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Prostate Cancer Glossary

Definitions of Prostate Cancer Terms

A

Active Surveillance

See also “Watchful Waiting,” is an approach to a medical problem in which a patient and/or physician monitors a potentially dangerous condition, where time is allowed to pass before medical intervention or therapy is used. During this time, repeated testing may be performed. A good example would be PSA monitoring of early stage A or B organ confined prostate cancer.


Adenocarcinoma

A cancer that originates in glandular epithelium, the lining or inner surface of an organ.


Adjuvant Treatment

Treatment that is added to increase effectiveness of a primary therapy; for example, radiation added to radical prostatectomy (RP).


Adrenal Glands

Two glands located above the kidneys that produce an array of different hormones, including small amounts of the male hormone testosterone.


Androgen Hormone

A male sex hormone, which produce male physical characteristics. In men the main hormone is testosterone.


Anti androgen Drug

A diverse group of medications that counteract the effects of androgens (male sex hormones-testosterone) by blocking the androgen receptor sites in target organ cells.


Androgen Deprivation Therapy (ADT)

Hormone therapy in which the goal is to reduce levels of male hormones (usually Testosterone) in the body, or to stop them from affecting prostate cancer cells.Lowering androgen levels often stops or significantly slows the growth of prostate cancer cells, although it does not cure prostate cancer.


Antibody

A protein substance used by the immune system to identify and neutralize pathogens. Antibodies are produced in response to an antigen to provide immunity.


Antigen

A biological substance, such as bacteria, virus, or a vaccine, that produces an immunological response by producing antibodies against it.


Artificial Urinary Sphincter

A prosthetic device inserted in the body to remedy incontinence by constricting the urethra.


Asymptomatic

Without obvious signs or symptoms of disease. Cancer is in its early stages, often grows and develops without any symptoms.


Autologous Transfusion

When one donates blood for oneself prior to a planned operation, in case a transfusion is needed during the operation.


B

Benign Prostatic Hyperplasia (BPH)

A non-cancerous condition in which the prostate grows and pushes against the urethra and the bladder blocking the flow of urine. There is an abnormal multiplication of the non-malignant prostate cells.


Benign Tumors

A non-cancerous tumor that does not invade nearby tissue or spread to other parts of the body the way cancer can.


Biological Therapy

Also known as biotherapy or immunotherapy, is a new form of cancer treatment designed to stimulate or restore the ability of the body’s immune system to fight infection or disease. Biological therapy is based on the knowledge and tools of modern molecular biology, immunology, and genetics.


Biopsy

Is a sample of tissue taken from the body to be examined microscopically to ascertain if cancer is present. A doctor will recommend a biopsy when an intial test suggests an area of tissue in the body isn’t normal. It is the most important procedure in diagnosing cancer.


Bladder Catheterization

The placing of a catheter into the urinary bladder through the urethra.


Blastic Lesions

Refers to the increased density of bone seen on x-rays when there is extensive new bone formation due to cancerous destruction of the bone. Because of the extra cells in the bone, the image appears cloudy on x-rays with an added layer look when compared to unaffected bone.


Blood Chemistry

Analysis of the numerous chemical substances found in the blood. The analysis of these substances will provide clues to evaluate the function of the major body systems, including the liver and kidneys, minerals, cholesterol, etc.; important because abnormal values can indicate spread of cancer or side effects of any treatments.


Bone Marrow

Soft spongy tissue in bone cavities; produces blood cells.


Bone Scan

A nuclear medicine test in which a small amount of radioactive material is injected into the blood. It travels through the blood stream and collects in the abnormal cells in the bones. The scanner can then make images of the bones which can show areas of increased uptake of the radioactive material, suggesting the presence of cancer.


Brachytherapy

The treatment of cancer, especially prostate cancer, by the insertion of radioactive implants (seeds) directly into the affected tissue.


C

Carcinoma

Cancer that develops from the epithelial cells, specifically in the tissues that line or cover an organ.


CAT Scan

Also known as a computerized axial tomography, a CAT scan is a detailed x-ray that can show both bones and soft tissue of the body. The patient lies on a table which slides through a donut shaped scanner that directs x-rays through the body from many different angles.


