other parts of the body quickly, which causes many new problems. That’s why men age 40 and older must pay attention to warning signs and schedule an appointment with their doctor if anything seems out of the ordinary. Screening guidelines from the American Cancer Society for prostate cancer are as follows:
Age 50 for men who have an average risk of prostate cancer
Age 45 for men with a high risk of prostate cancer (if you have an immediate family member under 65 that has been diagnosed with prostate cancer or you are African American).
Age 40 for men with a very high risk for prostate cancer (if you have more than one immediate relative diagnosed with prostate cancer before age 65).
3. Prostate Cancer Symptoms May be Difficult to Recognize
There are symptoms that suggest that there are cancerous cells within the prostate, but the symptoms are similar to other diseases or conditions. They can be so subtle that they go unnoticed until they cause more problems. Symptoms can include one or more of the following:
an increased need to urinate
trouble controlling urine stream
sexual issues including painful ejaculation and erectile dysfunction
Many do not present these symptoms and are only detected by physical exam or PSA testing. Men who experience any of these symptoms should think about screening for prostate cancer, especially if they are 50 or older. If something is unusual it’s best to have it checked out by your physician.
4. Prostate Cancer Can Be Hereditary
Age and lifestyle can contribute to the development of prostate cancer. However, studies show that it can be caused by hereditary factors. A BRCA1 or BRCA2 gene mutation can lead to prostate cancer (this is the same gene mutation that is associated with some breast cancers). Learn more about the gene panel tests that can find cancer-associated mutations. Men who have other males in their families that have been diagnosed with prostate cancer should monitor themselves closely and consult their physician to look for the signs of prostate cancer.
Treatment isn’t always necessary once prostate cancer is detected.Researchers are not completely sure of the exact connection between the BRCA gene and this type of cancer but they have found that men with this gene mutation increases the likelihood of a prostate cancer diagnosis.
5. Treatment Isn’t Always the First Option for Prostate Cancer
Many people believe that treatment is necessary immediately once cancer is detected, but this isn’t always the case for prostate cancer patients who have a slow-growing type of cancer.
Often there are signs of prostate cancer in laboratory work, but little symptoms present otherwise. A biopsy is sometimes recommended which will provide important details as to the risk of progression and or the need for treatment. Your doctors may suggest that waiting and monitoring is an acceptable course of action. For patients who are advanced in age, rushing into treatment is not always the best option. It can put a large amount of stress on them and decrease their overall health. During this time your doctor is going to run tests periodically to watch for signs of growth. You should also watch for more symptoms that may appear and tell your doctor about them. At that point the oncologist can decide the correct direction for treatment.
6. Prostate Cancer is More Common in Some Races
For reasons that researchers are not sure of as of yet, African American men are 60% more likely to develop prostate cancer than white men. Additionally, it is even less present among Latino and Asian men. Because of this, African American men should begin watching for prostate cancer earlier than other races.
7. Lifestyle May Affect Risk of Developing Prostate Cancer
A sedentary (inactive) lifestyle can increase the chance of cancerous prostate cells. Diet can also be a risk factor and eating healthy foods may decrease the likelihood of most types of cancer.
Though prostate cancer treatment has advanced and the recovery rate is very high, men must be aware of potential warning signs. Family history, race, lifestyle, and age are all factors that can increase a person’s risk for prostate cancer.
Remember to get regular checkups by your physician and don’t shy away from prostate cancer screening once you have reached the age. It’s worth the time and effort of the short exam!
Arizona Oncology has offices located throughout the state, where you will receive state-of-the art prostate cancer treatment in a caring and comfortable environment close to home, work, and family. Our team of physicians and cancer care specialists are ready to help you every step of the way.
If you’re scheduled for a prostate biopsy, your doctor is likely testing a tumor for cancer. During this outpatient procedure, tissue will be removed from the tumor using a needle. It will then be analyzed by a pathologist, a doctor who reviews the results of the biopsy and provides information about the findings. The results of your biopsy are provided in a pathology report.
Your oncologist or urologist will use the pathology report as a key piece of information in determining if cancer is present and the stage, based on the cell structure in the tumor. It will also play a key role in determining whether treatment is needed at this time.
What Is Included in a Prostate Cancer Pathology Report?
