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Prostate Biopsy

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Prostate Cancer

Prostate cancer is a malignant tumor that often appears after the age of forty. One in every ten patients may develop prostate cancer and previously it was thought that 3 in every 100 could die of it, but this has changed as a result of better diagnostic procedures. Prostate cancer is the most common cancer after that of skin cancer.


  In Spanish: Entrevista Canal Uno, Bogotá, 2016/11/18
  Biopsia de próstata - Cáncer de próstata


Prostate cancer is the development of undifferentiated (malignant) cells within the prostate; most often detected in the back part of it near the rectum but may be located in any part of it or even outside of it as metastasis in the bones and lymph nodes.
The symptoms of prostate cancer are more evident as the cancer progresses and in its initial stages it is absolutely symptomless.

Factors that Increase the Risk of Developing Prostate Cancer

The factors that increase the risk of developing prostate cancer the most are genetic, nutritional,  environmental and hormonal derived from androgens.

Age

Prostate cancer usually appears in men over 40 and its frequency increases with the age of men, especially over 50. At least 65% of men over 70 are believed to have microscopic evidence of prostate cancer, but fortunately its growth is very slow and the men in this age bracket almost always die of other causes. Different studies have shown that the younger the man is who develops prostate cancer, the more aggressive it is, which in turn requires a more radical treatment.

Family History and Genetic Factors

Hereditary factors play an important role and men with a family history of prostate cancer have a greater risk of developing it. Having a family history prostate cancer doubles the risk of developing it and three relatives with prostate cancer increases the risk eleven times.

Race

Afro-American men have the highest risk of developing prostate cancer with a probability 50% higher than that of white men. Though men living in Asia have a lower risk, their risk increases if they move to North America, which suggests environmental or nutritional factors.

Socioeconomic Factors

The lack of access to preventive testing or timely diagnosis of the cancer before it enters in metastasis increases the risk of developing prostate cancer.

The high risk in Afro-American men is associated with socioeconomic factors impeding a timely diagnosis as their access to quality preventive exams is very limited. For example, in a study of 2000 veterans which included whites and blacks enjoying the same level of health care, there were no major differences in the development of cancer.

Exams of elevated sensitivity, such as C.M.P. –Prostate, which diagnose disease allover the body, significantly increase the resistance of the body to the cancer as they allow treatment of a greater number of illnesses, raising the general health of the patient which in turn increases his resistance to the cancer.

Biological Factors

There is some evidence that some genetic factors may facilitate the development of prostate cancer.

Exposure to Chemicals

Exposure to cadmium, dimetilformamide and acrilonitril can raise the risk of developing prostate cancer. It has also been suggested that farmers have a greater risk of developing this cancer. The risk increases with activities related with paint and varnish, exposure to grease and lubricants, metallic dust, pesticides and in professions associated with home maintenance and furnishings.

Exposure to Diesel fumes

Several works have linked diesel fumes to prostate cancer due to the PAH.

Infection and Swelling

The herpes virus, el papiloma y el citomegalovirus, along with some bacterial infections transmitted by sexual contact are suspected to cause the development of prostate cancer in males with a genetic susceptibility.

There is evidence that the swelling caused by these infections is a condition facilitating the development of prostate cancer

Prostate Biopsies

Biopsies cause inflammation and swelling. The inflammation increases in direct proportion to the number of incisions made and all the trauma caused. Repeated biopsies indirectly increases the chances of developing prostate cancer. Biopsies can also dramatically affect the quality of life and secondly, in the case of prostate biopsies, facilitate the spread of the cancer.

Dietary Factors

There are dietary factors that increase or decrease the risk of developing prostate cancer. Some studies show that obese men or those who eat a lot of greasy food may develop prostate cancer but recent studies seem to suggest that high calorie intake is a more important factor in developing prostate cancer. Food cooked at very high temperatures may increase its appearance along with moderate to heavy drinking.

Eating fish twice or more a week, vegetarian diets, whole grains, fiber, soybeans and vitamins D and E may reduce the risk.