Chemotherapy

Treatment of cancer that uses certain chemical substances that interfere with cell division not only of cancer cells, but all young and dividing cells of the body. Chemotherapy alone may destroy immunity if given too long and too intensely. It is not usually curative for prostate cancer patients except in rare instances.


Clinical Trial

A study conducted using participants/patients who receive specific interventions according to the research plan or protocol. These interventions may include medical products (drugs or devices), procedures, or changes to a participant’s/patient’s behavior (such as diet) to evaluate effectiveness.


Combinational Hormonal Therapy (CHT)

The blocking in manufacturing of testosterone through surgical or chemical castration plus an antiandrogen to inhibit the prostate cancer receptor cells from utilizing dihydrotestosterone converted from the testosterone of the adrenal glands.


Complete Blood Count (CBC)

A full blood panel ordered by a doctor that examines a patient’s blood specimen that gives information on cell counts for each type of cell and the concentrations of various proteins and minerals. Mainly the number of white blood cells (WBC) red blood cells (RBC) and platelets (PLT), hemoglobin (Hgb) levels, and hematocrit (HCT) levels are determined.


Computed Tomography (CAT or CT Scan)

An x-ray procedure that uses a computer to produce a detailed picture or cross section of the body.


Cryosurgery or Cryoablation

Minimally invasive computer-guided procedure in which all or part of the prostate gland tissue is frozen using argon gas.


Cystoscopic Examination

An examination of the urethra and urinary bladder using a cystoscope. A cystoscope is a long narrow tube with a light at one end of an opening so the physician can observe the inside of the urethra and blader.


D

Digital Rectal Examination (DRE)

A procedure in which a physician inserts a gloved and lubricated finger in the rectum to examine the area as well as the prostate gland for signs of cancer. The doctor checks the size and feels for iffegular or firm areas.


Double – Blind Study

A controlled experiment in which neither the patient nor the doctor knows whether the patient is getting the experimental or control drug/dose. The key that identifies the subjects/patients and which group the belonged to is kept by a third party, and is not revealed until the study is over. In a single – blind study only the patient doesn’t know which of the several treatments he is receiving.


Drug “Interaction”

This is a situation in which one drug affects the activity of another drug when both are given at the same time.


E

Edema

The swelling or accumulation of fluid in a part of the body.


Endocrinologist

A physician who specializes in treating disorders of the endocrine system. This includes all endocrine glands and hormone systems of the body (i.e. pituitary gland, adrenal gland, testes.)


Enzyme

A protein that acts as a catalyst, increasing the rate at which chemical change occurs in the body.


External Urethral Sphincter Muscle

A voluntary and involuntary ring-like band of muscle fibers that contract to retain urine in the bladder. When voluntary control is lost, this is known as incontinence- the leakage of urine.


F

Fine Needle Aspiration

The use of a thin needle to withdraw tissue from the body.In the case of suspected prostate cancer used in conjunction with transcretal ultrasound of the prostate (TRUS/P).


Fistula

An epithelial lined passage or tunnel formed in the body congenitally, by disease, injury, or occasionally by surgery or radiation; and leading from one internal organ to another or from an internal organ to the body’s exterior. Anal fistula is the most common.


Foley Catheter

A long flexible tube placed through the urethra into the bladder for continuous urinary drainage.


Frozen Section

A technique in which tissue is removed from the body by biopsy, then frozen, cut into thin slices, stained and examined under a microscope. A pathologist can usually rapidly examine a frozen section for immediate diagnosis. This procedure is often done during surgery to help the surgeon decide the most appropriate course of action.


G

Gleason Score

A subjective method of measuring the differentiation of cells to classify tumors by their microscopic appearance and how aggressively the cancer cells may multiply. This system divides prostate cancer into five histological patterns ranging from 1-5. Patterns 1 and 2 represent well- differentiated tumors and are dealt with more easily; Gleason patterns 3 represents moderately well-differentiated tumor cells beginning to scatter; Gleason patterns 4 and 5 indicate poorly differentiated cells with the potential for fast growth. The total Gleason score is determined by adding a primary and secondary score pattern for each prostatic lesion i.e. 3+4=7. The most well-differentiated cancer cells would consist entirely of Gleason pattern 1 ( primary +secondary + 1+1 or Gleason 2 ) and the most poorly differentiated cancer cells would have a 5+5 or total Gleason score of 10.


