What are the 4 stages of prostate cancer?

Key takeaways

  • Prostate cancer starts in the prostate gland, but can spread outside of it if not detected and treated early.
  • To confirm a diagnosis of prostate cancer and assess the stage of the cancer, doctors will use tests such as the PSA test and DRE, as well as a biopsy, ultrasound, MRI, and CT scans.
  • The cancer is staged based on the size and spread of the tumor, with Stage I being the least advanced and having a high survival rate.

Prostate cancer starts and grows in the prostate gland, but may spread outside the prostate, particularly when not detected and treated early. As it grows and spreads away from the prostate, the tumor may invade nearby tissues and consequently get carried via lymph nodes and lymph vessels traveling to distant tissues.

Grading of prostate cancer

Prostate cancer is primarily screened using the prostate-specific antigen (PSA) test and the digital rectal exam (DRE). And when screening tests give abnormal results, your physician will run further tests to confirm the diagnosis, grade the cells, and then assess the stage of the cancer.

To confirm the diagnosis, your doctor will order a prostate biopsy.  The test involves obtaining a sample of tissue from the most affected areas of the prostate and having the cells examined by a pathologist to determine if they are cancerous. And since cancerous cells appear different from healthy cells, the biopsy helps to confirm the diagnosis.

The appearance of cells is also used to grade the cancer. Usually, the cells are classified using the Gleason system, which uses the numbers 1 to 5 to grade the patterns of cells seen in the tissue sample as the most common (primary) and the second most common (secondary) patterns of cells.

Cells that look much similar to normal cells are given a score of 1, and then the scores 2-4 are given an increasing order of difference from normal ones. Therefore a score of 4 represents cells that are more different and have a higher chance of uncontrolled replication than a score of 2. And a score of 5 is given to cells that are completely different from normal prostate cells.

The total Gleason score is obtained by adding the primary and secondary scores, with the least tally that indicates cancer being 6—a score that shows a low-grade, least aggressive cancer. A Gleason score of 7 indicates a medium-grade cancer, while tallies of 8, 9 or 10 show a high-grade cancer.

Generally, the higher the score, the more the cancer cells appear different from normal prostate cells, and the more aggressive the cancer. Aggressiveness of a cancer means it has more chances of spreading to other areas of the body.

Today, the Gleason score is used alongside the grade group score to help stage prostate cancer. Other tests that help assessing the stage of prostate cancer include Transrectal ultrasound, prostate-specific antigen (PSA), MRI of the prostate, abdominal and pelvic CT scan to detect the potential spread of the cancer, nuclear scans to detect spread to bones, and surgical biopsy to check lymph nodes of your pelvis for the tumor.

So what are the stages of prostate cancer?

Staging of a prostate cancer means classifying the cancer according to how far it has spread and its effects on the prostate. The staging system helps in tailoring treatment to properly address the tumor.

To determine the stage of a cancer, your doctor will use a number of indicators. For instance, your doctor will use the TNM system, which has three different aspects. Tumor (T) describes the size of the main area of the cancer, nodes (N) identifies whether the cancer has spread to the lymph nodes and to what extent, while metastasis (M) describes how far from the prostate the cancer has spread.

Similarly, your physician will use the Gleason score and the grade group score to stage the cancer. The higher the Gleason or grade group score, the more aggressive and widely spread the cancer. Plus, your doctor will use the PSA level, ultrasound, MRI, CT scans, nuclear scans, and surgery to correctly stage the cancer.

  1. Stage I Prostate Cancer

The least advanced prostate cancer, usually small and not yet spread beyond the prostate, is called stage I prostate cancer.  It is characterized by a PSA level that’s less than10 ng/mL, a Gleason score of 6, and a grade group score of 1. The cancer has a 5-year survival rate of almost 100 percent.

Stage I prostate cancer is managed by active surveillance for nearly all patients with a Gleason score of 6, unless the patient is unwilling or unable to undergo additional biopsies or has high-volume disease.

Active surveillance means your doctor monitors the tumor over time to check whether further treatment is necessary. Apart from active surveillance, stage I cancer may be treated using radical prostatectomy—the surgical removal of the prostate; or radiation therapy, either alone or with prostate removal.

