Diagnosis of Prostate Cancer

The cause of prostate cancer is unknown. It is known, however, that the growth of normal cells and cancerous prostate is stimulated by male hormones, particularly testosterone.

Compared to other cancers, prostate cancer develops relatively slowly. In fact, many men with prostate cancer will not die from the disease, but with the disease. As a man ages, his risk of developing prostate cancer increases. Over 75% of cases are diagnosed in men over 65 years of age.

When a cancerous tumor is small and is located only within the prostate, the cancer is often not detected. The cancer may not cause symptoms and may be too small for a doctor to get it palpable during a routine examination of the prostate. The doctor performs this examination, which receives the name of digital rectal examination (DRE - digital rectal examination), by inserting a finger into the rectum to feel the size and shape of the prostate.

A man can live for many years without finding out they have cancer. As the cancer grows, however, the prostate can eventually squeeze the urethra, which is surrounded by the prostate. Then, symptoms such as difficulty urinating. Generally, this is the first symptom of prostate cancer. (It is important to note, however, that the difficulty in passing urine can be caused by other non-cancerous conditions of the prostate and not always mean that prostate cancer is present).

With or without symptoms, a growing cancer can also start attacking the cells near the prostate. Simultaneously, the cells may be released from cancer and spread to other parts of the body such as the lymph nodes, lungs, and bones, especially the hip bones and lower lumbar region. The most common symptom of this spread is bone pain.

As the primary prostate tumors, tumors that have spread to other parts of the body can expand and compress these other parts.

The American Cancer Society (ACS) has developed guidelines to help doctors detect prostate cancer in its early stages. The ACS recently revised these guidelines to reflect new scientific knowledge. The new guidelines recognize that screening for prostate cancer, including a DRE and annual test to measure prostate-specific antigen (PSA - prostate-specific antigen) in the blood, should be offered to the general male population aged greater than or equal to 50 years of age.

Moreover, men with two or more first degree relatives affected by the disease, or those with african-American origin, should start screening for prostate cancer at an earlier age. Although there is still some disagreement on this matter and until there is more scientific evidence, age 45 years of age may be an appropriate time for men with higher risk begin screening.

There are some circumstances in which prostate cancer screening can not be recommended. How prostate cancer can be a cancer that develops slowly, a man with a life expectancy less than 10 years will probably pass away due to some other disease and probably would not benefit from screening and treatment for prostate cancer. For this reason, the new ACS guidelines include guidance for patients that explains the risks and benefits of screening for prostate cancer.

You and your doctor can discuss the ACS guidelines together and determine if screening is appropriate for you and, if so, when should you start it.

PSA is a substance produced by normal cells and prostate cancer. When prostate cancer is developed or when other prostate disorders are present, the amount of PSA in the blood often increases. The new ACS guidelines advise men with high PSA results showing a doing a biopsy. This will help determine if cancer is actually present.

A PSA test can usually be considered within the normal range when present values between 0 and 4 nanograms per milliliter, sometimes appearing in abbreviated form (ng / ml) in the laboratory report. If the results are within the range above (reported as being greater than 10 ng / ml), certainly doctor may suggest a biopsy.

Sometimes, PSA results are in borderline or gray zone. This occurs when the result is between 4 to 10 ng / ml. The results of the PSA test in this range can be conflicting and not always mean that cancer is present. Certain other conditions, such as benign prostatic hyperplasia (a type of non-cancerous growth of the prostate, also called BPH) and prostatitis (inflammation of the prostate) can cause an abnormal PSA in the test.

If your doctor believes that the rise in PSA is due to benign disease (eg, prostatitis) you may have to wait and repeat the PSA test a few months later and, if necessary, a biopsy later. The new ACS guidelines suggest a biopsy for any man with abnormal DRE results, even if the PSA is normal.

Because of PSA testing in the gray zone may be conflicting, your doctor may advise you to take one or more PSA tests more modern.

The percentage ratio of free PSA / total PSA is a blood test that measures the amount of PSA circulates free (unbound) amount bound in the blood and other blood proteins. If the PSA results are borderline and the percentage ratio of free PSA is low (less than or equal to 10%) then it is more likely that prostate cancer is present. If this is the case, a biopsy may be needed. If the results of the percentage ratio of free PSA are normal, even with a borderline PSA, biopsy is not required.

