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Prostate cancer can be a serious disease, but most men diagnosed with prostate cancer do not die from it. In fact, more than 3.1 million men in the United States who have been diagnosed with prostate cancer at some point are still alive today.
The American Cancer Society’s estimates for prostate cancer in the United States for 2022 are:
About 268,490 new cases of prostate cancer
About 34,500 deaths from prostate cancer
1 in 8 men will develop prostate cancer--this is the same as breast cancer in women
1 in 7 black men will develop prostate cancer
1 in 5 veterans will develop prostate cancer
If you have a close family member (father o brother) who has had prostate cancer, your chances are 50% greater.
If caught early you have greater than 99% survival rate at five years, and 97% at 10 and 15 years.
(early diagnosis indicates cancer contained in the prostate capsule)
If caught late the survival rate drops to 32% at five years
(late diagnosis indicates the cancer has spread regionally, or to distant sites)
Prostate-specific antigen, or PSA, is a protein produced by normal, as well as malignant, cells of the prostate gland. The PSA test measures the level of PSA in a man’s blood.
For this test, a blood sample is sent to a laboratory for analysis. The results are usually reported as nanograms of PSA per milliliter (ng/mL) of blood.
The blood level of PSA is often elevated in men with prostate cancer.
There is no specific normal or abnormal level of PSA in the blood, and levels may vary over time in the same man. Most doctors consider PSA levels of 4.0 ng/mL and lower as normal.
Therefore, if a man has a PSA level above 4.0 ng/mL, doctors often recommend a prostate biopsy to determine whether prostate cancer is present.
It is recommended that you start being checked in your forties. If you have a family history of prostate cancer, are a black man or a veteran then make sure get started with PSA’s at age 40. We are starting to see some men in their thirties developing prostate cancer.
The Gleason score is a system used to grade prostate cancer based on how aggressive and likely it is to spread.
How It's Calculated:
A pathologist examines prostate tissue samples under a microscope. Each sample is assigned a grade from 1 (least aggressive) to 5 (most aggressive).
The two most common grades are added together to calculate the Gleason score.
Interpretation:
Gleason scores range from 6 (least aggressive) to 10 (most aggressive).
Higher scores indicate a more aggressive cancer with a higher risk of spreading.
For example, a Gleason score of 7 (3 + 4) indicates that the cancer is moderately aggressive, with the majority of the tumor being grade 3 and a smaller portion being grade 4.
Clinical Use:
The Gleason score is an important factor in determining treatment options for prostate cancer. It helps predict the likelihood of the cancer spreading, the risk of recurrence, and the overall prognosis.
Additional Notes:
Gleason scores can vary depending on the pathologist who interprets them.
The Gleason score is not the only factor used to make treatment decisions. Other factors, such as age, overall health, and the presence of other medical conditions, are also considered.
Androgen deprivation therapy (ADT) is a treatment used for prostate cancer that aims to reduce the levels of male hormones (androgens), such as testosterone, in the body. Prostate cancer cells rely on androgens for growth, so lowering their levels can help slow down or stop the progression of the disease.
How ADT Works:
ADT can be achieved through two main methods:
Surgical castration: Removal of the testicles, which produce testosterone.
Medications:
Gonadotropin-releasing hormone (GnRH) agonists (e.g., leuprolide, goserelin): These block the production of testosterone in the testicles.
Androgen receptor antagonists (e.g., enzalutamide, apalutamide): These prevent testosterone from binding to and activating prostate cancer cells.
Benefits of ADT:
Slows down or stops the growth of prostate cancer
Reduces the risk of cancer spread
Improves symptoms such as pain and bone metastases
Extends life expectancy in men with advanced prostate cancer
Side Effects of ADT:
ADT can cause a number of side effects, including:
Hot flashes
Loss of libido
Erectile dysfunction
Bone loss
Increased risk of cardiovascular disease
Increased risk of certain types of cancer (e.g., breast cancer)
Purpose of PSMA PET Scan
A prostate-specific membrane antigen (PSMA) PET scan is an imaging test used to detect and locate prostate cancer. It is a highly sensitive and specific tool that can help diagnose prostate cancer, monitor its progression, and guide treatment decisions.
How it Works
During a PSMA PET scan, a radioactive tracer is injected into the bloodstream. This tracer binds to PSMA, a protein that is overexpressed in prostate cancer cells. A PET scanner then detects the tracer and creates images of the areas where prostate cancer may be present.
Benefits
Highly sensitive and specific for detecting prostate cancer
Can detect small tumors that may be missed by other imaging tests
Provides accurate information about the location and extent of prostate cancer
Helps guide treatment decisions, such as surgery, radiation therapy, or chemotherapy
Procedure
The patient will typically receive an injection of the tracer about an hour before the scan.
The patient will lie down in the scanner while images are taken.
The scan usually takes about 1-2 hours.
Risks
The radioactive tracer used in a PSMA PET scan is very low dose and generally considered safe.
However, some patients may experience mild side effects such as nausea, vomiting, or dizziness.
Who Should Get a PSMA PET Scan
Men with elevated prostate-specific antigen (PSA) levels
Men who have been diagnosed with prostate cancer and are monitoring for recurrence
Men who are considering treatment for prostate cancer
Conclusion
A PSMA PET scan is a valuable tool for detecting and monitoring prostate cancer. It provides accurate information about the location and extent of the disease, which can help guide treatment decisions and improve patient outcomes. If you have any concerns about prostate cancer, talk to your doctor about whether a PSMA PET scan may be right for you.