  1. State II Prostate Cancer

The cancer is still restricted to the prostate and has not spread to the lymph nodes or other parts of the body.  Also, it may or may not be felt during a prostate exam, though it may appear on ultrasound imaging.

Stage II prostate cancer has a PSA score of less than 20ng/mL, but is further divided into three phases depending on Gleason scores and grade group scores. Stage IIA has a Gleason score of 6 or less and grade group score of 1, stage IIB has a Gleason score of 7 (3+4) and grade group score of 2, while stage IIC has a Gleason score of 7 or 8 and grade group score of 3 or 4.

For stages IIA and IIB, active surveillance may be adequate. But, in some cases, doctors recommend removing the prostate together with the surrounding lymph nodes in order to prevent further spread of the cancer. Your doctor may also consider radiation therapy, in the form of external beam or brachytherapy.

For stage IIC, a combination of hormone therapy with radiation therapy in select patients—group grade 3 or those with more than 50-percent positive biopsy cores, usually gives great results.

  1. Stage III prostate cancer

At this stage, the cancer may or may not have spread outside the prostate. If the tumor hasn’t spread outside the prostate, the 5-year survival rate still remains close to 100-percent. But when the tumor has spread, the survival rate is reduced.

Stage III prostate cancer is divided into three sub-groups: IIIA, IIIB and IIIC. In stage IIIA, the cancer hasn’t spread outside the prostate, has a PSA level of 20ng/mL or higher, a Gleason score of 8 or less, and grade group score of 1 to 4.

Stage IIIB has spread outside the prostate and may have reached the seminal vesicles or the surrounding tissue, but it hasn’t reached the lymph nodes or other parts of the body. It may have any PSA level, but a Gleason score of 9 or 10, and grade group score of 5.

Stage IIIC prostate cancer may or may not have spread to the lymph nodes or other nearby organs. It has any PSA level, but a Gleason score of 9 or 10 and a grade group score of 5.

Stage III prostate cancer is treated through a combination of external beam radiation and hormone therapy. In some cases, brachytherapy or radical prostatectomy—with removal of pelvic lymph nodes—is considered. Active surveillance isn’t used for stage III prostate cancer because there is a higher risk of disease progression if not treated.

  1.     Stage IV prostate cancer

This is the most advanced form of prostate cancer. The cancer has typically spread to distant parts of the body and affected several organs. Stage IV prostate cancer is divided into IVA and IVB. Stage IVA tumor has spread to nearby lymph nodes but hasn’t reached other areas of the body. Stage IVB tumor has reached distant lymph nodes and many other areas including bones or organs.

The treatments for stage IV prostate cancer include hormone therapy, chemotherapy, external beam radiation, targeted radiation and potentially prostate surgery.

Effective, state-of-the-art treatment

Successful treatment of prostate cancer depends on regular screening to increase the chances of early detection, correct grading of the cancerous cells, and proper staging of the cancer. Early detection ensures a higher survival rate just as the right staging ensures that the treatment administered is safe and effective.

At St Pete Urology, after a diagnosis, our skilled and experienced urologists select the right tests to determine the stage of the cancer. Then through a multidisciplinary approach, we provide a tailored treatment with the highest potential of achieving the best possible outcomes.

Call us today to book your screening, diagnosis and treatment of prostate-related problems. For more information on prostate cancer and other urological disorders, visit https://stpeteurology.com/

References

What are the key signs of prostate cancer?

Key takeaways

  • Prostate cancer occurs when prostate cells grow and multiply uncontrollably, and can be malignant and life-threatening if it spreads to other parts of the body.
  • Early-stage prostate cancer does not have any unique signs or symptoms and is difficult to detect, making regular screening and testing important for early detection.
  • Common screening tests for prostate cancer include the PSA test and the DRE, and men who are 55-69 years old, African-American, or have a family history of prostate cancer should consider getting screened.

The prostate is a tiny, walnut-shaped gland in the pelvis. Located near the bladder and felt through a digital rectal exam, the prostate produces the fluid that transports and nourishes sperm. The fluid—called seminal fluid—is squeezed out via the urethra during ejaculation.

What is prostate cancer?

Prostate cancer occurs in the prostate when prostate cells grow and multiply non-stop. The growth of the prostate can either be benign or malignant. Benign growth of the prostate, also called benign prostatic hyperplasia, is rarely a threat to life as it doesn’t invade tissues around your prostate, doesn’t spread, and can be removed or shrink back.

