Breast Tissue: A Case Study

Prostate cancer being a huge cause of mortality and medical expense in men age forty and above has only recently become a topic of general conversation to men in America (Plowden, 2009). African-American men are affected by prostate cancer at a disproportional level than all other men. They are diagnosed up to 65% more frequently and the mortality rate is twice that of Caucasian counterparts (Emerson, 2009). The African-American male is also less likely to take advantage of free prostate cancer screening (Oliver, 2007).

PSA test results are interpreted as: 0-4 ng/mL is normal. Between 4 to 10 ng/ML is 25% of developing cancer, and > 10 ng/ml is a > 50% risk of cancer. However, some men with normal PSA levels still have prostate cancer, while other men with high PSA levels do not. PSA levels increase with age often due to a higher prevalence of benign prostate hypertrophy (BPH). Therefore, no PSA cutoff can accurately guarantee that a man does not have prostate cancer.

Another method to detect this cancer is with a Prostate Specific Antigen (PSA). Protein in the blood that is produced only by prostate cells is reflected the volume of both benign and malignant prostate tissue in the PSA. The higher the PSA level is the more likely it is that Prostate Cancer present. (“Prostate

Men should talk with a doctor if they are 45 and at high risk for prostate cancer. This includes those with a family history, especially African American men.

Organizations are not the only ones at odds with current screening methods. Depending on which organization a physician prefers to follow, a patient may be told to have PSA screening by one physician and be advised to avoid PSA screening by another physician. There are several different factors why this screening is controversial. The most important is the sensitivity and specificity of PSA screening. Research has shown that PSA screening presents with an unusually high amount of false positive results (U.S. Preventative Services Task Force, 2012). This raises some concerns whether the benefit of screening outweighs the possibility of over

The first reason being the level accuracy of PSA testing is questionable. The test determines a positive for the cancer based on the levels of prostate-specific antigens in the blood of the patient, which can be abnormally high for multiple other reasons not related to prostate cancer. The major evidence supporting said claim is that individuals with more than 4.0 ng per mL (the threshold to test positive) can have false positive rates of 70% (Mulhem 2). The second reason would be the implications of testing positive for prostate cancer, including but not limited to unnecessary treatment of the disease. While the analysis does not back up unnecessary treatment with any statistical evidence, it does go to explain further tests and procedures to confirm and understand the nature of the patient’s condition. This bleeds over to the negative physical and psychological side-effects of regular prostate cancer screening cited by the analysis. Mulhem explains that after testing positive for prostate cancer, more tests are performed to determine the accuracy of the screening and if so, reveal the specificities of the cancer. The most common of these tests being the prostate biopsy, a procedure that causes a significant portion of participants to develop moderate to severe problems requiring a follow-up with their doctor (Mulhem

Second is age- and race-specific PSA reference ranges. Age- and race-specific PSA reference ranges compare the PSA test results among men in the same group. Third is Percent-free PSA (fPSA) is the percentage of the total PSA that is unbound. Evidence suggests that fPSA is lower in men who have prostate cancer compared with men who do not. Fourth are the complexed PSA (cPSA) test measures the amount of bound PSA circulating in the blood. Fifth is the PSA density (PSAD) which is a test sometimes used by doctors in patients who have a large prostate gland. To determine PSAD, the PSA value (ng/mL) is divided by the volume (size in cubic centimeters) of the prostate. The size of the prostate gland is determined by Tran’s rectal ultrasound (TRUS), a procedure that uses sound waves to create a picture of the prostate. ( (Diagnosis))

Prostate cancer is a kind of cancer that affects the prostate gland in men. It is a common cancer that grows slowly and its treatment can be done successfully if it is detected at an early stage. Sometimes, symptoms are not visible in case of cancer limited to the prostate gland which may result into metastatic cancer. To detect the symptoms, active surveillance can be done. There are various options available

The average age of diagnosis is between 65 - 70 years old. The risk of PCa increases with advancing age due to improved living causing an accumulation of cancer-causing faults in their DNA. It is thought to be due to a mix of genetic and environmental factors (Bechis, et al, 2010).

Benign prostate hyperplasia (BPH) and prostate cancer share a few similarities, elevated prostate-specific antigen (PSA). Along with enlargement of prostate gland that causes urinary symptoms such as, frequent urination, hesitancy, dribbling, and frequent nighttime urination. However, they are quite different which is why more tests need to be done to confirm one or the other condition. These two diseases are also similar in the fact that they both cause an enlargement of the prostate. However with BPH the central portion of the prostate is enlarged and with prostate cancer more commonly the lateral lobes or side of the prostate are enlarged, but can affect any were on the prostate. Both can even be detected by a digital rectal exam however

The recommendation to reduce PSA screening by the Canadian Task Force of Preventative Health Care originated from the observations that PSA screening does not decrease the relative risk for acquiring PCa, nor does it decrease the mortality rate of PCa. Since the implementation of proactive and opportunistic PSA screening in Canada the annual incidence of PCa has increased but the mortality rate has not decreased (Pron, 2015). Ontario spends approximately $119.2 million on PSA screening annually and considering PCa mortality rates decreased prior to PSA screening introduction in the late 1990s, the $119.2 million spent on PSA screening appears redundant (Ontario Health Technology Assessment, 2015).

Prostate cancer is the most common type of cancer in American men after skin cancer. There are many risk factors that increase the disease such as age, being the far most important risk factor, along with race, family history and diet (ASCO, 2015). The prostate is a walnut shaped gland of the male reproductive system that functions to create part of the semen, which is fluid in which sperm swim in when ejaculation occurs. It is located inferior to the bladder, anterior to the rectum, surrounding the urethra. For this reason, when a prostate becomes abnormal, many signs and symptoms manifest themselves when a male urinates. When the prostate becomes enlarged by cancer or any other disease, it blocks the neck of the urethra causing a weak stream,

A digital rectal exam is completed yearly to establish prostate location, size, and the presence of nodules. (ACS, 2011)

PSA levels are found increased in these conditions, as the tissue barrier is disrupted between the prostate gland lumen and the capillaries. PSA screening has limited accuracy, which can lead to over diagnosis of the disease, performance of unnecessary diagnostic testing and treatment. Therefore, many men with false positive PSA screening, who have no cancer, are subjected to invasive procedures such as prostate biopsies, radical prostatectomy and radiation therapy. Biopsies not only cause discomfort to the patient, but have other risks such as infections, hematuria, prostatitis, sepsis, endocarditis, cystitis, hypotension and urinary symptoms. The pros and cons of PSA testing should be informed to patient before performing the test. For these reasons, professional organizations, including the US Preventive Services Task Force (USPSTF), American Cancer Society (ACS), and American Urology Association (AUA), have issued clinical practice guidelines recommending that clinicians inform patients about the pros, cons, and uncertainties of PSA screening, and that screening decisions be based on patient preferences (Han

Acid Phosphatase is an enzyme found in seminal fluid. It comes from the prostate gland (Johnson 2009). Typically, the more Prostatic Acid Phosphatase found in a sample of semen is a sign of prostate cancer. This is important because the Acid Phosphatase Color Test was once used to determine of a male had prostate cancer. It was later replaced by Prostate Specific Antigen, aka PSA. Forensic scientists still use this test to identify semen, however. In 1938, Gutman and Gutman reported increased levels of acid phosphatase in patients with metastatic prostate cancer (Taira, Merrick, Wallner, and Dattoli, “Reviving the Acid Phosphatase Test for Prostate Cancer”). It was later replaced by the Prostate Specific Antigen in 1971 (Taira, Merrick, Wallner, and Dattoli, “Reviving the Acid Phosphatase Test