Another way to examine the PSA involves the adoption of the reference values for PSA specific to different age groups. Higher levels of PSA are normally observed more frequently in men with older ages than at younger men, even without cancer. A range of reference values for PSA specific to different age groups compares the results of the men within the same age group. If PSA levels are high for a man in relation to his own age group, then there is a greater chance that prostate cancer is present.

In men with older ages with results of borderline PSA, this comparison can be more useful than conflicting. As a result, the reference values for PSA specific to different age groups are not routinely adopted.

If your PSA level has already been measured and a TRUS (Transrectal Ultrasound) has also been performed, then it can be determined PSA density (PSAD). To determine which is the PSAD, your doctor will divide the numerical value of serum PSA by size, or prostate volume (the results of TRUS). The chance of getting prostate cancer is higher when the PSAD is high.

Finally, PSA velocity will show how quickly the PSA level increases during a period of time. Two or more PSA tests are often required during the course of several months. Although PSA velocity may be useful in helping your doctor to better interpret the result borderline PSA, in fact she is not used to diagnose prostate cancer. Instead, it is mostly used as a tool to keep track of how their PSA levels are compared for a certain period of time.

Often the PSA increases as part of the natural aging process, an increase in PSA that occurs from time to time does not necessarily indicate that prostate cancer is present. Furthermore, if the PSA increases very rapidly, ie morfe than 20% from baseline to year (as determined by his physician), there is a possibility of prostate cancer.

If your PSA is borderline or abnormal, your doctor can help you determine which tests are right for you. To detect prostate cancer and to determine the size and extent of spread or stage of the disease, your doctor may perform tests involving palpation of the prostate exam in the internal parts of the body, measure the levels of substances in the blood, and examination samples of prostate cells. Click here for descriptions of specific tests.

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700 Women with urinary Cancers missing out on prompt diagnosis each year

Main category: Urology / Nephrology
Also included in: Cancer / Oncology;??Women's health / Gynecology
Article Date: June 25, 2013-0:00 PDT current ratings for:
700 Women with urinary Cancers missing out on prompt diagnosis each year

Family physicians can be attributing symptoms of cancer of the bladder and kidneys, causes harmless

About 700 women in England with the symptoms of cancer of the kidney or bladder are missing out on a fast diagnosis and treatment of their condition, each year, research reveals in the journal online only BMJ Open.

It may be because of family physicians tend to give women, rather than men - first symptoms benign causes, such as bacterial infections and some women therefore need to visit their doctor several times before they are referred to a specialist, i.e. researchers.

Currently, the survival rates for cancer of the kidney and bladder in England show that fewer women than men living five years after diagnosis.

The researchers studied the numbers of patients diagnosed as cancer of the kidney and the bladder in England between 2009 and 2010. They used data from the National Audit of the diagnosis of Cancer in Primary Care, covering general practices representing 1170 - equivalent to about 14% of the total national. They studied two interrelated measures of the speed of diagnosis: the number of consultations, the patient is before he transferred. and the time interval between the first visit to the GP with symptoms and specialist referral.

In total, 920 patients have been diagnosed with cancer of the bladder during the study period, 252 (27%) were women; and 398 have been diagnosed with cancer of the kidney, 165 (42%) were women. These proportions are similar to national figures: 28% and 38%, respectively.

Women were nearly twice as likely than men to have consulted their doctor three or more times, before they were referred to a specialist, the analysis showed.

About one in ten (11%) men with bladder cancer had three or more visits before referral, compared to 27% of women. The corresponding figures for the kidney cancer were 18% and 30%.

The interval between the first GP consultation mean and specialist orientation is a not differ greatly between men and women - four against six days for bladder cancer and 10 to 16 days for kidney cancer. But among the 25% of women experiencing more delays, it took two more weeks to get referred that the 25% of men with longer deadlines. When this has been reduced to 10% of those who know longer delays, the figure rose to more than two months for women with bladder cancer and more than three weeks for those who have cancer of the kidney, compared with men.

Two-thirds of all patients with cancer of the bladder and a quarter of people with kidney cancer had blood in their urine (Hematuria), a symptom of the red flag for further investigation.

But the presence or absence of this symptom could not explain the difference between the sexes in the period of reference, the analysis said.

Even when they came to see their doctor with hematuria, women with bladder cancer were more than three times as likely to have three or more visits GP before the switch compared to men with the same symptom.