On the other hand, prostate cancer is a malignant growth that can spread to nearby organs like the bladder or rectum and is, therefore, a threat to life. This cancer can spread to other parts of your body and may grow back after removal.

When prostate cancer cells break away from the prostate, they can spread through lymph nodes or blood vessels to other parts of your body. 

Upon spreading, the cancer cells attach to other tissues and grow to form new tumors that cause damage in the areas where they land.

Prostate cancer is one of the most common types of cancer. 

Although most cases of prostate cancers grow slowly and are restricted to the prostate gland, where they tend to cause little harm, some types of cancer are aggressive, spread quickly, and are life-threatening.

What are the key signs of prostate cancer?

Early-stage prostate cancer doesn’t have any unique signs or symptoms. It starts in the outer areas of the prostate and grows slowly. These areas are away from the urethra, so the growing tissue mass does not press against the tube and affects your urination.

There are no early urinary signs of prostate cancer. When symptoms occur, they are usually related to the non-cancerous condition called enlarged prostate or another health condition.

Nevertheless, as the tumor grows and spreads, it begins to affect the organs around the prostate. So with time, it will eventually show signs as it breaks out of the gland (locally advanced prostate cancer) or spreads to other areas of the body (advanced prostate cancer).

Unfortunately, even late-stage prostate cancer shares signs with other urological disorders, making it difficult to tell whether it is due to cancer or other conditions, such as prostatitis or benign prostate enlargement (BPH). 

That is why the key to establishing if you have prostate cancer is seeing a urologist, who will order tests to help find out what is causing the symptoms.

When they occur, the symptoms of prostate cancer include:

  1. Dull pain in the lower pelvic area
  2. Trouble starting to urinate or to empty your bladder
  3. Interrupted or weak urine flow
  4. Dribbling of urine after urinating or a feeling that the bladder hasn’t emptied properly
  5. Frequent urination, particularly at night
  6. Pain or burning sensation when urinating
  7. Difficulty having an erection, painful ejaculation, or decrease in the amount of ejaculate
  8. Blood in urine or semen
  9. Pain or pressure in the rectum
  10. Persistent pain in the back, hip, or pelvis
  11. Unexplained weight loss
  12. Bone pain
  13. Loss of appetite

Diagnosis of prostate cancer

Prostate cancer is highly treatable when detected early. But for the condition to be discovered early, frequent screening is necessary. 

Screening means you undergo testing even though you have no symptoms. The prostate-specific antigen (PSA) test and the digital rectal examination (DRE) are the most commonly used screening tests. Both help detect cancer early, although they aren’t perfect tests.

Speak with your urologist about whether or not you should undergo screening. Your doctor will assess your degree of risk and decide whether you should have the PSA test and the DRE. Generally, you should be screened if you are 55-69 years or older, African-American male, or have a family history of prostate cancer.

If the screening tests show that you might have cancer, your doctor will recommend a biopsy for confirmation. The decision to have a biopsy is based on the PSA and DRE results. Your doctor will also consider family history, ethnicity, and other health factors.

At St Pete Urology, we offer screening, diagnosis, and treatment of prostate cancer. Through our patient-centered, compassionate approach to care, we have ensured that most of our at-higher-risk clients are enrolled in screening.  

We have employed a collaborative, multidisciplinary approach that ensures all our patients get the best possible care. 

Call us today for more information on prostate cancer and other urology disorders.

References

7 Tips for Keeping a Healthy Prostate

Prostate problems are common in men over 40. The prostate, a tiny walnut-sized gland found only in males, surrounds the urethra and produces a thick, white fluid that mixes with sperm to form semen. Though smaller early in life, the gland grows bigger with age and can sometimes become enlarged or swollen by conditions such as prostate enlargement, prostatitis or prostate cancer.

All men, no matter their age, can find themselves dealing with a prostate issue, which is why every man should be concerned about his prostate health. Fortunately, there are easy ways to prevent or reduce the risk of developing prostate health problems.

