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Prostate cancer: Five types ‘found’

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Prostate cancer and PSA

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As there are many conditions that can cause the PSA level to go up, it is not safe to presume a diagnosis of prostate cancer from this test alone.

Prostate specific antigen (PSA) in the blood is commonly used to aid in the diagnosis of cancer. Should it be adopted as a routine screening test for the cancer?

 

THE word “cancer” strikes fear in everyone’s hearts. Among men, prostate cancer ranks as the most common cancer worldwide. In Malaysia, it is the fourth most common cancer diagnosed in men.

For prostate cancer, a test measuring the levels of prostate specific antigen (PSA) in the blood is commonly used to aid in the diagnosis of cancer.

However, the PSA test is increasingly being touted as a routine screening test for men above a certain age. This issue is shadowed by many questions, foremost among them: Should all men take the PSA test? Is it the best method for early cancer detection?

This article will attempt to clear up some of the confusion surrounding PSA testing.

How to know if you have prostate cancer

Most of the time, there are no clear symptoms related to prostate cancer. Some of the symptoms that may develop are not always clear-cut in pointing to prostate cancer as they may also be attributed to other conditions.

For instance, some men with prostate cancer may notice blood in their urine or semen, a need to urinate more frequently, slower than normal urine flow, and difficulty in getting an erection.

These symptoms can also be present in cases of an enlarged prostate, infection and bladder stones. Thus, they are not the most reliable indicators of cancer.

However, if these symptoms are present, your doctor should suspect cancer and conduct several tests to confirm the diagnosis: a digital rectal examination (DRE), a PSA test and/or a prostate biopsy.

A DRE is performed with the doctor inserting a finger into the patient’s anus to feel the prostate. Since the prostate is in front of the rectum, the prostate will be easily felt by pressing the finger on the rectal wall. The surface of the prostate tumour will usually feel irregular and hard.

At the same time, the doctor may also recommend a PSA test. The PSA is a protein produced by cells of the prostate gland. Certain medical conditions, like prostate cancer, prostatitis, urinary tract infection, enlarged prostate, injury and sexual activity, can increase PSA levels.

Because so many conditions can cause the PSA level to go up, it is not safe to presume that it’s prostate cancer from this test alone. Therefore, the doctor may prescribe antibiotics before repeating the PSA test.

It is also advisable to refrain from riding a bike or ejaculating 48 hours before getting a PSA test. If the PSA remains high, a prostate biopsy is recommended.

A prostate biopsy involves inserting an ultrasound probe into the rectum to visualise the prostate. A needle is then used to take samples of prostate tissue via the rectum. The tissues will then be examined by a pathologist through a microscope.

A prostate biopsy will be able to confirm the presence of cancer. However, a negative test does not necessarily rule out cancer because there is a possibility that the biopsy missed the area of the prostate that contained the cancer.

In this situation, a saturation biopsy (where 20-30 biopsy samples are taken) may be needed.

PSA – how high is too high?

There is a lot of controversy over PSA measurements. There is actually no cut-off point for a normal PSA reading, as the level varies with age and race.

The usual upper limit of normal for PSA given by laboratories is 4 ng/ml, across the age ranges.

However, the PSA test is not a diagnostic test; it simply predicts the risk of prostate cancer. It is also worth repeating that any cause of inflammation to the prostate may result in a raised PSA level, so it does not necessarily point to prostate cancer.

There is a high false positive rate for the PSA test – for every 100 cases of raised PSA levels, there may be 76 who do not harbour any cancer!

PSA testing is also used in the treatment of prostate cancer, for active surveillance. Active surveillance is a means of monitoring the prostate cancer, using regular tests, to keep tabs on its progression and delay unnecessary treatment.

In active surveillance, the doctor will monitor the rate at which the PSA level changes (PSA velocity) or the speed at which the PSA values double (PSA doubling time). This allows doctors to determine whether they need to switch to active treatment to treat the cancer.

Do you need the PSA test?

Many men and doctors still believe that the PSA test is a beneficial tool in screening for prostate cancer. However, we need to treat the PSA test with great caution, especially when using it in men who have no signs or symptoms of cancer.

Over 90% of prostate cancers detected by screening are localised or early stage cancers. They are unlikely to cause death or disability because they are slow-growing tumours.