And women with kidney cancer were almost twice as likely as men to discover three or more consultations, when he had blood in their urine.

As nearly 3,000 women are diagnosed every cancer each year in England, the authors calculate that about 700 women will experience delays in diagnosis.

Reinforce the need to follow the guidelines and view the blood in the suspicious urine could encourage GPs to guide women faster, but it will not help in cases where this symptom is not present, warn the authors, requiring new approaches to address this problem.

"Great potential to improve the speed of diagnosis of cancer of the urinary tract in women, the conclusions of signals", the authors write. "Interventions to prevent the initial allocation of hematuria in women with cancer of the urinary tract to cause benign [GPs] must be quickly developed and evaluated," they urge.

Article adapted by Medical News Today press release original. Click on "references" tab above for the source.
Visit our Urology / Nephrology section for the latest news on this subject. "Gender inequalities in the promptness of the bladder and the kidney after symptomatic presentation: evidence from secondary analysis of a survey of primary care English checking ',
Georgios Lyratzopoulos et al.
BMJ Open 2013; 3:e002861. DOI 10.1136/bmjopen-2013-002861, please use one of the following formats to cite this article in your essay, paper, or report:

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Bankruptcy An Increased Risk Following Cancer Diagnosis

Main Category: Cancer / Oncology
Also Included In: Public Health;??Health Insurance / Medical Insurance
Article Date: 17 May 2013 - 0:00 PDT Current ratings for:
Bankruptcy An Increased Risk Following Cancer Diagnosis

People diagnosed with cancer are more than two-and-a-half times more likely to declare bankruptcy than those without cancer, according to a new study from Fred Hutchinson Cancer Research Center. Researchers also found that younger cancer patients had two- to five-fold higher bankruptcy rates compared to older patients, and that overall bankruptcy filings increased as time passed following diagnosis.

The study, led by corresponding author Scott Ramsey, M.D., Ph.D., an internist and health economist at Fred Hutch, was published online as a Web First in the journal Health Affairs. The article will also appear in the journal's June edition.

Ramsey and colleagues, including a chief judge for a U.S. Bankruptcy Court, undertook the research because the relationship between receiving a cancer diagnosis and bankruptcy is less well understood than the much-studied link between high medical expenses and likelihood of bankruptcy filing.

"This study found strong evidence of a link between cancer diagnosis and increased risk of bankruptcy," the authors wrote. "Although the risk of bankruptcy for cancer patients is relatively low in absolute terms, bankruptcy represents an extreme manifestation of what is probably a larger picture of economic hardship for cancer patients. Our study thus raises important questions about the factors underlying the relationship between cancer and financial hardship."

For this study, researchers analyzed data from a population-wide registry of individuals over age 21 who lived in western Washington and who were diagnosed with cancer between Jan. 1, 1995 and Dec. 31, 2009. They were compared to a randomly sampled age-, sex-, and ZIP code-matched population of people without cancer. Cancer cases were identified using the Cancer Surveillance System of Western Washington, a population-based cancer registry based at Fred Hutch that is part of the National Cancer Institute's Surveillance Epidemiology and End Results Program (SEER).

The cancer and control cohorts were both linked with the records of the U.S. Bankruptcy Court for the Western District of Washington. The court serves 19 counties in western Washington, including all 13 counties represented in the Cancer Surveillance System of Western Washington. Researchers included Chapter 7 or Chapter 13 bankruptcy filings only.

"This is the strongest evidence we have between a disease and risk for severe financial distress," Ramsey said. "I've not seen other studies that linked databases of this quality."

Ramsey directs the Hutchinson Institute for Cancer Outcomes Research (HICOR), which is dedicated to health economics and cancer outcomes research. Its mission is to improve the efficiency and effectiveness of cancer prevention, early detection and treatment to reduce the economic and human burdens of cancer. HICOR is believed to be the first of its kind among comprehensive cancer centers nationwide.