Here are 7 tips for keeping your prostate healthy:

1. Eat more fruits and vegetables

Fruits and vegetables are great sources of anti-inflammatory and anticancer compounds, such as polyphenols, antioxidants, minerals, vitamins and fiber. Plants that boost prostate health are plentiful and include favorites such as tomatoes, broccoli, cauliflower, bok choy, cabbage, Brussels sprouts, pink grapefruits, watermelons, papaya and guava. Equally powerful are green leafy vegetables like spinach, lettuce, spring mix and kale which contain cancer-killing ingredients such as folic acid, vitamin D, turmeric and curcumin. Be sure to add fruits and vegetables to your everyday meals to boost your prostate health!

2. Eat more plant proteins and cut down on animal fat

You should avoid diets that are high in animal fat, including dairy products and red meat. Heavy consumption of red meat increases your risk of prostate cancer. So go for lean proteins, such as fish and chicken, but avoid grilled meat since grilling produces carcinogens that can inflame your prostate. Instead try baking, steaming, or broiling your meat.

High animal fat intake reduces antioxidant production in the body. And since it is the antioxidants that help to maintain a healthy prostate, excess fat diminishes prostate health. A good option for a healthy prostate is fish, which contains omega-3 acids that minimize the risk of prostate problems. Fish such as tuna, herring or salmon are good choices, but if fish is not your thing, then walnuts and flaxseed can be great sources of omega-3 acids.

Ideally, you should go for whole, natural foods that provide a lot of fiber. Soy is also good for your prostate and you can get it through sources like soy nuts, soy flour or tofu. Likewise, you should eat foods rich in selenium such as wheat germ, tuna, beef liver, eggs, sunflower, cashews, sesame seeds, mushrooms, onions, garlic and kidneys. Selenium boosts prostate health and minimizes the risk of prostate cancer.

3. Achieve a healthy weight

Obesity has been associated with various prostate health issues, including prostate cancer. If you are overweight, cutting back your weight, particularly abdominal fat, reduces the risk of BPH. In fact, if you desire to shrink your prostate size and get relief from annoying urinary symptoms, weight loss is valuable. Weight loss also helps reduce the risk of prostate cancer and relieves prostatitis.

4. Regular exercise

Moderate or vigorous activity minimizes the risk of BPH, urinary tract symptoms and prostatitis. Regular exercise also decreases stress, releases tension, improves immune function and maintains healthy hormone levels, all of which are important for a healthy prostate.

Aim for at least 30 minutes of moderate or intense physical activity every day. Try walking, swimming, running or bicycling, and make sure your exercise routine is not boring by varying your activities and even inviting friends to join you.

5. Drink tea

Both green tea and hibiscus tea contain potent antioxidants. Studies show that regular intake of tea helps with prostatitis, BPH and prostate cancer. Green tea also slows down the growth of aggressive prostate cancer.

Make sure to choose caffeine free sources of tea since caffeine irritates both the prostate and bladder and worsens symptoms of prostatitis. As a measure to cut down on caffeine intake, make sure to reduce energy drinks, coffee and soda.

Like tea, water is also great for the prostate. Drinking plenty of water will help you remain hydrated and enjoy normal prostate function. Make sure to drink at least 8 glasses of water every day, and to increase water intake during and after exercise.

6. Avoid smoking

Smoking affects every cell in your body. In fact, when cigarettes are burned, they are complete carcinogens. While smoking has less effect on low-grade or benign prostate cancer, it increases the risk of fatal prostate cancer. The heaviest smokers have 24-30 percent higher risk of death from prostate cancer than non-smokers. Smoking also increases the risk of prostate cancer progress after diagnosis.

Studies also show that smoking indirectly promotes benign prostatic hyperplasia (BPH) and increases prostate inflammation. Apart from smoking, alcohol use and inadequate sleep may adversely affect your prostate health. Also, a healthy sex life is good for your prostate.

7. Talk to your doctor

Do you have family history of prostate cancer? Let your doctor know. Remember that having a father or brother who has had prostate cancer more than doubles your risk of developing the disease. Speak with your doctor about your risk of prostate issues and explore the medical screening tests you should undergo as you age, follow dietary recommendations and be alert to any risk factors.
If you intend to begin a new exercise program, make sure to inform your urologist about it. Your doctor should know if you are experiencing symptoms such as:

  • Discomfort or pain anywhere in your rectal or pelvic area
  • Blood in your urine or semen
  • Difficulty or pain when urinating

Are you or your loved one suffering from a prostate problem? St Pete Urology offers specialty urology services in a state-of-the-art facility and surgery center in St. Petersburg, Florida. We provide the latest innovations in surgical techniques and medical technology, delivering comprehensive care to those with urologic conditions. For more information about the prostate gland, BPH and prostate cancer, visit the St Pete Urology website.

