Thursday, October 21, 2010

Prostate Cancer Symptoms, Treatment & PSA Tests; Couples counseling improves sexual intimacy after prostate treatment




Prostate Cancer Symptoms and Treatment

By LiveScience Staff

Prostate cancer is diagnosed in about 20 percent of men. It may be more prevalent, however, because some men never know they have it and die of other causes before the slow-growing cancer becomes a problem. 
Prostate cancer is the most common type of cancer found in American men, after skin cancer, according to the American Cancer Society. And prostate cancer is the second leading cause of cancer death in men, after lung cancer.

Only men have a prostate gland, which is just below the bladder, in front of the rectum. It is about the size of a walnut.

The prostate grows from birth to adulthood. But in some men, it keeps growing. This can lead to an enlarged prostate, a non-cancerous condition called benign prostatic hyperplasia (BPH).  This can cause problems passing urine.

In some cases, certain cells in the prostate become cancerous and continue multiplying.

Scientists don't know what causes prostate cancer, officially called prostate adenocarcinoma. Risk factors include smoking, age and family history.  A diet high in red meat also plays a role, studies suggest. Black men are more likely to get prostate cancer than others.

Experts don't agree on whether all men should be routinely tested for prostate cancer. One test involves the doctor putting a gloved finger in the rectum to feel for bumps or hard spots on the prostate. A blood test, called PSA (prostate-specific antigen) looks for signs of the disease in the blood.

"These tests are not perfect, though," states the American Cancer Society. "Uncertain or false test results could cause confusion and worry." And, the society notes, surgery is sometimes performed or radiation therapy conducted even when a doctor is not sure how fast the cancer might spread. Importantly, prostate cancer grows slowly, according to the American Cancer Society. In fact autopsies suggest that as many as 90 percent of men over age 80 have prostate cancer, most never knowing it and dying of something else.

"If you are older than age 70, you may opt for expectant management (also called watchful waiting) if your prostate cancer is growing slowly," according to the Mayo Clinic.

Early and accurate diagnosis of prostate can, however, improve odds of survival, studies show.

The American Cancer Society suggests the decision about whether to test should reside with patient and doctor after a discussion about the cancer and its risks. The talk should take place at age 50 for men who are at average risk, at age 45 for men at high risk of getting prostate cancer (African American men and men who have a father, brother, or son found to have prostate cancer before age 65), and at age 40 for men with several family members who had prostate cancer at an early age.
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Prostate Cancer: PSA Test (Part 2)


-IMAGEALT-
A breast cancer cell seen through an electron microscope.
CREDIT: The National Cancer Institute.

This is the second part of a three-part series on the PSA test for prostate cancer.
 
Cancer of the prostate is one of the most common types of cancer among American men. More than 6 in 10 cases of prostate cancer cases occur in men 65 and older. Treatment for prostate cancer works best when the disease is found early.

Prostate-specific antigen (PSA) is a protein produced by the cells of the prostate gland. The PSA test measures the level of this protein in the blood. It can be detected at a low level in the blood of all adult men.

A fundamental problem with the PSA test is that, while elevated levels can indicate the presence of cancer, they can also be caused by other problems such as benign enlargement of the prostate that comes with age, infection, inflammation and seemingly trivial events such as ejaculation and a bowel movement.

Another major problem with the PSA test is defining what is “abnormal.” Older men usually have higher PSA measurements than younger men. African-Americans normally have slightly higher values than whites.

PSA test results are usually reported as nanograms of PSA per milliliter (ng/mL) of blood. In the past, most doctors considered PSA values below 4.0 ng/mL as normal. However, recent research found prostate cancer in men with PSA levels below 4.0 ng/mL

Some researchers have suggested lowering the PSA cutoff levels. For example, a number of studies have used cutoff levels of 2.5 or 3.0 ng/mL instead of  4.0 ng/mL.

Many doctors are now using the following ranges with some variation: 0 to 2.5 ng/mL is low, 2.6 to 10 ng/mL is slightly to moderately elevated, 10 to 19.9 ng/mL is moderately elevated, and 20 ng/mL or more is significantly elevated.