Among the study's key findings: Between 1995 and 2009 there were 197,840 people in western Washington who were diagnosed with cancer and met the inclusion criteria for the study. Of those, 4,408 (2.2 percent) filed for bankruptcy protection after diagnosis. Of the matched controls who were not diagnosed with cancer, 2,291 (1.1 percent) filed for bankruptcy. Compared to cancer patients who did not file for bankruptcy, those who did were more likely to be younger, female and nonwhite. The youngest age groups had up to 10 times the bankruptcy rate as compared to the older age groups. The authors noted that because cancer is generally a sudden and unexpected event, the risk of bankruptcy is influenced by factors such as debt load before diagnosis, assets, presence and terms of health and disability insurance, number of dependent children, and incomes of others in the household at the time of the cancer diagnosis. "The youngest groups in the study were diagnosed at a time when their debt-to-income ratios are typically highest - often unavoidably, because they are paying off student loans, purchasing a home, or starting a business," the authors wrote. "All working-age people who develop cancer face loss of income and, in many cases, loss of employer-sponsored insurance, both of which can be devastating for households in which the patient is the primary wage earner." In contrast, people age 65 or older generally have Medicare insurance and Social Security benefits. These older people are likely to have more assets and possibly more income than working-age people. "However, it is likely that having stable insurance (specifically, coverage not tied to employment) plays a major role in mitigating the risk of bankruptcy for those over age sixty-five," the authors wrote. The proportion of cancer patients who filed for bankruptcy within one year of diagnosis was 0.52 percent, compared to 0.16 percent within one year for the control group. For bankruptcy filings within five years of diagnosis, the proportion of cancer patients was about 1.7 percent, compared to 0.7 percent for the control group. The incidence rates for bankruptcy at one year after diagnosis, per 1,000 person-years, for the cancers with the highest overall incidence rates were as follows: thyroid, 9.3; lung, 9.1; uterine, 6.8; leukemia/lymphoma, 6.2; colorectal, 5.9; melanoma, 5.7; breast, 5.7; and prostate. 3.7. The incidence rate for all cancers combined was 6.1. The high bankruptcy incidence rate for those with thyroid cancer may be because thyroid cancer affects younger women more often than other cancers do according to the researchers. "Compared to men, younger women are more likely to live in single-income households and to have lower wages and lower rates of employment, and therefore less access to high-quality health insurance - leaving them more financially vulnerable," the authors wrote.Article adapted by Medical News Today from original press release. Click 'references' tab above for source.
Visit our cancer / oncology section for the latest news on this subject. The National Center on Minority Health and Health Disparities at the National Institutes of Health funded the research. Co-authors included Karen Overstreet, chief judge of the U.S Bankruptcy Court, Western District of Washington; and researchers from the University of Washington; University of Utah School of Medicine; and University of Bristol (U.K.).
Fred Hutchinson Cancer Research Center Please use one of the following formats to cite this article in your essay, paper or report:

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'Bankruptcy An Increased Risk Following Cancer Diagnosis'

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Diagnosis of Early Breast Cancer Doesn’t Shorten Life Expectancy of Older Women

Among women age 67 or older, a diagnosis of ductal carcinoma in situ (DCIS) or Stage I breast cancer doesn’t appear to worsen survival; survival is similar to that of older women without breast cancer. Diagnosis of more advanced breast cancer, however, is linked with worse survival. These results were published in the Journal of Clinical Oncology.

Older women are a rapidly expanding segment of the U.S. population. The incidence of breast cancer increases with age, but it’s been uncertain how a diagnosis of breast cancer (particularly early-stage breast cancer) affects life expectancy among older women.

To explore the impact of a breast cancer diagnosis on the survival of older women, researchers conducted a study among more than 64,000 women who had been diagnosed with breast cancer at age 67 or older. Survival in these women was compared with survival in a group of similarly aged women without breast cancer. In the analysis, the researchers accounted for the other health problems, prior mammography use, and sociodemographic variables.??

Women who were diagnosed with DCIS or Stage I breast cancer and received standard treatment had similar survival to women without breast cancer. The most common cause of death among women with DCIS or Stage I breast cancer was cardiovascular disease. Women with Stage II or higher breast cancer had shorter survival than women without breast cancer. Risk of death was 50% higher among women with Stage II breast cancer, three-times higher among women with Stage III breast cancer, and close to 10-times higher among women with Stage IV breast cancer. The survival differences between women with advanced breast cancer and women without breast cancer decreased with age.

These results suggest that among older women, a diagnosis of DCIS or Stage I breast cancer does not shorten life expectancy.

Reference: Shonberg MA, Marcantonio ER, Ngo L, Li D, Silliman RA, McCarthy EP. Causes of death and relative survival of older women after a breast cancer diagnosis. Journal of Clinical Oncology. Early online publication March 14, 2011.

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