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How do you keep your prostate healthy?

Prostate health is an important part of overall health for men. The prostate is a walnut-sized gland situated between the bladder and the penis. The urethra, the tube through which urine exits the body, runs through the prostate. One of the prostate’s main functions is producing a fluid that nourishes and protects sperm. For men, the prostate is an important part of both the urinary and reproductive systems.

The prostate is also the organ where the most common form of cancer for men develops. This cancer affects many men and the chances of developing it increase with age. The prostate also grows in size as men age. The rate and side effects of this growth can vary, but the most common symptoms are difficulty urinating and having to urinate frequently.

Given the importance of the prostate’s role and how easily it can develop problems, good prostate health is important. Luckily, there are simple lifestyle changes that can help improve prostate and overall health. These changes start with diet and exercise. There is a great deal of evidence that diet can help determine prostate health as well as cancer risk. It is recommended to have at least five servings of fruits and vegetables a day. Whole-grain bread and pastas are also recommended.

Protein is an important food group and eating the right kinds of protein plays a big role in prostate health. It is recommended to limit the intake of red and processed meats. Healthier sources of protein include fish, chicken, beans and eggs. Like protein, consuming the right fats is important, too. Healthy fats from olive oil, nuts, and avocados are much better than fats from animal byproducts or the trans fats found in fast food.

Sugar, salt and exercise play a role in prostate health as well. Sugary drinks like soda should be limited or cut out completely. Sweets in general should be an occasional treat, not a food group in your diet. Salt intake should be cut down for prostate health and keep in mind that most processed foods are very high in salt content.

Exercise is also important for maintaining good prostate health. There is evidence that regular exercise helps bring down the risk of stroke, heart disease and certain types of cancer.

Small changes to diet and exercise can add up to big health improvements, but there is still more you can do. Another important tool in keeping your prostate healthy is having a good relationship with your urologist. Yearly prostate exams and an open dialogue with a trusted urologist is key to maintaining prostate health and resolving issues early, before they turn into serious health problems. The urologists at St Pete Urology are dedicated to helping you keep your prostate healthy.

BPH: What Is It and What Causes It?

BPH: What is it and What Causes it?BPH is the abbreviation for benign prostatic hyperplasia, also called prostate gland enlargement, a condition commonly found in men as they age. Enlarged prostate glands can cause serious urinary issues such as blocked urine flow, urinary tract issues and kidney problems. The treatments for BPH include medications and minimally invasive surgery.The most common symptom is an urgent and frequent need to urinate. These may be accompanied by a difficulty beginning urination, a weak and interrupting stream, extended dribbles at the end of urination, or an inability to completely empty the bladder during urination. Urinary tract infections and bloody urine are other less common symptoms.

It is important to note that the size of the prostate does not necessarily correlate to the enlargement of the prostate. For instance, some men may have prostates that are only slightly enlarged and still suffer from symptoms worse than men with far greater enlarged prostates.

The prostate gland is found just below the bladder, and the tube that allows urine to exit the body runs directly through it. This is why urine flow is affected when the prostate enlarges. The primary cause of BPH is not fully known, but it may be related to changing sex hormone levels in men as they age.

The main risk factor for BPH is aging. Although BPH rarely affects men under 40, one-third of men between the ages of 40 and 60 experience it. And half of men experience it by age 80. Family history also plays a role in your chances of developing these problems. Men with a blood relative with BPH are more likely to develop it themselves. Diabetes, heart disease and obesity all increase the risk factors as well, while exercise helps lower them.

There are several complications that can result from BPH. The most common one is the inability to urinate, which may require a catheter if severe enough. Urinary tract infections can occur as well. Bladder stones and bladder damage may occur when the bladder cannot be fully emptied, which is more likely to happen to someone with BPH. Kidney damage is another complication that occurs when pressure that has built up in the bladder directly damages the kidneys.