The Sedentary Lifestyle

Vigorous working out can reduce the risk of metastasis in prostate cancer.

Reduced Sexual Activity

Frequent ejaculation, be it masturbation or sexual activity, has been associated with a reduced risk of developing prostate cancer as it eliminates carcinogens. Promiscuous sexual activity however increases the risk of infections

Health

It is also known that the poorer the health of the patient with prostate cancer, the more aggressive it is as the weakened immune system facilitates the extension of the cancer. It is for this reason that patients, for instance with AIDS, develop the cancer more easily.

Healthy eating habits, physical exercise, positive attitude, avoiding excesses and etc. increase the resistance to cancer.

Symptoms

As explained previously, the cancer presents no symptoms in its initial stages, for which it is prudent to detect it as early as possible, along with improving the health in general of the patient which improves his defenses. Usually the more advanced the cancer, the greater the number of symptoms and the greater their intensity. The most frequent symptoms are:


1. difficulty or pain urinating
2. weak stream
3. dripping
4. frequent desire to urinate
5. blood in the urine
6. blood in the semen
7. Probable back pain if there is metastasis in the backbone.
8. Pain on ejaculating
9. Pain in the back
10. Muscular pain
11. Pain in or near the testicles
12. An elevated PSA

These symptoms may appear when the prostate cancer is present and relatively advanced but are also very common with other illnesses and diseases, for which it is indispensible to take exams such as C.M.P.- Prostate which can clarify the situation

The Classification of Prostate Cancer

There are various classifications of prostate cancer and the most precise are those that depend on surgical results.
 

ABCD Classification

The most common classification is that which refers to the extension of the tumor (A, B, C, D). The explanation of this technique has been adapted to actual knowledge as previously it was considered that the prostatic antigen was part of this classification. Now it is known that its usefulness is very limited because the PSA goes up for many reasons aside from prostate cancer.

Cancer

Prostate               

Stage A
The cancer is located within the prostate and it is found by accident when it is removed to correct an obstruction. This is generally curable.
         Cancer

    Prostate
Stage B
The cancer, though located completely within the prostate, is big enough to be suspicious by initial diagnostic means. It is generally curable.
     Cancer

      Prostate
Stage C
The cancer breaks through the outer wall of the prostate and enters neighboring tissues but has not entered in metastasis. Some cases are curable. In addition to initial diagnostic means, it is indispensable to have a bone scan to differentiate it from stage D.
Stage D
The cancer has produced metastasis especially in the bones (detected in the bone scan) and in the lymph nodes. It is not presently curable but there is palliative treatment.

The Gleason scoring system

This is a simple classification system based on operating discoveries microscopically classifying the cells from well differentiated (first degree) to very undifferentiated (fifth degree). Two structural patterns are studied (first and secondary) adding up to a minimum of two points and a maximum of ten points.

Degrees one and two are normal. Third degree (moderately well differentiated cells) is the most common and it is still considered normal. For this reason, the sum of the two values, equal to six can also be considered normal.

The fourth degree corresponds to cancer and is the most important and some times difficult to differentiate from the third degree. The total of the two values equal to seven is suspicious. Even the eighth degree, adding the two values may be questionable.

The fifth degree is undifferentiated, corresponding to cancer.
In this way, a Gleason score of10 would be the most serious of all and a Gleason score of 2, totally normal.

For clear evaluation the total of the two factors should be reported, for example: 7 (3+ 4), and the higher the number the more serious. It is common for a biopsy to show a Gleason score of 7 or less and there is no cancer but rather an inflammatory reaction or other non malignant illness. For this reason the result of the biopsy is not reliable for a Gleason score of less than 8. It is worth considering that biopsies usually show results of less than 8, reducing their usefulness considerably.


The TNM Grading

This has replaced the ABCD system for classifying prostate cancer and follows that of Gleason scoring in its usefulness.

The T means a primary tumor and represents the extension of the cancer within the prostate and the tissue directly adjacent.

The N means lymphatic nodes and is for when the prostate cancer has invaded neighboring lymphatic nodes.

