PSA Screening
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PSA Screening
Prostate cancer screening is the screening process used to detect undiagnosed prostate cancer in men without signs or symptoms. When abnormal prostate tissue or cancer is found early, it may be easier to treat and cure, but it is unclear if early detection reduces mortality rates. Screening precedes a diagnosis and subsequent treatment. The digital rectal examination (DRE) is one screening tool, during which the prostate is manually assessed through the wall of the rectum. The second screening tool is the measurement of prostate-specific antigen (PSA) in the blood. The evidence remains insufficient to determine whether screening with PSA or DRE reduces mortality from prostate cancer. A 2013 Cochrane review concluded PSA screening results in "no statistically significant difference in prostate cancer-specific mortality...". The American studies were determined to have a high bias. European studies included in this review were of low bias and one reported "a significant reduction ...
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Prostate Cancer
Prostate cancer is cancer of the prostate. Prostate cancer is the second most common cancerous tumor worldwide and is the fifth leading cause of cancer-related mortality among men. The prostate is a gland in the male reproductive system that surrounds the urethra just below the bladder. It is located in the hypogastric region of the abdomen. To give an idea of where it is located, the bladder is superior to the prostate gland as shown in the image The rectum is posterior in perspective to the prostate gland and the ischial tuberosity of the pelvic bone is inferior. Only those who have male reproductive organs are able to get prostate cancer. Most prostate cancers are slow growing. Cancerous cells may spread to other areas of the body, particularly the bones and lymph nodes. It may initially cause no symptoms. In later stages, symptoms include pain or difficulty urinating, blood in the urine, or pain in the pelvis or back. Benign prostatic hyperplasia may produce similar symptoms ...
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Prostate
The prostate is both an Male accessory gland, accessory gland of the male reproductive system and a muscle-driven mechanical switch between urination and ejaculation. It is found only in some mammals. It differs between species anatomically, chemically, and physiologically. Anatomically, the prostate is found below the Urinary bladder, bladder, with the urethra passing through it. It is described in gross anatomy as consisting of lobes and in microanatomy by zone. It is surrounded by an elastic, fibromuscular capsule and contains glandular tissue as well as connective tissue. The prostate glands produce and contain fluid that forms part of semen, the substance emitted during ejaculation as part of the male Human sexual response cycle, sexual response. This prostatic fluid is slightly alkaline, milky or white in appearance. The alkalinity of semen helps neutralize the acidity of the vagina, vaginal tract, prolonging the lifespan of sperm. The prostatic fluid is expelled in the ...
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Lutetium-177
Naturally occurring lutetium (71Lu) is composed of one stable isotope 175Lu (97.41% natural abundance) and one long-lived radioisotope, 176Lu with a half-life of 3.78 × 1010 years (2.59% natural abundance). Thirty-five radioisotopes have been characterized, with the most stable, besides 176Lu, being 174Lu with a half-life of 3.31 years, and 173Lu with a half-life of 1.37 years. All of the remaining radioactive isotopes have half-lives that are less than 9 days, and the majority of these have half-lives that are less than half an hour. This element also has 18 meta states, with the most stable being 177mLu (t1/2 160.4 days), 174mLu (t1/2 142 days) and 178mLu (t1/2 23.1 minutes). The isotopes of lutetium range in mass number from 149 to 184. The primary decay mode before the most abundant stable isotope, 175Lu, is electron capture (with some alpha and positron emission), and the primary mode after is beta emission. The primary decay products before 175Lu are isotopes of ytterbium a ...
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Gallium-68
Natural gallium (31Ga) consists of a mixture of two stable isotopes: gallium-69 and gallium-71. The most commercially important radioisotopes are gallium-67 and gallium-68. Gallium-67 (half-life 3.3 days) is a gamma-emitting isotope (the gamma ray emitted immediately after electron capture) used in standard nuclear medical imaging, in procedures usually referred to as gallium scans. It is usually used as the free ion, Ga3+. It is the longest-lived radioisotope of gallium. The shorter-lived gallium-68 (half-life 68 minutes) is a positron-emitting isotope generated in very small quantities from germanium-68 in gallium-68 generators or in much greater quantities by proton bombardment of 68Zn in low-energy medical cyclotrons, for use in a small minority of diagnostic PET scans. For this use, it is usually attached as a tracer to a carrier molecule (for example the somatostatin analogue DOTATOC), which gives the resulting radiopharmaceutical a different tissue-uptake specificity from ...
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Transrectal Ultrasonography
Transrectal ultrasonography, or TRUS in short, is a method of creating an image of organs in the pelvis, most commonly used to perform an ultrasound-guided needle biopsy evaluation of the prostate gland in men with elevated prostate-specific antigen or prostatic nodules on digital rectal exam. TRUS--guided biopsy may reveal prostate cancer, benign prostatic hypertrophy, or prostatitis. TRUS may also detect other diseases of the lower rectum and can be used to stage primary rectal cancer Colorectal cancer (CRC), also known as bowel cancer, colon cancer, or rectal cancer, is the development of cancer Cancer is a group of diseases involving abnormal cell growth with the potential to invade or spread to other parts of th .... References Urologic procedures Medical ultrasonography Digestive system imaging Prostate cancer {{Med-diagnostic-stub ...