The pathology report provides a general description of the sample size, the area of the tumor it was taken from, and a general conclusion of what was found. This section of the report includes:
A description of how the tissue appears to the pathologist without the aid of a microscope. This includes the sample size and weight, and the appearance and color of the tissue.
A Gleason Score which is a system of describing and rating how the cancer cells look under a microscope. A higher rating is an important predictor of the cancer’s aggressiveness (likelihood of growing and spreading). A complete explanation about the Gleason Score is found below.
The number of core biopsy samples taken, if more than one. The core samples are taken when a needle is passed into the tumor and tissue is removed. The pathologist records the number of samples and the location of extraction. The locations where the samples are taken from are:
The apex which is the area of the prostate that is located farthest from the bladder.
The mid-zone which is the middle of the prostate gland.
The base which is the area of the prostate closest to the bladder.
Potential Findings of a Prostate Pathology Report
After the pathologist examines the prostate tissue samples, a conclusion will be drawn. Following is an explanation and description of possible findings.
Benign Prostate Tissue
The most hoped-for conclusion is that the tumor is benign. Any findings beginning with benign and followed with prostate tissue, prostate glands or prostatic hyperplasia mean no cancer was found in the tissue sample. However, other conclusions may be drawn from this including:
Benign prostatic hyperplasia is an indication of the prostate gland enlargement which can be caused by an over-abundance of prostate cells. Commonly, this happens in older men and it is not cancer.
If your oncologist still suspects cancer based on other findings from a rectal exam or blood test results, the doctor may order another biopsy in the future to see if the cancer has progressed.
Another benign finding may be acute or chronic inflammation of the prostate. This condition may increase PSA levels (detected in a blood test), but does not indicate cancer.
Other non-cancerous terms that may be on the report are:
Shrinkage of prostate tissue is called atrophy.
Shrinkage of the entire prostate is called diffuse atrophy.
Shrinkage of a certain area is focal atrophy.
Adenosis which shows benign changes in the gland.
Atypical Findings
When the pathologist sees cells under the microscope that are not typical, (atypical or suspicious of cancer) they might not conclude that cancer is not present. Caution is taken and the oncologist may order a second biopsy in a few months. Additionally, urine, blood, and imaging tests may be ordered.
A report stating “low-grade prostatic intraepithelial neoplasia is present means the cells look to be mostly normal.
If the findings say “high-grade prostatic intraepithelial neoplasia,” the pathologist will conclude that the cells are precancerous. These cells may become cancer over time. However, this indicates less risk for cancer than the “atypical or suspicious of cancer” conclusion.
Prostate Cancer
Ninety-five percent of prostate cancer is classified as adenocarcinoma, and whether the cancer is this type or another type will be listed on the report.
If the pathologist finds cancer cells, they will be graded with the Gleason System to determine severity.
What Does the Gleason Score Mean?
The Gleason Score is an indicator of how aggressive the prostate cancer may be. The pathologist will identify the primary pattern (most common cell type) and the secondary pattern (next most common cell type) and those cells are given a grade. The Gleason System uses numbers from 1 to 5.
Grade 1 means the cancerous tissue is close to normal.
Grades 2 through 4 show the cancerous tissue is between normal and very abnormal.
Grade 5 means the cancerous tissue and the pattern of growth are very abnormal.
The primary and secondary cell pattern are graded independently, and the two grades are added to find the final Gleason Sum. A report might indicate the tumor is graded 2+4=6. The first number, in this case 2, is reflective of the majority of the cells. The second number, in this case 4, reflects the second most seen cells. The highest rating that can the Gleason Sum can be is 10.
The Gleason Score will indicate the potential behavior of a cancerous tumor and will be used by the oncologist to decide on the plan for treatment. However, the doctor will also take into consideration other factors such as rectal exam results, PSA level (detected in a blood test), MRI findings, and whether the cancer has spread beyond the prostate.
Even though statistics show 1 in 8 U.S. women will be diagnosed with breast cancer, there is hope on the horizon. Overall, survival rates continue to rise and women are living longer after beating the disease. In order to keep this momentum, however, which can lead to improved care and better outcomes, it’s necessary to continue advancing our understanding of the disease through research.
Breast cancer research opens the door to finding better ways to prevent, detect, and treat breast cancer, and to improve the quality of life of both cancer patients and survivors. From studying causes and prevention to learning how to manage and treat, here are some of the main focuses in breast cancer research today.