The M signifies metastasis and means that the prostate cancer has invaded distant tissues such as the bones and lungs.

These letters are followed by a number from 0 to 4 representing the extension of the tumor and occasionally a small letter which represents additional information.

Stage T0, no evidence of cancer

Stage T1, the cancer is limited to the prostate and detected by initial diagnostic means of greater sensitivity.

Stage T2, the cancer is confined to the prostate and discovered by initial diagnostic means of greater sensitivity and occasionally by those of lesser sensitivity.

Stage T3, the cancer has extended to the immediate neighboring tissues and/or to the seminal vesicles.

Stage T4, the cancer has extended to neighboring organs such as the bladder.

The Stages N and M indicate respectively the presence of cancer in neighboring lymphatic nodes and metastasis and they are represented when they are positive as N+ and M+, followed by numbers and/or letters in progressive order depending on the size and extension.

Diagnosis of prostate cancer

Digital rectal examination: allows suspecting prostate cancer when this has grown enough to deform the princludesostate, or when it is located near the rectum. As this Digital rectal examination does not allow evaluating the front of the prostate, other diagnostic means more reliable are necessary.

PSA (Prostate specific antigen): This is useful for evaluating the response to treatment but not for diagnosing prostate cancer, as the PSA also increases for many illnesses such as benign prostate hypertrophy, prostatis, cystitis and seminal vesiculitis, breast cancer, sexual activity, stress, etc. and digital rectal examination. PSA along with C.M.P. - Prostate allows calculating the PSADI which is a very sensitive indicator of the evolution of prostate cancer.

Prostate Biopsy: Can determine with a lot of certainty the presence of cancer when this is very advanced, that is to say when the Gleason scores are high, usually above 8. Unfortunately the values under 8 can result in false positives, that is to say cancer is detected when it does not exist. Additionally, the biopsy is very painful, can spread the cancer and can be complicated with hemorrhaging, infection (especially septicemia) and the spreading of the tumor. Also, the reuse of needles and other implements increases the possibility of transmitting infections and AIDS. Most biopsies result negative, even when there is cancer for which they are repeated until there is a permanent inflammatory reaction promoting cancer development.

Conventional ultrasound testing: Allows an idea of the approximate size of the prostate but due to its low sensitivity is usually associated with prostate biopsies and the serious consequences that these may have.

C.M.P. - Prostate, in addition to detecting prostate cancer, detects other illnesses in the prostate and the rest of the body, allowing a timely treatment and improving the general resistance of the patient to cancer. The additional advantage is that it is totally painless and safe and can be carried out without any limitations.
 

Prostate cancer treatment

If prostate cancer has been diagnosed you should know the different treatment options. The treatment chosen depends on the type of cancer and its extension and principally on your personal priorities after considering the benefits and inconveniences, your age and general health, as the better your health, the less extreme treatments are required and it is even possible that no treatment is necessary.

Aggressive actions such as biopsies may paradoxically cause metastasis and it is better to avoid them. It is also good to remember that extreme treatments reduce quality of life and may additionally affect the health of the patient and the resistance of the immune system.

Actually the PSADI velocity index allows having an approximate idea of the speed of growth of the cancer and because of this measuring the PSADI is part of the C.M.P. –Prostate test.

The most recent prostate cancer treatments are:

Observation

This consists in observing the patient without any kind of treatment until the symptoms appear or get worse. It is recommended in cases just beginning in very healthy patients whose quality of life would be very affected by the treatment, in very old men whose life expectancy may be very reduced, and naturally if the patient wishes this and requests it.

Surgery

Pelvic Lymphadenectomy: This consists in removing the lymph nodes in the pelvis whicch are immediately examined under microscope. If the nodes have cancer, the prostate is not removed and another treatment is recommended.

Radical Prostatectomy: The prostate is removed along with neighboring tissues and lymph nodes. This produces impotency, along with urinary and fecal incontinence.

Transurethral prostatectomy: Part of the prostate tissue is removed through the urethra, through a cystoscopy. This is used to alleviate an obstruction, especially in old men or persons who could not resist a radical operation or its side effects.

