Under ultrasound guidance, the doctor places a narrow needle through the wall of the rectum into the abnormal or suspicious area of the prostate gland. The needle removes a cylinder of tissue, usually about 1/2 inch long and 1/16 inch across. This tissue is sent to the laboratory and examined under a microscope to see if cancer cells are present.
Internal radiation treatment is given by placing radioactive material directly into the tumor or close to it. This procedure is also called interstitial radiation therapy or seed implantation.
A thin, flexible tube through which fluids enter or leave the body, e.g., a tube to drain urine.
The use of drugs given by injection or by mouth, which can directly kill cancer cells. Since these drugs travel through the bloodstream, they can attack cancer cells that have metastasized through the bloodstream to most parts of the body (with exception of the brain, which excludes many drugs).
The least aggressive removal of a tumor to preserve an organ such as the breast, the tongue, the voice box, or a limb. This usually requires a course of radiation therapy to address any cancer cells that may remain in the conserved organ that would have been removed with a more radical procedure.
Early detection means that the disease is found at an early stage of development before it has grown large or spread to other sites. Many forms of cancer can reach an advanced stage without causing symptoms. Just as mammography can help find early breast cancer, the PSA blood test can help find early stage prostate cancer.
Digital Rectal Examination (DRE)
The doctor inserts a gloved finger into the rectum to feel for anything not normal. Some tumors of the rectum and prostate gland can be felt during a DRE.
External Beam Radiation
The process is much like getting a diagnostic x-ray, but for a longer time. Radiation is focused from a source outside the body on the area affected by the cancer.
Fractionated Stereotactic Radiotherapy (FSRT)
A form of IGRT which involves temporary attachment of an external device with precisely known geometry to the head or the body, or the use of internal anatomical structures which do not change in position relative to the body. After imaging the patient with the device attached or precisely defining the internal structure, a tumor may be precisely. An arrangement of narrow X-ray beams is designed which only intersect through the tumor. A dose of radiation is delivered with minimal set-up margin in a few treatments or, for larger tumors; a conventional dose is delivered using the conventional number of treatments.
A cell or group of cells that produce and release substances used nearby or in another part of the body.
The most often used prostate cancer grading system is called the Gleason system. This system assigns a Gleason grade ranging from 1–5. The grade is based on how closely the arrangement of cancer cells resembles normal cells in a healthy gland. Because prostate cancers often have areas within them of different grades, a grade is assigned to the two areas that make up most of the cancer. These two grades are added together to give a Gleason score between 2 and 10. Tumors graded Gleason score 5–6 behave only slightly worse than tumors with sores of 2–4, but significantly better than tumors graded score 7.
A method of classifying prostate cancer cells on a scale of 2–10. The higher the Gleason score (also called the Gleason sum), the faster the cancer is likely to grow and spread beyond the prostate.
High Dose Rate Brachytherapy
Placement of metal encapsulated radioactive seeds inside a temporary catheter placed directly into or adjacent to a tumor or organ. The catheter(s) remains in place for a few days, but the radioisotope is only inserted by a remotely activated device one or two times per day over that time. The radioisotope remains in place only during a treatment, so the patient need be necessarily hospitalized. The treatment must be given in a heavily shielded room to avoid radioactive exposure of others. Radiation is delivered quickly and intermittently over a period of minutes.
A chemical substance released into the body by the endocrine glands. These glands include the thyroid, adrenal, testes, and ovaries. The substance travels through the bloodstream and sets in motion various body functions. Testosterone and estrogen are examples of male and female hormones.
Hormone therapy is 1) treatment with hormones, 2) use of drugs to interfere with hormone production or hormones action, or 3) the surgical removal of hormone-producing glands. Hormone therapy may kill cancer cells or slow their growth.
Image Guided Radiation Therapy (IGRT)
CT scans are obtained with the patient immobilized in the treatment position. Other imaging information from MRI scans or PET scans may be fused to the CT image. This information is analyzed by a sophisticated computer to precisely map the location of a cancer and its predicted areas of spread. Normal tissue organs at risk are also mapped. Non-uniform radiation beams are then aimed from several directions at the areas that need it, while trying to reduce the exposure of organs at risk. Before every radiation treatment, an image using plane X-rays or CT is obtained in the treatment position and superimposed over the planning image. The machine then automatically corrects positioning variation to assure a high degree of precision.