Because age is an important factor in increasing PSA levels, some doctors use age-adjusted PSA levels to determine when diagnostic tests are needed. When age-adjusted PSA levels are used, a different PSA level is defined as normal for each 10-year age group.

Doctors who use age-adjusted levels usually suggest that men younger than age 50 should have a PSA level below 2.4 ng/mL, while a PSA level up to 6.5 ng/mL would be considered normal for men in their 70s. Doctors do not agree about the accuracy and usefulness of age-adjusted PSA levels.

But there’s even more to make you nuts when you’re evaluating your PSA.

PSA is either free or attached to a protein molecule. If you have a benign prostate condition, there is more free PSA. Cancer produces more of the attached form. A free PSA test that indicates prostate cancer can lead to more testing, such as a biopsy.

PSA velocity is the change in PSA levels over time. A sharp rise in the PSA level may indicate a fast-growing cancer.

The relationship of the PSA level to prostate size is PSA density. An elevated PSA in a man with a very large prostate is not as alarming as a high PSA reading in someone with a small prostate.

Another problem with PSA are false test results.

If you have an elevated PSA but no cancer, you get what is called a false positive. This type of result can lead to medical procedures, anxiety, health risks and expense. Most men with an elevated PSA don’t have cancer.

When you have prostate cancer and your PSA test comes back in the normal range, you get a false negative. It’s important to understand that most prostate cancers are slow-growing; they can be around for many years before they cause symptoms.

Prostate Cancer: PSA Test (Part 3)

[This is the final part of a three-part series on the PSA test for prostate cancer.]

Cancer of the prostate is one of the most common types of cancer among American men. More than 6 in 10 cases of prostate cancer cases occur in men 65 and older. Treatment for prostate cancer works best when the disease is found early.

Prostate-specific antigen (PSA) is a protein produced by the cells of the prostate gland. The PSA test measures the level of this protein in the blood. It can be detected at a low level in the blood of all adult men.

A fundamental problem with the PSA test is that, while elevated levels can indicate the presence of cancer, they can also be caused by other problems such as benign enlargement of the prostate that comes with age, infection, inflammation and seemingly trivial events such as ejaculation and a bowel movement.

PSA test results are horribly confusing and often terrifying. In the first parts of this series, we discussed the sources of much of the confusion. In this column, we’ll address the primary question about PSA: Does it save lives?

The answer is: We don’t know. What’s worse is that we don’t know if PSA screening outweighs the risks of follow-up diagnostic tests and cancer treatments.

For example, prostate surgery can cause incontinence and erectile dysfunction. Even a  prostate biopsy has risks because it can cause bleeding and infection.

The PSA test can detect small tumors. However, finding a small tumor does not necessarily reduce a man’s chance of dying from prostate cancer. PSA testing may identify very slow-growing tumors that are unlikely to threaten a man’s life. Also, PSA testing may not help a man with a fast-growing or aggressive cancer that has already spread to other parts of his body before being detected.

So, what should a man do to protect himself from prostate cancer?

Some doctors encourage annual screenings for men older than age 50; others recommend against routine screening. However, most doctors and medical organizations agree that men should learn all they can about prostate cancer, so they can reach informed decisions.

My personal history with PSA tests is illustrative of many of the problems men face with this type of screening. I hope that sharing it will help.

I’m 69 years old. I’ve been having physical exams almost every year since I hit my 50s. These physicals included a PSA blood test and a digital rectal exam (DRE).  Until recently, all tests produced normal results.

My PSA was always around 1.5. Most doctors want your PSA to be under 4. (The numbers stand for nanograms of PSA per milliliter of blood.) And, my DREs found no irregularities, just some benign enlargement.

About three years ago, my family physician gave me a DRE and found nothing, but my PSA test came in at 2.97. My doctor told me to see a urologist for a follow-up exam because my PSA, while under 4, had increased.

The urologist did another DRE and ordered another PSA test. The test came in at 2.96. The urologist said that he thought 2.96 was my new PSA and that I should not worry about it.