Although common, BPH is a serious condition that can negatively affect quality of life and well being. But with many treatment options available, men can find relief by promptly seeking medical help. The doctors at St Pete Urology specialize in treating these issues and improving the lives of men as they age. For more information, visit the St Pete Urology website or make an appointment for a consultation.

Prostate Cancer: Symptoms and Signs

What is Prostate Cancer?

Prostate cancer only affects men because it occurs in the prostate, a small gland located below the bladder that produces the male seminal fluid to nourish and transport sperm.

What Are The Symptoms of Prostate Cancer?

Some cases of prostate cancer are silent. However, there are signs that might indicate the condition:

  • Urinary and Other Problems:
  • difficulty starting or maintaining a steady stream of urine
  • frequent urination and leakage of urine
  • excessive nighttime urination urge
  • leaking small amounts of urine
  • weak urination stream or straining to empty the bladder
  • blood in the urine or seminal fluid
  • onset of erectile dysfunction
  • discomfort when sitting

Risk factors

Factors that may increase your risk of prostate cancer include:

  • Age
  • Family history
  • Race
  • Obesity

Prostate cancer is one of the most common types of cancer affecting men. When detected early and still contained to the prostate gland, it usually grows slowly. When initially confined to the prostate gland, it may not cause major harm. Prostate cancer that has been detected early has a better chance of successful treatment.

Treatment and Diagnosis

If you or your loved one is experiencing the signs or potential risk factors, it is best to make an appointment with a urologist. The urologist can take a biopsy, which is the only sure way to know if you have cancer. Additional steps that your doctor may employ include:

  • A PSA test
  • A DRE (this is a manual exam)
  • Biomarker tests

Like any cancer, early detection and intervention are key to resolving it. If not caught and treated early, the cancer can metastasize or spread.

Untreated, prostate cancer can spread to nearby organs such as the bladder, or to the bones or other organs, through your bloodstream or lymphatic system. If prostate cancer reaches the bones, it can cause pain and broken bones. As prostate cancer advances, it can be treated and somewhat controlled but it is unlikely to be cured at a later stage.

Prostate Cancer Prevention

Doctors recommend the following changes to prevent prostate cancer. These recommendations are healthy lifestyle changes for all individuals:

  • Choose a healthy diet full of fruits, vegetables and whole-grain foods.
  • Avoid high-fat foods.
  • Exercise at least 3 to 4 times a week.
  • Maintain a weight that is healthy for your body mass.

Men who face a higher risk of prostate cancer may consider medications or other treatments. Your urologist may prescribe 5-alpha reductase inhibitors. Not only do these drugs reduce the overall risk of developing prostate cancer through controlling prostate gland enlargement, they also may reduce hair loss.

Many men would rather avoid prostate exams and knowing if they have prostate cancer. They may fear that if cancer is detected they will experience impotency or incontinence because of treatment. However, recent medical developments have made such concerns unnecessary. To learn more about prostate problems, visit the St Pete Urology website or make an appointment for a consultation.

How to tell if your prostate is enlarged?

The prostate gland is an integral part of the male reproductive system. It secretes seminal fluid, which nourishes sperm as they grow and facilitates their transportation during ejaculation. It is located between the bladder and the rectum and surrounds the base of the urethra. Due to its location next to key parts of the urinary system, the health of the prostate gland tends to have a direct impact on the health of a man’s urinary system.

The prostate gland grows larger as a man ages. While this gradual enlargement is normal, by the time a majority of men turn 50, the prostate has reached a size where it may start to affect the normal functioning of the urinary organs near it. It is at this point that a man is said to have an enlarged prostate, or clinically speaking, benign prostate hyperplasia (BPH).

Signs and Symptoms of an Enlarged Prostate

An enlarged prostate presses, pinches or causes a blockage in the urethra. The urethra carries urine from the bladder to outside the body. The direct effects of an enlarged prostate are manifested by difficulty in the discharge of urine. These difficulties could be in the form of:

1. Frequent and sudden urges to discharge urine;

2. Difficulty starting a urine stream;

3. Weak urine stream; and

4. Dribbling urine.

If left untreated, the effects of an enlarged prostate can cause the following complications:

1. Acute Urine retention. This is a complete inability to pass urine. Medical attention must be sought immediately if this occurs;

2. Urinary tract infections;

3. Blood in the urine;

4. Pain when passing urine; and

5. Pain in the lower abdomen.

Sometimes an enlarged prostate does not produce symptoms. When this occurs in some men, it may not even be possible to diagnose the condition because it gives them no trouble at all.

