| According to the American Cancer Society, this year alone almost 200,000 men in the United States will be newly diagnosed with prostate cancer and 40,000 men will die from this disease. If these statistics are sobering, imagine the fright at actually hearing a diagnosis of prostate cancer. Often accompanying that fear comes a sense of helplessness, of being out-of-control because men are suddenly confronted with something totally unknown. When men listen to their doctors, look on the Internet, read books or speak to friends, the situation only worsens as they learn that much of the information available about prostate cancer, especially about treatment, is conflicting and frequently inaccurate. Doctors often disagree on which treatment they believe is the most effective for prostate cancer. Typically, if you go to a urologist, that doctor will recommend a radical prostatectomy. And, if you see a radiation oncologist, that doctor will recommend some type of radiotherapy. Because of this confusion, men with prostate cancer, plus their families, need to be part of the decision-making process for treatment of this disease. In fact, the choice of treatment is one of the most important decisions a man will make during his lifetime. This web site is written to educate men and their families about prostate cancer, how it works and how to evaluate the various methods of treatment. Readers will quickly learn that cure of prostate cancer is dependent on three things: Finding prostate cancer early with a PSA test. Selecting a treatment method with a proven high cure rate. Selecting a doctor who knows how to cure prostate cancer. Readers will also learn about a very important subject never discussed by doctors: that most doctors performing seed implants are not adequately trained and should not be treating prostate cancer! Before producing this web site, we asked ourselves, "If I had prostate cancer, was not a doctor, and knew nothing about this disease, what would I want to know?" We determined we would want to: Learn about this disease, about the various treatments and, especially, about the cure rates and how they were calculated; Know how to access the medical journal references so that we could review them if we desired; Know about my doctorÂs level of training and especially what his/her particular cure rates are; and Have all the cards put on the table without any hype. That is how this web site has been written. It is important to educate yourself about prostate cancer. It is also important that you are not afraid to ask hard questions of the doctors who are going to treat you. If seed implantation is discussed, ask your physician about his/her level of training and cure rates. Ask, "did you have a two-day training course?" Ask, "using PSA nadir 0.2 ng/ml, what is the cure rate of your patients who did not have hormones?" After all, if you were the manager of the Atlanta Braves or some other favorite baseball team, to evaluate a player, you would look at a baseball playerÂs batting average. Cure rates, calculated by PSA nadir 0.2 ng/ml, are the "batting averages" for doctors treating prostate cancer. This is not the time to be reluctant to ask for information. It is your life and the quality of that life that is at stake. Special Notes: This page contains extensive additional information on prostate cancer research and treatment not found in our brochure. You are invited to explore all the areas on this site, including the Integrated Prostate Health Program, Frequently Asked Questions, Biopsy Info and Travel pages. We have also included a recent review of the prostate cancer field by a noted investment analyst, Mr. William Baker. Please take the time to read this report Click here to read the GARP Monitor Report. Two press releases have been added to our web site Click here to read the latest news. We regularly update the material; the last update was June 25, 2002. On each section, please click the "refresh" button on your browser menu to download changed material. In December, 1998 our report detailing the largest series of men treated with brachytherapy in the modern literature was published in The Cancer Journal. Entitled "Simultaneous Radiotherapy for Prostate Cancer: I-125 Prostate Implant Followed by External-Beam Radiation" ,this landmark article covers 1,020 patients with follow-up to 14 years. We have updated our findings on PSA nadir and have discovered that in order for men to be potentially cured of prostate cancer, they must achieve and maintian a PSA nadir of 0.2 ng/ml, the identical PSA nadir level used in most radical prostatectomy studies. Our most recent two articles detail these findings about PSA nadir. Click here to receive a copy of these reports. Please note that based on extensive analysis, we have now changed our PSA nadir requirements to 0.2 ng/ml. Information on these pages is in the process of revision to update results to the new standard. To read summaries of these articles, click on an article title to the left. Additionally, Dr. James Lewis, Director of the Education Center for Prostate Cancer Patients (ECPCP) in New York and author of The New Guidelines for Prostate Cancer Treatment, has just published his latest book, entitled The Best Treatment Options for Prostate Cancer. This is an excellent reference text for men with prostate cancer who are seeking options for treatment. Call Dr. Lewis' office at 516-942-5000 if you would like to purchase a copy of the book. Another resource for prostate cancer is a new book from Thomas A. Farrington entitled "Battling the Killer Within". It contains a look at prostate cancer through the eyes of a prostate cancer survivor. To find out more about this informative book or purchase a copy, please go to the web site located at http://www.battlingthekillerwithin.com. The information contained in this web site is based on our experience in treating more than 3,000 men with prostate cancer over the past 20 years. This web site is also based upon research findings, both ours and other investigators, which have been published in scientific, peer-reviewed medical journals as referenced on page 34. For additional information, see questions 90 and 91 on pages 32 and 33. And, if you have any further questions, contact us, and we will send you a video about prostate cancer and Radiotherapy Clinics of Georgia. If you have any questions or need further information after reading this web site, please contact