Intensity Modulated Radiation Therapy (IMRT)
CT scans are obtained with the patient immobilized in the treatment position. Other imaging information from MRI scans or PET scans may be fused to the CT image. This information is analyzed by a sophisticated computer to precisely map the location of a cancer and its predicted areas of spread. Normal tissue organs at risk are also map. Non-uniform radiation beams are then aimed from several directions at the areas that need it, while trying to reduce the exposure of organs at risk.
Invasion or Infiltration
The direct spread of cancer cells from a primary tumor into surrounding tissues.
Low Dose Rate Brachytherapy
Placement of metal encapsulated radioactive seeds inside a temporary catheter placed directly into or adjacent to a tumor or organ. The radioisotope remains in place for a few days, so the patient must be hospitalized in a shielded room to avoid radioactive exposure of others. Radiation is delivered slowly and continuously over a period of days.
The spread of cancer cells to adjacent regions or distant areas of the body by way of the lymph system or bloodstream, respectively.
Placement of metal encapsulated radioactive seeds directly into a tumor or organ. The radioisotope has a relatively short half-life and low energy so that the patient will not be appreciably radioactive to others after a period of a few months. Radiation is delivered very slowly and continuously over a period of months.
See Prostate-Specific Antigen.
Prognosis is the outlook for the patient’s treatment, a prediction of the course of the disease. Prognosis is usually related to stage and host factors (such as the patient’s genetic profile and ability to function).
The prostate gland is located between the penis and the bladder surrounding the urethra and is in front of the rectum and behind the pubic bone. The prostate produces seminal fluid, which transports the sperm during ejaculation. Urine is carried from the bladder outside of the body by the urethra that passes through the prostate gland for approximately 1½ to 2 inches. The healthy prostate is about the size of a walnut and weighs approximately one ounce.
Prostate Specific Antigen (PSA)
PSA is a protein made by the prostate gland. Levels of PSA in the blood often go up in men who have prostate cancer. The PSA test is used to help detect prostate cancer as well as to monitor the results of treatment.
Surgery to remove the entire prostate gland, the seminal vesicles, and nearby tissue.
The performance of a complete battery of diagnostic procedures to determine the extent of the primary tumor (T stage), evidence of regional spread (N-stage), or evidence of distant metastases (M-stage).
Stereotactic Radiosurgery (SRS)
A form of IGRT that involves attachment of an external device with precisely known geometry to the head or the body. After imaging the patient with the device attached, a tumor may be precisely targeted based upon the relationship of its location to the external device. An arrangement of narrow X-ray, gamma ray, or particle beams is designed which only intersect through the tumor. A large dose of radiation is delivered with little or no set-up margin in a single treatment.
See Transurethral Resection of the Prostate.
The male hormone that is made primarily in the testes. In men with prostate cancer, testosterone in also encourage growth of the tumor.
Three-Dimensional Conformal Therapy
This treatment uses sophisticated computers to precisely map the location of the cancer within the prostate gland. CT scans are obtained with the patient immobilized in the treatment position. The patient is fitted with a plastic mold resembling a body cast to keep him still so that the radiation can be more accurately aimed. Radiation beams are then aimed from several directions at the spots that need it.
The ultrasound picture is taken by an ultrasound “probe” that is inserted into the rectum, which is right next to the prostate gland. The probe transmits pictures of the prostate onto a screen, just like watching the prostate on a TV.
Transurethral Resection of the Prostate (TURP)
This operation removes part of the prostate gland that surrounds the urethra (the tube through which urine exits the bladder). This operation can be used to relieve symptoms caused by a tumor before other treatments begin, although it is not expected to treat the disease or remove all of the cancer. More often, it is used to relieve symptoms of noncancerous prostate enlargement.
The process involves imaging the body on region affected by the cancer and simulating the positioning and X-ray beam angles to be used in treatment. For treatment of tumors in the head, neck, or throat, the patient is fitted with a thermoplastic, which is directly attached to the treatment table. For other sites of disease, a plastic mold resembling a body cast is fabricated to help place the patient in an identical treatment position from day to day. The images are loaded on a sophisticated computer where the cancer and organs at risk are outlined. A dosimetrist or physicist will use the computer to derive the best arrangement of X-ray beams to treat the cancer.