Yet, most of the men with early stage cancers detected through PSA testing will receive treatment for their cancer. This can cause more harm than benefit, as early treatment of prostate cancer identified through screening will lead to side effects, without actually improving survival rate.

Another concern with using PSA for screening is that it usually necessitates a prostate biopsy to confirm the diagnosis. Despite this invasive procedure, about 75% of men with abnormal PSA levels who proceeded to have a biopsy turned out not to have any cancer.

The US Preventive Services Task Force (USPSTF) does not recommend routine PSA screening for men without symptoms. Therefore, men need not be pressured to take a PSA test, unless they are above 50 years old, have lower urinary tract symptoms, and have a family history of prostate cancer.

If you are unsure whether you fall into this category, ask your doctor. You should discuss your risk factors and prostate symptoms (if any) with the doctor, and the potential harm of screening.

Do not trust anyone who claims that you can diagnose prostate cancer from a PSA test alone.

 

The members of the MMHI are Prof Dr Tan Hui Meng, Assoc Prof Dr Ng Chirk Jenn, Prof Dr Low Wah Yun, Prof Dr Khoo Ee Ming, Assoc Prof Dr Tong Seng Fah, Dr Verna Lee Kar Mun, Dr Lee Boon Cheok, Prof Dr George Lee Eng Geap, Assoc Prof Dr Zulkifli Md. Zainuddin, Dr Christopher Ho Chee Kong, Assoc Prof Dr Ong Teng Aik, Dr Yap Piang Kian and Dr Goh Eng Hong. For further information, e-mailstarhealth@thestar.com.my. The information provided is for educational and communication purposes only and it should not be construed as personal medical advice. Information published in this article is not intended to replace, supplant or augment a consultation with a health professional regarding the reader’s own medical care. The Star does not give any warranty on accuracy, completeness, functionality, usefulness or other assurances as to the content appearing in this column. The Star disclaims all responsibility for any losses, damage to property or personal injury suffered directly or indirectly from reliance on such information.

If you want to learn more about the prostate, you can get a copy of “Men’s Health and The Prostate” published by MMHI, available at RM45 each. To obtain copies, contact Ms Poh or Mr Teo at 03-56391777; fax: 03-56391870; email:perandro@hotmail.com. Proceeds from the sale of this book go towards the research funds of the Malaysian Society of Andrology and The Study of The Aging Male. The book can be delivered to any address within Malaysia by mail or courier without any additional charge.

via Prostate cancer and PSA – Health | The Star Online.

Prostate cancer aggression test ‘may avoid needless ops’

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Prostate tumour: The challenge is spotting which ones need to be removed

 

A prostate cancer test, which predicts how aggressive a tumour is, could spare men unnecessary operations, researchers suggest.

Early data, presented at the National Cancer Research Institute conference, suggests a genetic test can tell apart aggressive and slow-growing tumours.

A big challenge in treating the cancer is knowing whether surgery to remove the gland is needed.

Cancer charities said a successful test would be a “game-changer”.

Prostate cancer is the most common male cancer in the UK. There are more than 40,000 new cases diagnosed and 10,000 deaths each year.

Tough choice

The decision to remove the prostate is based on an examination of a tumour sample under the microscope.

However, the procedure has significant side-effects such as infertility, difficulty maintaining and keeping an erection and uncontrolled urinating.


We need to validate it and we’re not there yet, but it is the strongest test we’ve had so far”

Prof Dan BerneyQueen Mary University of London

One of the researchers, Prof Dan Berney, from Queen Mary University of London, told the BBC: “We need a better test as we are over-treating many men; most will die with, not of, prostate cancer.

“We need to discriminate between the aggressive forms and those that will grumble along and just need monitoring.”

The commercial test, developed by Myriad Genetics but independently assessed by Queen Mary University of London, looks at the activity level of genes inside a sample of the tumour.

If 31 genes involved in controlling how cells divide are highly active, it indicates the cancer is aggressive.

Prof Berney said such information could “substantially change” decisions made by doctors and patients but the costs were “huge” and it was certainly not going to be offered on the NHS in the next few years.

“We need to validate it and we’re not there yet, but it is the strongest test we’ve had so far,” he added.