Two years later, my PSA was still 2.96. Then, this year, it came in at 4.1.  My family physician sent me to a urologist.

Before I went to the urologist, I did some research and learned that something as seemingly insignificant as a bowel movement could affect a PSA test. I told the urologist that I recalled going to the bathroom just before having blood drawn. He thought that this BM could have affected the test.

Another DRE. Okay. Another blood test. The PSA was 3.3. The urologist said no biopsy was required. The increase from 2.96 to 3.3 was not a cause for concern.

What now? I’m tempted to forget about PSA tests, but I’ll probably have another in a year.
The Healthy Geezer column publishes each Monday on LiveScience. If you would like to ask a question, please write fred@healthygeezer.com. © 2010 by Fred Cicetti.

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Couples counseling improves sexual intimacy after prostate treatment

September 25, 2011
Couples counseling improves sexual intimacy after prostate treatmentEnlarge

This is Leslie Schover, Ph.D, a professor in MD Anderson's Department of Behavioral Science. Credit: Image courtesy of MD Anderson 

VIDEO: Hope for Restored Sexual Function for Prostate Cancer Patients and their Partners
VIDEO: Sexual Counseling for Couples after Prostate Cancer Treatment
PODCAST: Listen to expert Leslie Schover discuss results of face-to-face and internet-based counseling.

Prostate cancer survivors and their partners experience improved sexual satisfaction and function after couples counseling, according to research at The University of Texas MD Anderson Cancer Center. The article, published in the September issue of Cancer, a journal of the American Cancer Society, revealed both Internet-based sexual counseling and traditional sex therapy are equally effective in improving sexual outcomes. Couples on a waiting list for counseling did not improve.

Men experienced a marked improvement in their sexual function for up to one year, and women who started out with a improved significantly with counseling.

"We know that one of the crucial factors in a man's having a good sexual outcome after treatment is a partner who also wants their sex life to get better," said Leslie Schover, Ph.D, a professor in MD Anderson's Department of , lead investigator on the study and author of the paper, "A Randomized Trial of Internet-Based Versus Traditional Sexual Counseling for Couples After Localized ." "Women's issues such as ill health, post-menopausal and lack of desire for sex can be a major barrier in achieving satisfactory sexual outcomes."

Leslie Schover explains the significance of results in randomized trial incorporating couples counseling for prostate cancer patients and their partners. Credit: Video courtesy of MD Anderson

CAREss (Counseling About Regaining Erections and Sexual Satisfaction) randomized 115 heterosexual prostate cancer survivors who were experiencing erectile dysfunction and their partners into three groups: a wait list group that received delayed counseling, a face-to-face counseling group, and a group that received an Internet-based sexual counseling program.

After three months, the wait-list couples were randomized into either the face-to face or the Internet-based counseling group. A second Internet-based group of 71 couples was added to boost the numbers and allow researchers to analyze the relationship between extent of website use and outcomes.

Couples were assessed before and after the three-month wait-list period, again after counseling, and also at six and 12-month follow-ups. In addition to web-based education and exercises, participants in the Internet-based group received feedback from their counselor through email.

Treating the Body and the Mind

Many prostate cancer survivors are as concerned about loss of desire and lack of satisfying orgasms as they are about erectile dysfunction. Men in this study improved on most dimensions of sexual function. From baseline to one year, men improved significantly in erectile function, but also in orgasmic function, intercourse satisfaction and overall . Sexual desire remained stable.

Leslie Schover discusses results of face-to-face and internet-based counseling. Credit: MD Anderson

Some patients and/or partners are too anxious about sexual issues to seek help from a therapist face-to-face. An internet-based program that offers online tools and surveys, as well as interaction with the therapist by email, gives them a less threatening option. "Not only do men often use the internet to search for information on sex, but prostate cancer patients consider the web a valuable resource for information on the impact of treatment on sex," said Schover.

Another advantage of web-based counseling for couples is the potentially lower cost. While many insurance companies cover medical treatment of erection problems after , the cost of sex therapy is often not reimbursed. Already burdened with co-payments for their cancer treatment, many couples cannot afford additional costs associated with mental health care.

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