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About Prostate Cancer

The prostate, found only in men, is a small rounded gland located just below the bladder and before the genitals. Its function is to produce seminal fluid, which protects and nourishes sperm cells in semen.

Prostate Anatomy
Prostate cancer is usually a series of small tumors found within the prostate. While most cancers can grow quite rapidly, prostate cancer typically is a slow growing cancer. Because of its slow growth, there may be few or no symptoms. This is the reason why the serum Prostate Specific Antigen (PSA) testing becomes very important.
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Causes & Risk Factors
Like most cancers, it is unknown exactly who, why, or when someone will get it. Some of the risk factors for prostate cancer includes:
Age
Because it is slow growing and primarily found in older men, the chances of a man under the age of 40 being detected with prostate cancer are rare. However the chances increase rapidly after age 50. After the age of 50, all men are recommended to undergo a yearly PSA test to determine if they are at risk.
Family History
If an immediate family member, such as a brother or father, had prostate cancer, your chances almost doubles. Two or more relatives diagnosed with prostate cancer increases your chances even more dramatically. Three or more relatives, and your chances are close to 100%. If any member of your family is diagnosed with prostate cancer, it is wise to begin regular check-ups with your doctor.
Race
Men of all races are susceptible to prostate cancer. However African-American men are more likely to develop prostate cancer than any other race. Not only are they more likely to develop it, but the aggressiveness of the cancer is greater among this race. Caucasian-American men are next in risk, followed by Asian men living in Asia who have the lowest incidence. While Asian men have a lower risk over all, the risk seems to increase with the amount of time that they spend in western cultures indicating that diet may be an issue.
Diet, Obesity & Nutrition
While it is not clear exactly how diet effects the risk, diets high in fats seem to play a role. Men that eat more meat than others seem to have a higher rate of prostate cancer than those that tend to eat more vegetables.
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Diagnosing
Prostate Specific Antigen (PSA) Levels
PSA test may be done regularly to monitor your PSA levels. Levels below 4 ng/ml are typically normal. However the rate of change of your PSA is the most important test. Therefore if there is a significant change in two sequential PSA scores, this may indicate prostate cancer even if the total score is low. If your PSA levels are rising, these tests may be done more frequently to determine if you are at risk.

PSA
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Digital Rectal Examination (DRE)
After age of 50 a DRE should be done annually. Your doctor will insert his finger into the anus to feel if there are any abnormalities with your prostate. If there are abnormalities or if your PSA levels indicate a higher risk, a biopsy may be done as a next step.

DRE
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Transrectal Ultrasound (TRUS)
TRUS is one of the important method to examine prostate cancer.
TRUS give us a lots of informations such as prostate valume, suspected area of cancer , calcification and seminal vesicles involvement. For a TRUS, a small probe is introdued into the rectum.

TRUS
Prostate Needle Biopsy
While PSA levels , DRE, and /or TRUS results may indicate your risk, the only way to know for sure if you have prostate cancer is by means of a needle biopsy. For a biopsy, a small probe is placed in the rectum. The probe uses ultrasound to show the location of the prostate. This is called TRUS (transrectal ultrasound). Once the prostate has been imaged, a needle is placed within the prostate and a small amount of tissue is extracted. More than one sample will be taken. In fact, the more biopsies (over 6) the more accurate and complete the diagnosis. These samples are then sent to a pathology lab for diagnosing.
Gleason Grading and Gleason Scores
Samples from the prostate biopsy are looked under a microscope. Gleason score system has been widely used to assess a malignant potential and varied from Gleason 1 to 5 depending on tissue structure. There are 5 patterns in the appearance of cells, Gleason 1 being nearly normal cell and 5 being severely abnormal. Gleason score is the standard way of assessing your risk. To determine your Gleason score, 2 predominant samples are graded according to their appearance. The two grades are added up and that is your Gleason score. For example, Gleason 3 and Gleason 4 are scored as Gleason score is 3+4=7. The range of the Gleason score is 2 to10. Generally speaking, the Gleason score tends to predict the aggressiveness of the disease and how it will behave. It is important that you know this score when determining your treatment options, as certain options may not be available to you.
Stages
Once prostate cancer has been diagnosed by a prostate biopsy, the physician must stage the disease to determine the extent of the cancer (i.e., the "T" stage) and whether it has spread beyond the prostate gland to the surrounding tissues, the seminal vesicles, the lymph nodes and/or the bones. The T stage is determined by the DRE and other imaging studies of the prostate gland and surrounding tissues, such as the ultrasound scan, CT scan, MRI scan, or MR spectroscopy scan. The T stage is divided into the following categories:
T1 : Doctor is unable to feel the tumor or see it with imaging (e.g., transrectal ultrasound)
T1a : Cancer is found incidentally during a transurethral resection (TURP) for benign prostatic enlargement. Cancer is present in less than 5% of the tissue removed.
T1b : Cancer is found after TURP but is present in more than 5% of the tissue removed.
T1c : Cancer is found by needle biopsy that was done because of an elevated PSA
T2 : Doctor can feel the tumor when a digital rectal exam (DRE) is performed but the tumor still appears to be confined to the prostate
T2a : Cancer is found in one half or less of only one side (left or right) of the prostate
T2b : Cancer is found in more than half of only one side (left or right) of the prostate
T2c : Cancer is found in both sides of the prostate
T3 : Cancer has begun to spread outside the prostate and may involve the seminal vesicles
T3a : Cancer extends outside the prostate but not to the seminal vesicles
T3b : Cancer has spread to the seminal vesicles
T4 : Cancer has spread to adjacent organs, such as the urethral sphincter, rectum and/or wall of the pelvis
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