‘Intriguing’

Dr Iain Frame, director of research at Prostate Cancer UK, said: “Developing an effective test to distinguish aggressive from non-aggressive prostate cancer could be a game-changer for those affected by the condition.

“We urgently need to reach a point where we can focus resources on saving more of the 10,000 men who lose their lives to this disease every year, whilst sparing the many others who needn’t have concerns.

“The results of this study are certainly intriguing, and take us a step closer to the diagnostic process for prostate cancer that men deserve. We will watch with great interest developments in this area.”

Dr Harpal Kumar, the chief executive of Cancer Research UK, said: “Being able to tell apart aggressive and slow-growing tumours would help us take a major step forward in prostate cancer treatment.

“Understanding more about the nature of a patient’s tumour could spare thousands of men from unnecessary treatment and the resulting side-effects, whilst also meaning that those who do need treatment receive it rapidly.”

via BBC News – Prostate cancer aggression test ‘may avoid needless ops’.

Prostate cancer: Case to test men in their 40s

Man's arm after having a blood test
PSA levels can be measured in blood

Men could be offered a screening test for prostate cancer in their late 40s, a study suggests.

The idea is controversial as prostate specific antigen (PSA) testing can be unreliable, throwing up false positive results that can cause undue worry and even treatment over something benign.

Swedish researchers say checking every man aged 45-49 would predict nearly half of all prostate cancer deaths.

Their findings, in The BMJ, come from a study of more than 21,000 men.

No consensus

There is no routine screening programme for prostate cancer in the UK.


At least half of all men can be identified as being at low risk and probably need no more than three PSA tests in a lifetime”

Prof Lilia and colleagues

Men over 50 can request a free PSA test on the NHS if they wish.

A recent prostate cancer screening trial in Europe, ERSPC, showed that screening reduced mortality by 20%. However, this was associated with a high level of “over treatment”. To save one life, 48 additional cases of prostate cancer needed to be treated.

In 2010, when the UK National Screening Committee in England last reviewed the issue, it again decided screening should not be introduced.

But Prof Hans Lilia and colleagues from Lund University in Sweden and the Memorial Sloan-Kettering Cancer Center in the US say there could be a strong case for routine PSA testing and that men in their late-40s are prime candidates.


PSA testing

  • PSA is a protein produced by both normal and cancerous prostate cells
  • A high level of PSA can be a sign of cancer
  • A PSA reading higher than four, but less than 10 is usually due to a benign enlarged prostate
  • A reading higher than 10 may also just be a non cancerous prostate disease
  • The higher the level of PSA, the more likely it is to be cancer

Source: Cancer Research UK

They looked back at a study carried out between 1974 and 1984 involving 21,277 Swedish men aged 27-52. All the men had donated blood samples at the start of the study. The researchers used these stored samples to run PSA tests.

Armed with the results, they then checked to see if the PSA reading predicted what had happened to the men in terms of clinical outcomes – ie had those with high/positive PSA results gone on to develop prostate cancer.

A high PSA was linked with an increased risk of prostate cancer.


We are currently in the process of a scheduled review for a screening programme for prostate cancer and will make a recommendation towards the end of 2013”

Dr Anne Mackie of Public Health England

The researchers then checked the results to see if there was a best age at which men should be screened.

Balance of risks

Screening too young – below 45 years of age – detected too few deadly cancers.

And delaying screening until after a man’s 50th birthday missed too many.

Screening men at the age of 45-49, however, spotted nearly half (44%) of the cancers that went on to be deadly.

In the study, 1,369 of the men had prostate cancer, 241 had advanced disease and 162 died from it.

They say all men should be offered a PSA test in their mid-to-late 40s. Those with a high result would return for frequent screening and checks (and treatment if necessary), while those with normal results could wait until their early 50s for their next PSA test.

“At least half of all men can be identified as being at low risk and probably need no more than three PSA tests in a lifetime,” they say in the British Medical Journal.

“This is likely to reduce the risk of over-diagnosis while still enabling early cancer detection among those most likely to gain from early diagnosis,” they say.

Dr Anne Mackie, Director of NHS Screening Programmes at Public Health England, said they reviewed evidence for screening on a three-yearly basis to make sure that the programmes offered by the NHS are based on the best and most up-to-date information available.

She said they would consider the findings of the BMJ study.