H

Hematuria

When blood is found in the urine.


HIFU (High Intensity Focused Ultrasound)

is a medical procedure that applies high intensity focused ultrasound energy to locally heat and destroy cancerous and/or damaged tissue through ablation.


Hormone Therapy (HT)

Also called Androgen Deprivation Therapy (see above definition), it is the use of medication or surgery (removal of testicles) to prevent cancer cells from getting the hormones needed to grow. In prostate cancer this means the hormone testosterone.


I

Immunotherapy

Treatment by stimulation of the body’s immune system.


Impotence

Inability to have an erection suitable for intercourse.May be a result of an injury secondary to radiation therapy, surgical resection of the prostate, hormonal deprivation therapy, or other aspects of neurological, vascular or disease processes.


Incontinence

Inability to hold urine in the bladder. May be a result of radiation therapy, surgical resection of the prostate, or other disease process.


L

Laparoscopic Lymphadenectomy

The surgical removal of lymph nodes. This is a non-invasive procedure, and is done with a laparoscope through multiple small incisions.


LHRH Agonists

Compounds that are similar to LHRH that suppress the production of testosterone in the testes ( i.e., lupron and zoladex.)


Lupron Depot (Leuprolide)

A long-acting LHRH analog used in chemical castration and combination hormonal therapy, that is given monthly through injection.


Luteinizing Hormone – Releasing Hormone (LH-RH or LHRH)

A hormone that controls sex hormones in men and women. For men, these can decrease androgen production by inhibiting the release of testosterone by the testicles. This treatment is sometimes called “chemical castration” like a orchiectomy, but whose effects are reversible.


Luteinizing Hormone – Releasing Hormone (LH-RH or LHRH) antagonist

These medications bind to the receptors in the pituitary gland reducing the release of luteinizing hormone (LH) from the pituitary which then leads to a reduction of testosterone release from the testes.


Lymphadenectomy

A procedure in which lymph nodes are taken from your body for purposes of diagnosing or staging cancer.


Lymph Nodes

Many small bean-shaped structures scattered along the vessels of the lymphatic system. The nodes serve a very important role in the immune system. They have special cells that can filter out bacteria and cancer cells that may travel through the system.


M

Magnetic Resonance Imaging (MRI) Scan

Also known as a magnetic resonance imaging, an MRI uses very strong magnet, radio waves, and a computer to make very detailed images of areas inside the body. The picture produced by the computer and high powered magnet can detect if the tumor has penetrated the prostate gland and/or invaded the seminal vesicles or other adjacent organs. It can also be used to evaluate whether lymph nodes are enlarged, indicating a presence of cancer.


Malignant Tumors

Cancerous tumors.


Metastasis

The spread of disease/cancer cells from one part of the body to another not directly connected with it. This can be by way of the lymph system, blood stream or direct extension.


Metastatic Work Up

Can include bone scans, bone x-rays, chest x-rays, MRI’s, blood PSA tests and probably blood acid phosphatase and alkaline phosphatase.


N

Nerve Sparing Technique

A surgical technique during a radical prostatectomy where one or both of the neurovascular bundles controlling erections are spared. The utilization of this procedure is determined by the extent of the prostate cancer.


Nocturne

A condition where an individual must get up several times during the night to urinate.


Nuclear Scan

A procedure in which a radioactive tracer is injected in the blood stream (usually via a vein in the arm.) The material is absorbed by the body’s organs and tissues allowing a special gamma camera to take pitures.


O

Oncologist

A medical doctor specializing in the study, diagnosis, and treatment of cancer.


Oncology

The branch of medical science that deals with the study, diagnosis, and treatment of cancer.


Orchiectomy (Castration)

A surgical procedure in which the testicles are removed (see hormone therapy). This maneuver is permanent, and the patient will be sterile and 50- 60% will become impotent.