The key to diagnosing and treating an enlarged prostate lies with frequent prostate monitoring by a qualified urologist. Men approaching age 50 should get tested or at least keep a watch out for any of the symptoms listed above. The good news is there are many successful treatment options for the condition. Our specialists at St Pete Urology are experienced and well qualified to help with any questions, concerns and treatment. If you think you may have an enlarged prostate, or are experiencing any problems, by all means contact us. For more information, visit the St Pete Urology website.

What is a PSA Test and When Should You Get It?

The PSA test measures the level or amount of PSA (prostate-specific antigen) in blood. The prostate-specific antigen is a protein synthesized by both non-cancerous and cancerous tissue in the prostate — a tiny gland found below the bladder in men. After it is produced, the PSA finds its way into semen and in small quantities in the blood. But since cancerous cells produce more PSA than non-cancerous cells, the test is carried out to detect high levels of PSA in blood, which may indicate the existence of prostate cancer.

What are the benefits of the PSA test?

Early detection of certain types of prostate cancer is critical for successful treatment and recovery. When the PSA test shows elevated levels of the antigen in blood, it may help to identify prostate cancer that is likely to grow quickly or spread to other parts of the body. In turn, the test helps to catch and treat such cancers early before they begin causing serious symptoms or become life-threatening. Also, by enabling early detection of prostate cancer when the necessary treatment is less aggressive, the test reduces the risk of certain adverse effects of treatment, such as urinary incontinence and erectile dysfunction.

What are the risks associated with the PSA test?

Carrying out the test itself comes with very little risk. It requires only a simple drawing of blood used to run the test in a laboratory. However, once the results of the test are out, there are a number of potential downsides involved. For instance, since false positives are quite common and elevated PSA results may have other causes other than prostate cancer, including prostate infection (prostatitis) and enlarged prostate (BPH), the test results may expose some patients to unnecessary or inappropriate treatments.

Some types of prostate cancer don’t produce much PSA, which means that a test may incorrectly indicate that you don’t have the cancer (a false negative). And follow-up tests for checking out the underlying causes of an elevated PSA test are often stressful, invasive, time-consuming or expensive. Furthermore, living with a localized or slow-growing prostate cancer — one that doesn’t require treatment — can cause stress and anxiety.

When should you get your first PSA test?

Before you get the first PSA test, it is recommended that you discuss the benefits and risks of the test with your doctor. During the discussion, a comprehensive review of your risk factors and preferences is done. For example, the urologist will consider your age, race, size of your prostate, medications you are taking (dutasteride and finasteride affect PSA levels), and how frequently your PSA levels change when making a decision about getting the test.

At St. Pete Urology, we advise men who are at higher risk of the disease, such as African American men and those with a brother or father who have had the cancer, to get their first test at the age of 40-45. Having the test before you reach 50 helps us to establish your PSA baseline and thereafter monitor the changes in your PSA levels to determine whether or not you’ll need annual PSA screening and prostate biopsy. If your blood PSA level is very low, we’ll put off any further PSA tests. But if you are a man of moderate to low risk of the disease, we recommend you get your first PSA test at age 50 or older (generally between 55 and 70).

What happens if your first PSA test result is high?

If you don’t have symptoms of prostate cancer, another PSA test may be recommended if your first test showed an elevated PSA level. The second test is used to confirm the validity of the original finding. But if the second PSA test still gives elevated PSA level, the urologist may direct that you continue with more PSA blood tests and digital rectal exams (DREs) at frequent intervals to monitor any changes in your prostate over time.

If your blood PSA level continues to rise over time or the urologist finds a suspicious lump in your prostate during a DRE, additional tests may be suggested to establish the nature of the problem. For example, a urine test may be run to find out if you have a UTI (urinary tract infection). Imaging tests like X-rays, cystoscopy or transrectal ultrasound also may be recommended. Then if prostate cancer is suspected, the urologist carries out a prostate biopsy — collecting multiple samples of tissue from your prostate by inserting hollow needles into the gland and withdrawing tissue. The tissues are examined under a microscope by a pathologist to confirm the cancer.