“We are currently in the process of a scheduled review for a screening programme for prostate cancer and will make a recommendation towards the end of 2013,” she said.

The Prostate Cancer UK said more research efforts should be channelled into finding a better screening test for the disease.

BBC – http://www.bbc.co.uk/news/health-22164449

‘Aggressive’ prostate cancer gene find

DNA
Genetics appear to dictate how the cancer behaves

 

Men with prostate cancer and an inherited gene mutation have the worst form of the disease, research reveals.

The BRCA2 gene is linked to hereditary breast cancer, as well as prostate and ovarian cancer.

Now scientists say that as well as being more likely to get prostate cancer, men with BRCA2 are also more likely to develop aggressive tumours and have the poorest survival rates.

They say these men should be treated quickly to save lives.


This study shows that doctors need to consider treating men with prostate cancer and a faulty BRCA2 gene much sooner than they currently do, rather than waiting to see how the disease develops”

Prof Ros EelesLead researcher

Around one in every 100 men with prostate cancer will have the BRCA2 mutation.

These men might benefit from immediate surgery or radiotherapy, even if their disease is at an early stage and would normally be classified as low risk, according to the latest work in the Journal of Clinical Oncology.

Diverse disease

Prostate cancer can grow extremely slowly or very quickly, and this is something that is hard to predict early on.

Some men may live symptom-free for a lifetime, despite having this cancer.

For many, treatment is not immediately necessary.

But researchers say men with BRCA2 and prostate cancer should be treated early and aggressively because their tumour is more likely to spread.

Prof Ros Eeles and colleagues at The Institute of Cancer Research in London and The Royal Marsden NHS Foundation Trust found prostate cancers spread more quickly and were more often fatal in men who had inherited a faulty BRCA2 gene than in men without the faulty gene.


Prostate cancer

  • The prostate is a small gland in the pelvis found only in men. It’s job is to make the fluid part of semen that sperm swim in
  • Prostate cancer does not normally cause symptoms until the cancer has grown large enough to affect surrounding structures like the urethra that carries urine from the bladder
  • This can lead to problems passing urine – needing to pee more often or difficulty starting to urinate
  • Prostate cancer can be diagnosed by taking a biopsy (a small tissue sample of the prostate gland)
  • Some men may be advised to delay having treatment if the tumour is very slow growing and not causing any problems
  • Others may want to have surgery to remove the entire prostate

They looked at the medical records of prostate cancer patients which included 61 men with BRCA2, 18 men with a similar gene mutation called BRCA1, and 1,940 men with neither mutations.

Patients with BRCA2-mutations were significantly less likely to survive their cancer, living an average of 6.5 years after diagnosis compared with 12.9 years for non-carriers. They were also more likely to have advanced disease at the time of diagnosis.

‘More deadly type’

Prof Eeles said: “It is clear from our study that prostate cancers linked to inheritance of the BRCA2 cancer gene are more deadly than other types.

“It must make sense to start offering affected men immediate surgery or radiotherapy, even for early-stage cases that would otherwise be classified as low-risk.

“We won’t be able to tell for certain that earlier treatment can benefit men with inherited cancer genes until we’ve tested it in a clinical trial, but the hope is that our study will ultimately save lives by directing treatment at those who most need it.”

More than 40,000 men are diagnosed with prostate cancer every year.

Men with a significant family history of breast and/or ovarian cancer in addition to prostate cancer can be offered BRCA1/2 testing at diagnosis, but it is not routinely offered to all patients diagnosed with prostate cancer in the UK.

Dr Julie Sharp of Cancer Research UK, said: “This study shows that doctors need to consider treating men with prostate cancer and a faulty BRCA2 gene much sooner than they currently do, rather than waiting to see how the disease develops.

“We knew that men who inherit a faulty BRCA2 gene are at a greater risk of developing prostate cancer but this is the largest study to show that the faulty gene also makes the disease more likely to develop quickly and spread.”

BBC – http://www.bbc.co.uk/news/health-22065289#?utm_source=twitterfeed&utm_medium=twitter

Skin patches ‘may beat prostate cancer’

Prostate cancer

Prostate cancer cells

Skin patches which deliver oestrogen into the blood may be a cheaper and safer treatment for prostate cancer than current therapies, a study says.