P

Pathologist

A doctor who specializes in the diagnosis of disease by studying cells and tissues removed from the body during medical procedures. They help to facilitate the diagnosis and the direction of treatment for a patient.


PCA3Plus

Is a urine test that detects a specific gene called PCA3, which is highly expressed in prostate cancer cells. A urine sample is collected and sent to laboratory to obtain a PCA3 score. The higher the score, the more likely a biopsy will be positive for prostate cancer. The test is available in Europe and, more recently, in the United States, but it is not yet FDA approved.


Pelvic Node Dissection

Removal of lymph nodes near the prostate gland. This is done to determine if the cancer has spread to the lymph system, thus aiding in the staging of the cancer.


Penile Prosthetic Implant

A prosthetic device inserted into the penis that allows for an erection. There are over fifteen different varieties from one piece rigid structures to self contained unit implants.


Percent-Free PSA Ratio

Is a blood test that compares the amount of PSA bound to proteins in the blood to the amount of PSA that circulates by itself (unbound.) When the percent-free PSA ratio is found to be 22% or less, prostate cancer is more likely present.


Prostatectomy

To surgically remove the prostate gland


Placebo

A substance that has no real therapeutic pharmacological value i.e., sugar pill instead of an actual medicine. Placebos are often given to patients who require a pill for psychological reasons, but mostly as part of clinical trials to test the effectiveness of new drugs. The placebo effect is a classic example of the mind-body relationship.


Prognosis

A prediction of the course of the disease; the future prospects for the patient.


Proscar (Finasteride)

A recently approved FDA drug that shrinks the prostate gland in the treatment of early BPH. Long term effects are unknown at this time.


Prostate Acid Phosphatase (PAP)

an enzyme produced by the prostate that is elevated in some patients when prostate cancer has spread beyond the prostate. This is useful in staging the disease.


Prostate Gland

A walnut-size gland that is part of the male reproductive system. It is located beneath the urinary bladder and in front of the rectum, surrounding the neck of the bladder and approximately the first inch of the urethra. Its main function is to supply some of the fluid that nourishes and protects sperm in the semen.


Prostate Specific Antigen (PSA)

Is a protein produced by both normal and cancerous cells in the prostate. Growth of prostate cancer cells as well as other conditions such as a benign enlargement of the prostate (BPH) or inflammation/infection (prostatistis) can cause an elevation of the PSA level in the blood. The PSA is the most sensitive “marker” of the prostate cancer currently available and is used to monitor the progress of a patient undergoing treatment as well as after surgery or radiation therapy.
The normal range of PSA is generally considered between 0-4 nanograms of PSA per milliliter (ng/ml) of blood.


R

Radiation Therapy (RT)

Uses high energy rays to kill prostate cancer cells. Usually healthy cells are also affected. Like surgery, radiation therapy works best when the tumor is small and localized. There are two ways in which high frequency rays can be delivered: one by External Beam Radiation four or five times a week over six or seven weeks; the other by Interstitial Radiation Therapy also referred to as Brachytherapy, receiving rays from tiny radioactive seeds inserted directly into the prostate tumor. Other forms of radiation are Proton Beam Irradiation which has high selectivity without damage to surrounding tissue and negligible morbidity; 3-D Directed Radiation which utilizes computer generated scans that provide the ability to confine the radiation selectively to the targeted area without peripheral involvement; and Neutron Therapy which is specialized radio therapy using atomic particles.


Radical Retropubic Prostatectomy

To surgically remove the entire prostate gland and seminal vesicles through the lower abdomen.


Remission

Complete or partial disappearance of the signs and symptoms of disease in response to treatment; the period during in which a disease is under control, and does not progress any further. A remission does not necessarily mean a cure.


Retrograde Ejaculation

Semen flowing backwards into the bladder instead of out through the urethra during ejaculation. This is most often the case following a transurethral resection of the prostate gland (TURP) in the treatment of BPH.