us. We also have a video about Radiotherapy Clinics of Georgia and will be glad to send a copy to you. In Atlanta, Georgia, our phone number is 404-320-1550. Or if you are calling long distance, our phone number is 800-952-7687. Please read our privacy statement by clicking here. © 2002 Radiotherapy Clinics of Georgia Frank A. Critz, M.D. Medical Director Georgia Center for Prostate Cancer Research and Treatment This web site was prepared to help you understand the specifics of prostate cancer and its treatments. We begin with the basics and end with an extensive Question and Answer section. After learning the facts about prostate cancer, the patients profiled in this web site chose the ProstRcision® treatment offered by the only Center of Excellence for Radiotherapy of Prostate Cancer in the Southeast  Radiotherapy Clinics of Georgia (RCOG). These and other patients welcome the opportunity to share their stories with you. The Normal Prostate The normal prostate gland, which on average is about the size of an egg, is located in a manÂs pelvis, sandwiched between the bladder, above the gland, and the rectum, below the gland. The prostate gland consists of millions of prostate cells, which are surrounded by a thin covering called the capsule, much like the shell of an egg. Lying against the prostate, on both the right and left sides, are sex nerves; and running through the middle of the gland is the urethra, the tube that goes from the bladder out a manÂs penis for urination. The prostate produces semen, the material ejaculated at sexual orgasm. How Prostate Cancer Works Prostate cancer begins when, for reasons no one fully understands, one or more normal cells inside the prostate transform into cancer cells. In general, prostate cancer then enters the first of three phases of growth: Phase 1: Growth inside the prostate contained by the capsule. For a time, the transformed prostate cancer cells multiply and grow inside the prostate with growth contained by the prostate capsule. Phase 2: Penetration of the capsule and growth into the surrounding normal organs. In the second phase, cancer cells penetrate through the prostate capsule and extend into surrounding normal organs including the rectum, sex nerves, bladder, and into the muscles that control urination. These "microscopic capsule penetration" cancer cells continue to multiply. Phase 3: Spread, called metastases, by lymph and blood vessels to other parts of a manÂs body. In the third and final phase of prostate cancer, microscopic capsule penetration cancer cells, or cancer cells inside the prostate, invade lymph or blood vessels. Using lymph and blood vessels as a highway, prostate cancer cells spread throughout a manÂs body. Initially metastases usually go to lymph nodes and bones and later to lung, liver and other parts of the body. Finding prostate cancer early with the PSA and the Percent Free PSA test A simple blood test to see if a man has prostate cancer can be performed on a small amount of blood drawn in a doctorÂs office or laboratory. This test, called prostate-specific antigen or PSA, measures the amount of a large protein in the body that is produced only by prostate cells. Since no other cell in the body makes this protein, the PSA test measures the amount of PSA produced by normal prostate cells and any additional PSA produced by prostate cancer cells. A normal sized prostate in a man without cancer produces an average 1.1 ng/ml of PSA. As men age, their prostate glands often enlarge, producing more PSA, so PSA measurements up to 4.0 ng/ml are considered in the normal range. A massively enlarged prostate or a prostate gland inflamed by prostatitis can produce even greater amounts of PSA. (Note: ng/ml means the amount of PSA in a milliliter of serum.) Because prostate cancer cells typically produce more PSA than normal cells do, a PSA reading above 4.0 ng/ml signals the need for further testing. However, in men with normal sized prostates, a PSA reading above 2.0 ng/ml should raise concerns for prostate cancer. The percent free (or PSA II) test is very helpful for men with a PSA less than 10.0 ng/ml. Percent free PSA readings of 25% or less in men with PSA 4.1-10.0 ng/ml or 15% with PSA of 2.5-4.0 ng/ml indicates possible prostate cancer. The American Cancer Society recommends that, starting at age 50, men have a PSA test each year. However, sons and brothers of prostate cancer patients, as well as all African-American men, should begin their PSA tests at age 40. In addition to the PSA test, it is recommended that men periodically have examinations of the prostate called a digital rectal examination (DRE). This is because some prostate cancers, frequently the more aggressive types, do not produce very much PSA and a lump in the prostate could be found with a DRE. The Big Three: PSA, Gleason Score and Clinical Stage If an abnormal PSA is discovered, or if a doctor finds a lump in the prostate during the DRE, that patient should be evaluated for prostate cancer. Typically, the patient is referred to a urologist for prostate biopsy consideration. A biopsy is a 10-minute outpatient procedure that can be performed in any urologistÂs office. While observing the prostate with an ultrasound machine, the urologist inserts thin, hollow needles through the rectum into the patientÂs prostate and removes a tiny amount of prostate cells. The biopsy material is then sent to a pathologist who studies these prostate cells under a microscope to determine if cancer is present. The best of the biopsy techniques is the sextant biopsy. During a sextant biopsy, the urologist performs six needle ÂsticksÂ, taking samples from the top, middle and bottom of the right and left sides of the prostate. Each needle stick is then placed in a separate container. This enables doctors to map out where any cancer is located. If prostate cancer is discovered, three major factors are evaluated: 1. PSA amount, which indicates how much cancer is present. 2. Gleason Score, which indicates how fast the cancer is growing. 3. Clinical Stage, which indicates where the cancer is located. PSA amount: Of the "big three," the amount of PSA is the most important. Why? Because it is the best measure of how much cancer a man has in his body. Based upon PSA levels, men are classified into one of four PSA groups: Table 1. PSA Groups 0.0-4.0 ng/ml 4.1-10.0 ng/ml 10.1-20.0 ng/ml 20.1 ng/ml or more | |
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