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Transurethral Biopsy
Transurethral biopsy is a biopsy procedure in which a sample of tissue is removed from the prostate for examination under a microscope. A thin, lighted tube is inserted through the urethra The urethra (from Greek οὐρήθρα – ''ourḗthrā'') is a tube that connects the urinary bladder to the urinary meatus for the removal of urine from the body of both females and males. In human females and other primates, the urethra c ... into the prostate, and a small piece of tissue is removed with a cutting loop. References Transurethral biopsyentry in the public domain NCI Dictionary of Cancer Terms Biopsy Male genital surgery {{surgery-stub ...
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Transrectal Biopsy
Transrectal biopsy is a biopsy procedure in which a sample of tissue is removed from the prostate using a thin needle that is inserted through the rectum and into the prostate. Transrectal ultrasound ( TRUS) is usually used to guide the needle. The sample is examined under a microscope to see if it contains cancer Cancer is a group of diseases involving abnormal cell growth with the potential to invade or spread to other parts of the body. These contrast with benign tumors, which do not spread. Possible signs and symptoms include a lump, abnormal b .... References Transrectal biopsyentry in the public domain NCI Dictionary of Cancer Terms Biopsy Male genital surgery {{Oncology-stub ...
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Rectum
The rectum is the final straight portion of the large intestine in humans and some other mammals, and the Gastrointestinal tract, gut in others. The adult human rectum is about long, and begins at the rectosigmoid junction (the end of the sigmoid colon) at the level of the third sacral vertebra or the sacral promontory depending upon what definition is used. Its diameter is similar to that of the sigmoid colon at its commencement, but it is dilated near its termination, forming the rectal ampulla. It terminates at the level of the anorectal ring (the level of the puborectalis sling) or the dentate line, again depending upon which definition is used. In humans, the rectum is followed by the anal canal which is about long, before the gastrointestinal tract terminates at the anal verge. The word rectum comes from the Latin ''Wikt:rectum, rectum Wikt:intestinum, intestinum'', meaning ''straight intestine''. Structure The rectum is a part of the lower gastrointestinal tract ...
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Rectal Examination
Digital rectal examination (DRE; la, palpatio per anum, PPA) is an internal examination of the rectum, performed by a healthcare provider. Prior to a 2018 report from the U.S. Preventive Services Task Force, the DRE was a common and "dreaded" component of annual exams for older men, as it was thought to be a reliable screening test for prostate cancer. Usage This examination may be used * for the diagnosis of prostatic disorders, benign prostatic hyperplasia and the four types of prostatitis. Chronic prostatitis/chronic pelvic pain syndrome, chronic bacterial prostatitis, acute (sudden) bacterial prostatitis, and asymptomatic inflammatory prostatitis. The DRE has a 50% specificity for benign prostatic hyperplasia. Vigorous examination of the prostate in suspected acute prostatitis can lead to seeding of septic emboli and should never be done. Its utility as a screening method for prostate cancer however is not supported by the evidence; * for the evaluation of certain clinical ...
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Prostate Biopsy
Prostate biopsy is a procedure in which small hollow needle-core samples are removed from a man's prostate gland to be examined for the presence of prostate cancer. It is typically performed when the result from a PSA blood test is high. It may also be considered advisable after a digital rectal exam (DRE) finds possible abnormality. PSA screening is controversial as PSA may become elevated due to non-cancerous conditions such as benign prostatic hyperplasia (BPH), by infection, or by manipulation of the prostate during surgery or catheterization. Additionally many prostate cancers detected by screening develop so slowly that they would not cause problems during a man's lifetime, making the complications due to treatment unnecessary. The most frequent side effect of the procedure is blood in the urine (31%). Other side effects may include infection (0.9%) and death (0.2%). Ultrasound-guided prostate biopsy The procedure may be performed transrectally, through the urethra or t ...
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Over-diagnosis
Overdiagnosis is the diagnosis of disease that will never cause symptoms or death during a patient's ordinarily expected lifetime and thus presents no practical threat regardless of being pathologic. Overdiagnosis is a side effect of screening for early forms of disease. Although screening saves lives in some cases, in others it may turn people into patients unnecessarily and may lead to treatments that do no good and perhaps do harm. Given the tremendous variability that is normal in biology, it is inherent that the more one screens, the more incidental findings will generally be found. For a large percentage of them, the most appropriate medical response is to recognize them as something that does not require intervention; but determining which action a particular finding warrants ("ignoring", watchful waiting, or intervention) can be very difficult, whether because the differential diagnosis is uncertain or because the risk ratio is uncertain (risks posed by intervention, nam ...
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United States Preventive Services Task Force
The United States Preventive Services Task Force (USPSTF) is "an independent panel of experts in primary care and prevention that systematically reviews the evidence of effectiveness and develops recommendations for clinical preventive services". The task force, a volunteer panel of primary care clinicians (including those from internal medicine, pediatrics, family medicine, obstetrics and gynecology, nursing, and psychology) with methodology experience including epidemiology, biostatistics, health services research, decision sciences, and health economics, is funded, staffed, and appointed by the U.S. Department of Health and Human Services' Agency for Healthcare Research and Quality. Intent The USPSTF evaluates scientific evidence to determine whether medical screenings, counseling, and preventive medications work for adults and children who have no symptoms. Methods The methods of evidence synthesis used by the Task Force have been described in detail. In 2007, their methods ...
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