Radiation Therapy

This consists in using radiation to kill the cancer cells. The external irradiation is with a machine which irradiates the body and internal irradiation (brachytherapy) through radioactive seeds, wires or catheters. Radiation therapy frequently produces urinary problems.

Hormone therapy

This consists in blocking the hormonal action to impede tumor growth. The therapy often produces heat waves, alterations in the sexual functions, loss of sex drive, impotence and bone disorders. The treatment of hormone therapy treatments include:

Antagonists of the liberating factor of luteinizing hormone which impedes testosterone production by the testicle (luproide acetate, goselerin and buserelin)

Antiandrogens such as the flutamide and bicalutamide, which offset the testosterone.

Drugs that prevent that the adrenal glands produce androgens such as ketoconazole and aminoglutamide.

Other:

Orchiectomy or removal of the testicles, which are the main source of testosterone production.

Estrogens, which promote female sexual characteristics impeding testosterone production by the testicles. They are little used because of their serious adverse effects.

Cryosurgery, The cancer tissue is destroyed with very low temperatures.

Chemotherapy, medicines are used to kill or impede the growth of the malignant cells. They are administered orally or injected.

Immunotherapy or Biological therapy, this consists in stimulating the active or passive immune system that is responsible for preventing the growth of cancer cells.

High-intensity focused Ultrasound, this is the implementation of high intensity ultrasound through an intrarectal catheter to destroy cancer cells.

New treatments are investigated every day that will be published here.


_______________________________________

Questions for choosing the best treatment for prostate cancer


Is the cancer limited to the prostate, or has it already extended?
Prostate cancer can extend to neighboring organs and tissues, bones and the lungs. To know this adequate tests are necessary, beginning with a C.M.P.-Prostate. When a patient is in good health in spite of having cancer cells, his defenses are better and it is possible that the cancer doesn’t extend more. It is for this reason that many with prostate cancer that hasn’t extended don’t need any treatment. It is important to emphasize that a prostate biopsy doesn’t say anything about the extension of the cancer and thus is useless for this.

Is the cancer aggressive or slow growing?
The speed of the PSADI or PSADI velocity index gives a very precise idea of the speed of growth of the prostate cancer. The PSADI is measured in the C.M.P. - Prostate if you have a previous PSA.

How is your health in general?
A timely C.M.P. - Prostate is the ideal exam to know your health in general.

How old are you?
In young men the life expectancy is greater and there is a higher probability that the cancer can be cured in the near future without the need for surgery. Obviously the general health and the extension of the cancer are variables to consider in this.

Can the patient resist surgery?
C.M.P. - Prostate should be carried out before any surgery implying local or general anesthesia, or that implies certain risk such as in the case of a prostatectomy.

Is the patient willing to suffer for life the adverse effects of a radical prostatectomy to reduce the risk of death by prostate cancer?
The principal adverse effects are urinary incontinence and impotence, and eventually rectal incontinence and all that this implies. This should be carefully considered before a prostatectomy.

How important is it for the patient, in his work and recreation, to enjoy good control of the bladder and the intestine?
This also, should be thought about carefully before undergoing surgery.

How important is it for the patient to have an erection?
If the patient has an active sex life, he should know that this aspect of his life will change very much with the cancer treatment.

How much would it affect the life and activity of the patient to know that he is living with a cancer and not receiving treatment and needs frequent exams?

Some men can support the pressure of living with cancer while others can’t.

Each patient with prostate cancer should consider all of the previous points before deciding on the treatment which is best for him.

When prostate cancer is detected, the next step is to determine its extension and evaluate as thoroughly as possible the whole organism to determine the best treatment possible.

It is not always necessary to operate and many treatments should be ruled out. The best exam to evaluate the patient already detected with prostate cancer is the C.M.P. - Prostate



 

C.M.P-Prostate

Avoid the Prostate biopsy
with a C.M.P.-Prostate

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Dr. Gonzalo E. Díaz M. Cl 73 10-10 Of 404, Bogotá, Colombia
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