The main treatment is injections of a chemical to cut levels of testosterone – the driving force of many prostate cancers – but it causes side effects.

The Imperial College London study in the Lancet Oncology compared patches and injections in 254 patients.

It found patches were safe and should avoid menopause-like side effects.

‘Effective treatments’

Using oestrogen to treat prostate cancer is an old treatment.

Both oestrogen and testosterone are very similar chemically, so ramping up the levels of oestrogen in the body can reduce the amount of testosterone produced – and slow prostate cancer growth.

However, taking oral oestrogen pills caused significant health problems by overdosing the liver. The organ then produced chemicals which caused blood clots, heart attacks and strokes.

The preferred treatment is injections of a drug, LHRHa, which reduces the production of both oestrogen and testosterone. However, this has side effects similar to the menopause in women – resulting in poor bone health and diabetes.

Patch
The patch releases oestrogen through the skin

Prof Paul Abel, from Imperial College London, said: “We’re not claiming this is equivalent to current therapies yet, but it does look like we are getting castration levels of testosterone.”

However, the researchers need to follow patients for longer.

“The next step is to test if the oestrogen patches are as effective at stopping the growth of prostate cancer as the current hormone treatments, we’re now testing this in over 600 patients.”

Kate Law, from the charity Cancer Research UK which part funded the study, said: “More men than ever are surviving prostate cancer thanks to advances in research, but we still urgently need to find more effective treatments and reduce side effects.

“This trial is an important step towards better and kinder treatments that could bring big benefits to men with prostate cancer in the future.”

Dr Iain Frame, director of research at Prostate Cancer UK, said: “It is unclear as yet if hormone patches could be an effective alternative to hormone injections, but we await with anticipation the results of the further trials planned which could in time offer men hope for the future.”

BBC – http://www.bbc.co.uk/news/health-21628911

Prostate cancer research ‘lagging’

Close-up of prostate cancer cells

Experts are working on better tests for prostate cancer

Prostate cancer is the poor relation when it comes to funding for research to find a cure, says a charity.

Though it is the most common male cancer, prostate cancer is 20th in the league table of research funding, says Prostate Cancer UK, which is launching a campaign to highlight the issue.

It has been said that the disease will be the UK’s most common cancer by 2030.

The Department of Health said prostate cancer was a key target of its efforts to improve cancer survival rates.

Comedian Bill Bailey will front the campaign being launched by Prostate Cancer UK.

Owen Sharp, the charity’s chief executive, said: “Prostate cancer is simply not on the radar in the UK. Even though it kills one man every hour – that’s 10,000 men each year – most men and women don’t know enough about it.


We fund the best science we can to make the greatest impact – we don’t have quotas for specific types of cancer”

Dr Julie SharpCancer Research UK

“We need to follow the lead of the successful female movement against breast cancer and create a real change for men.”

According to the charity, breast cancer – the most common female cancer, which has a similar death rate to prostate cancer – received more than double the annual research spend – £853 per breast cancer case diagnosed, compared to £417 for prostate cancer.

Leukaemia got the most research funding – £3,903 per case diagnosed – charitable and government funds data for 2009 and 2011 show.

Every year in the UK, over 40,000 men are diagnosed with prostate cancer. Although it is one of the more treatable types of cancer, particularly if diagnosed early, one man dies every hour from it, says Prostate Cancer UK.

Dr Julie Sharp of Cancer Research UK said: “We fund the best science we can to make the greatest impact – we don’t have quotas for specific types of cancer.

“Last year, Cancer Research UK spent £332 million on research into cancers that affect both men and women, including basic research that can help improve our understanding of all cancers, and we spent nearly £20 million of this specifically on prostate cancer research.

“We want to bring closer the day when all cancers are cured and it’s research that will help us to do this.”

Prostate cancer rates have been rising, partly because men are living longer (cancer risk increases with age) and also because more cancers are being detected through widespread use of PSA testing.

A Department of Health spokesperson said: “As part of our commitment to improving cancer survival, including ensuring better treatments for all patients, we have invested £104 million into cancer research over the past year.

“Improving outcomes for men with cancer will be essential in meeting this aim. That is why we are investing £35 million in the biggest publicly funded clinical trial ever to take place in this country to look at the effectiveness of treatments for prostate cancer.”

BBC

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