Treatment of prostate cancer

The type of treatment recommended for prostate cancer usually depends on whether it is early-stage or advanced-stage disease. For early-stage cancer the options include watchful waiting, radical prostatectomy, brachytherapy, conformal radiotherapy and intensity-modulated radiation therapy. At St Pete Urology, watchful waiting means no immediate treatment is offered but the cancer is closely monitored through regular PSA tests. Prostatectomy involves surgically removing part of or the entire prostate; brachytherapy involves implantation of radioactive seeds into the prostate to deliver specific amounts of radiation to the tumor. Conformal and intensity modulated radiotherapies deliver targeted amounts of radiation to the tumor with minimal damage or exposure of healthy tissues.

For advanced-stage prostate cancer, which is typically a more aggressive tumor that grows quickly and spreads faster to other areas of the body, treatment includes chemotherapy and androgen deprivation therapy. Chemotherapy can eliminate cancer cells that have spread to other parts of the body. Likewise, androgen deprivation therapy (androgen suppression therapy or ADT) is used to reduce the effect of androgens — male hormones that stimulate cancer growth — thereby slowing down or stopping cancer growth.

At St Pete Urology, we talk to our patients openly and candidly about the risks and benefits of the PSA test before we can advise them to get it. We also discuss the results of the tests, give our recommendations for those with positive results and typically repeat the PSA test for those with negative results. Our patients have always told us that our attention to detail, quality of interactions and efficiency during their visits is unmatched. If you would like to know more about the PSA test, visit the “St Pete Urology” site.

What kinds of prostate problems are common in men over 50?

The prostate is a tiny walnut-sized gland that surrounds the urethra. But with hormonal changes that come with age, men of all ages usually experience changes in their prostate. As a result of these changes, prostate issues are quite common in men, particularly older ones. For example, the prostate often grows and swells with age, compressing the urethra and causing urinary issues.

Benign Prostatic Hyperplasia

With the prostate, there are usually two main issues: benign prostatic hyperplasia and prostate cancer. For men older than 50, benign prostatic hyperplasia (BPH) is the most frequent prostate issue. BPH, also called an enlarged prostate, means a non-cancerous increase in the number and size of prostate cells — so basically, it is an unhealthy increase in prostate size. While what triggers BPH isn’t well understood, it is believed that factors such as aging, inflammation, fibrosis and hormonal changes are the causes of the condition.

An enlarged prostate presses hard on the urethra and makes urination difficult. In men with the condition, symptoms include:

  1. Frequent urination, particularly at night.
  2. Difficulty starting a urine stream.
  3. Dribbling after passing urine.
  4. Weak urine stream, or a stream that starts and stops.
  5. Inability to empty the bladder completely.

But BPH also may have rare and more severe symptoms like:

  1. Urinary tract infection
  2. Blood in urine
  3. Inability to urinate

Prostate cancer

Prostate cancer is another frequent condition in men. In fact, it is the most common cancer after skin cancer, with about 1-in-6 American men being diagnosed with the disease during his lifetime. And like BPH, the cancer is most common in older men, with two-thirds of men diagnosed with the condition usually over age 65.

The cause of prostate cancer isn’t clear, but risk factors include age, family history, race and diet. The cancer grows slowly and rarely shows symptoms, so most men may never know that they have developed the disease until it is in advanced stage. But that also means only around 1-in-35 men with the cancer dies of the disease. Nevertheless, while some prostate cancers grow slowly and often require no or minimal treatment, there are other types that are quite aggressive and spread really quickly.

When caught early, there is a better chance of successfully treating the cancer. However, since it has similar symptoms to BPH, the condition is quite difficult to diagnose and by the time men see blood in their urine or feel chronic pain in their thighs, hips or lower back, it is often quite late. That is why it is critical for men of average to high risk of the cancer to have annual screening as early as appropriate.

Actually, for men of average risk of prostate cancer, the discussion to begin screening should start at the age of 50. While for those of higher risk, it is prudent to begin this discussion a little earlier, though not earlier than 40. But before screening, it is vital to discuss the risks and benefits of the testing with the doctor so the test offered meets the personal preferences and values of the patient.

For more information on prostate problems and how to prevent, diagnose and treat them, visit the “St Pete Urology” site.