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Prostate Cancer
Health Guide
Prostate cancer obviously effects only men but it accounts for around 7 percent of all cancers for men. By the age of 80 years, 80% of all men have malignant foci within the gland. Fortunately most of these lie dormant and inactive.

Symptoms and Diagnosis

Presentation is usually with symptoms of lower urinary tract obstruction, (with the inability to urinate freely). The initial diagnosis may be made with rectal examination. In-fact, discovery may be made as a part of some other routine examination, such as with a prostate specific antigen test (called a PSA test). However, to attain an absolute positive diagnosis a prostate biopsy needs to be performed. Your GP will recommend you see a specialist called a urologist for this condition if suspected.

Indications for biopsy

There are four basic reasons why your urologist would recommend that you receive an initial prostate biopsy:

* You have an elevated standard PSA level (of 4.0 ng/ml or more).

* There is a significant change in your standard PSA level over time.

* You have a standard PSA level of between 2.5 and 10.0 ng/ml and a low free/total PSA ratio as indicated by the PSA II test.

* You have a suspicious-feeling prostate on digital rectal examination.

How is a prostate biopsy done?

Essentially a biopsy involves using a needle to remove prostate tissue to check if there is cancerous cells present. The urologist will often ask you to have an enema prior to carrying out the biopsy, but there is no need for anaesthesia. You will almost certainly be given an antibiotic in order to prevent any possible infection. Finally, you will likely be asked to stop taking certain drugs for one or two weeks before the biopsy in order to minimize the risk of bleeding problems.

In carrying out the actual biopsy, using transrectal ultrasound (TRUS) to guide the precise placement of the biopsy needle, the urologist will take six or more samples of tissue from the prostate and then send them to the pathologist for examination. Atleast six evenly spaced specimens from different areas of the prostate are taken, as well as any areas of which look suspicious according to the ultrasound. This way the urologist will maximize the chance of finding prostate cancer tissue if it is there in the prostate.

What happens to the biopsy specimens?

The urologist will send the biopsy specimens to a pathologist for evaluation. A pathologist is a physician who has specialised in viewing tissues of he body and diagnosing abnormalities.

The pathologist will then study these specimens carefully under a microscope, and will send a report back to the urologist. This information is designed to help the urologist (and the patient) in deciding what to do next.

Treatment of Prostate Cancer

Treatment of prostate cancer depends on the stage of progression of the disease. Currently available treatment options for some stages of prostate cancer are potentially curative, but for locally advanced cancers the chance of being cured are lessened. Patients first diagnosed with metastatic prostate cancer complete cure is unlikely.

Treatment involves the following or combination of the following:

Watchful waiting

It is important that you understand that "watchful waiting" or "active surveillance" really is a form of treatment. For carefully selected men it may well be the best possible option. The doctor will carefully and regularly monitor the potential indicators of progression, including carrying out regular PSA tests and rectal examinations, as well as other possible tests such as transrectal ultrasound.

Watchful waiting is generally practiced on patients who, for some reason, the physician believes will be better served by avoiding curative treatments such as surgery or radiation. Age or other health problems may influence this decision. Also if the patient strongly that he would prefer the risk of disease

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