Researching the Causes of Breast Cancer
Cancer researchers are actively studying what causes breast cancer. Studies continue to uncover cancer-contributing factors such as lifestyle habits as well as inherited genes that may increase the risk of breast cancer. Here are some examples of ongoing studies:
Research into how exercise, diet, and body weight gain or loss affect breast cancer risk
Studies on how to best use genetic testing to detect gene mutations that lead to breast cancer
Exploration on how common gene variations (small changes in genes that are not as significant as mutations) may affect breast cancer risk
A look into environmental factors that can cause breast cancer
Research on how to Lower the Risk of Developing Breast Cancer
Researchers are actively looking for medicines that may help lower the risk of breast cancer:
Hormone therapy drugs, which are typically used to help treat breast cancer, are being researched to determine if some may also help prevent it
Non-hormonal drugs for breast cancer reduction are being evaluated through clinical trials
Exploration into drugs that may prevent breast cancer from coming back or spreading to the bones
Research on Ways to Manage Ductal Carcinoma in Situ
The behavior of Ductal Carcinoma in Situ (DCIS) is unpredictable. Ductal Carcinoma in Situ refers to a condition in which abnormal cells are found in the lining of a breast duct. DCIS is considered non-invasive or pre-invasive breast cancer, meaning these cells are contained within the ducts (in situ) and have not spread outside the breast. However, without additional treatment after surgery, these cells can become invasive, spreading to lymph nodes or other organs. Because of this unpredictability, determining the best method of treatment is challenging.
Researchers are continuously studying ways to use computers and statistical methods to estimate the chances that the DCIS will become invasive. They also ask women diagnosed with DCIS what factors (such as survival rates, recurrence prevention, and side effects) they consider most important in choosing a treatment. Most women with DCIS are candidates for lumpectomy. However, certain factors may make mastectomy a better option.
Breast Cancer Treatment Research
One major use for cancer research is finding new treatments or combinations of treatments that will work more effectively for specific types of breast cancer. Some research involves new combinations of treatments that are already considered the standard of care, while other research involves newer surgical techniques or drugs. This is the most common type of cancer research currently underway.
For example, one type of breast cancer that has been difficult to treat is triple negative breast cancer. However, recent clinical studies show that this aggressive cancer may be caused by a mutation in the BRCA gene.
Currently, testing for BRCA gene mutation is not routine for women diagnosed with triple negative breast cancer. Because of these findings, however, researchers are suggesting that they should be, since those who test positive may benefit from this new treatment. Knowing if the BRCA gene is involved opens up different treatment options than what would typically be given for triple negative breast cancer. The study, funded by Cancer Research UK and Breast Cancer Now, showed that triple negative breast cancers carrying the mutated BRCA gene showed a greater response to carboplatin (Paraplatin) rather than the standard chemotherapy given to triple negative patients.
Interested in Participating in a Breast Cancer Clinical Trial?
Arizona Oncology is dedicated to advancing breast cancer care by leading and participating in clinical trials that test the safety and efficiency of new or modified treatments. If you would like to learn more about clinical trials that might be right for you, please click here.
According to the American Cancer Society, lung cancer is the leading cause of cancer death in the United States , with about 222,500 new cases and 155,870 deaths each year. Fortunately, lung cancer deaths have begun to decline, due to a decrease in smoking. The field of cancer care has also advanced faster than most fields in medicine, and major progress has been made in lung cancer treatments, including surgery (delivered by thoracic surgeons), radiation treatments for lung cancer (delivered by radiation oncologists) and systemic therapies (delivered by medical oncologists).
Treatment for Lung Cancer
The majority of lung cancers can be split into two major groups – either non-small cell lung cancer (NSCLC), which makes up 80-85% of lung cancers, or small cell lung cancer (SCLC). We will focus on treatment options for NSCLC in this review. The decision to choose certain lung cancer treatments over others depends on many patient-related factors. Once lung cancer has been detected and diagnosed, we first need to carefully identify if the cancer cells are localized or have spread to regional lymph nodes or other parts of the body – this process is called staging. For lung cancer staging, we typically use CT scans, PET/CT scans, bone scans, MRI imaging and invasive procedures, including endobronchial ultrasound or mediastinoscopy. Based on the extent of the tumor, staging for lung cancer ranges from I or II (early stage), stage III (locally advanced) and stage IV (metastatic).
Lung cancer treatment decisions are then based upon the stage, tumor location, and functional status of the patient. Treatment for lung cancer typically includes surgery, systemic therapy, radiation therapy, or a combination of these modalities. Systemic therapies include chemotherapy, targeted therapy, and immunotherapy. For instance, patients with early stage lung cancers who are medically able to undergo surgery may be cured with surgery (such as a lobectomy or pneumonectomy) +/- chemotherapy alone. For patients with early-stage cancers who are not surgical candidates or who prefer a non-surgical approach, stereotactic body radiation therapy (SBRT) is a highly innovative technique that has been shown to provide excellent outcomes (discussed further below) in patients that have been diagnosed with non-small cell lung cancer. For more locally advanced stages that are not amenable to surgery, a combination of systemic therapy, such as chemotherapy, and radiation may be the most effective approach. Stage IV lung cancers (also known as metastatic lung cancer) are incurable and treatment is given to improve symptoms and slow down progression. These treatments have advanced quickly over the last few years, and we will highlight some key advances in the fields of radiation and systemic therapy.
Advances in Radiation Therapy for Lung Cancer
When radiation therapy for lung cancer patients first began in 1956 in the USA, it was very rudimentary. A highly potent X-ray machine was positioned close to the tumor, and the machine was turned on. The challenge was that radiation oncologists couldn’t always treat the entire lung tumor and, many times, the side effects were too severe to continue treatment.
As technology improved (Figure 1), we began to utilize CT and MRI scans to help identify the specific location of the tumor and the surrounding normal tissues (like the heart, lungs, liver, among many others). This helped to create a much more effective radiation treatment plan that could better target the lung cancer, and we called this 3-dimensional radiation therapy.
More recently, however, the newest radiation machines have enabled more accurate treatment of the tumor while minimizing radiation dose to the normal body.
We now use numerous beam angles to shape the radiation dose to the specific size and shape of the tumor – a treatment called intensity modulated arc therapy (IMRT). As technology has further improved, we can now deliver IMRT with an even higher degree of sophistication and conformality with a technique called volumetric-modulated arc therapy (or VMAT). Figure 2 shows the most modern radiation therapy linear accelerator, which is now available at our St. Mary’s and Green Valley offices.
As we have continued to improve our ability to deliver VMAT, we can now deliver very high doses of radiation in just a few treatments. This form of treatment is called stereotactic body radiation therapy (or SBRT) and offers an excellent opportunity to control cancer, reduce symptoms, and improve quality of life in very specific patients. Whereas treatment for these lung cancers used to take 30 to 35 treatments, it can now take as little as 1 to 5 treatments.
Figure 3 details an SBRT plan delivered using the advanced VMAT approach.
Advances in Systemic Therapy
Systemic therapies, which can include chemotherapy, targeted therapy, and immunotherapy, have also undergone significant advancements in the past several years. Chemotherapy has commonly been given to non-metastatic lung cancer patients whose tumors are large, have unfavorable characteristics, or whose tumors have spread to lymph nodes. The most common chemotherapy regimens are typically platinum-based chemotherapy for 4-6 cycles. Chemotherapy can also be used at a lower-dose to enhance the effectiveness of radiation therapy and can be given at the same time as radiation, depending on the clinical situation.
However, the biggest advances in systemic therapies have been made for metastatic (or Stage IV) non-small cell lung cancers (NSCLC). The first step in determining which systemic therapies are most appropriate for patients with metastatic lung cancer is to identify the histologic and molecular features specific to the lung cancer. About 20% of metastatic NSCLC cases have so called “actionable driver mutations” where we have specific systemic therapies that can target the mutation. The known mutations with targeted agents that are approved for treatment are EGFR, ALK-1 and ROS mutations – these mutations are associated with favorable prognoses. Additionally, the expression level of a protein called PD-L1 can help inform the treatment team if the patient is a candidate for immunotherapy. There are many other mutations that have been identified and new clinical trials are helping to identify novel targeted agents for those mutations.
These advances in surgery, radiation therapy, and systemic therapy only serve to highlight the rapid improvements in lung cancer therapies, and multiple clinical trials are underway to continue to push the efficacy, safety, and quality of life of novel therapies for lung cancer.