Robotic Radical Prostatectomy

This approach is used to perform radical prostatectomy with a state-of-the-art robotic system, called the daVinci Surgical System. It provides a magnified, 3-dimensional view during the operation and maintains surgeon dexterity through its robotic arms. The surgical technique has improved the ability to treat prostate cancer while reducing potential complications such as blood loss, incontinence and erectile dysfunction. The procedure is visualized with a small telescope and performed through several small incisions, rather than one large one.


S

Seminal Vesicles

Are a pair of pouch-like glands located just behind the prostate that secrete seminal fluid, which nourish and promote the movement of the sperm through the urethra.


Staging

A medical term for the process of determining if a known cancer is still confined within the organ of origin (the prostate) where it is curable, or if it has spread outside of the prostate gland where it is probably not curable, but treatable. It is a system for classifying patients with malignant disease according to the extent and severity of disease, and thereby helping to determine the appropriate therapy. The Tumor Nodes Metastasis (TNM) staging system ranges from T1a through T4c. See the table below.

Stages of Prostate Cancer

TNM Description
T1 Cancer present, but not detectable in DRE or on imaging
T1a Found incidentally, Less than 5 percent of sample malignant and low-grade
T1b Found incidentally, More than 5 percent of sample malignant and/or not low-grade
T1c PSA elevated, not palpable, found in needle biopsy
T2 Tumor is palpable in DRE; organ confined
T2a Confined to half or less than half on one of the prostate’s two lobes
T2b Confined to more than one half of one lobe of gland but not both
T2c The tumor is in both lobes but within the prostatic capsule
T3 Locally extensive cancer
T3a Penetration of prostate capsule on one or both sides
T3b Penetration of prostate capsule with seminal vesicle involvement
T4 Tumor extension to adjacent organs
T4a Cancer that has invaded the bladder neck and/or rectum and/or external urinary sphincter
T4b Cancer that involves other areas near the prostate
N Lymph node involvement
NO No cancer detected in the lymph nodes
N1 Cancer spread to one or more lymph nodes measuring less than 2cm
N2 Cancer spread to one or more lymph nodes measuring 2-5cm
N3 Cancer spread to one or more lymph nodes measuring more than 5cm
M Metastasis to distant sites other than lymph nodes (cancer spread)
MO Cancer that is confined to the prostate, surrounding tissues and pelvic lymph nodes
M1 Cancer that has spread beyond the pelvic area to bones, lungs, etc.


T

Testosterone

A male sex hormone produced by the testicles with a small amount produced by adrenal glands. It is associated with the activity and growth of the prostate gland and other sex organs.


Transrectal Ultrasound Of The Prostate(TRUS/P)

Is a specific ultrasound test that uses a probe inserted into the rectum to visualize the prostate gland. It can be used to measure the size of the gland, detect anatomic variations and sometimes detect abnormal tissue. It is also extremely useful for guidance of needle biopsies of the prostate gland and guiding the nitrogen probes in cryosurgery.


Transurethral Incision Of The Prostate (TUIP)

A surgical technique for treating BPH on individuals with small prostates. It is a simple operation which is less likely to cause a significant loss of blood. The instrument is passed into the neck of the bladder where one or two incisions are made through the wall to open the prostatic urethra.


Transurethral Laser Incision Of The Prostate (TULIP)

The use of laser through the urethra which melts the tissue with minimal bleeding and no need for a postoperative catheter.


Transurethral Resection Of The Prostate (TUR/P)

A surgical procedure by which portions of the prostate gland are removed through the penis. The technique is used to relieve obstruction of urine flow due to the enlargement of prostate (also known as “Roto-Rooter Procedure”). Many times unsuspected cancer cells are discovered during this procedure when removed tissue is examined by a pathologist. After this operation, a common side effect is retrograde ejaculation. This is when semen released during sexual activity flows backwards into the bladder rather than out through the urethra.


U

Ultrasound (Ultrasonography)

A non-invasive imaging modality utilizing high frequency sound waves too high for human ears to hear, for producing images from inside the body.


Ureter

The tube that carries urine from each kidney to the bladder.


Urethra

The tube that carries urine from the bladder and fluid from the prostate through the penis to the outside of the body. It begins at the neck of the bladder, surrounded by the prostate gland and ends at the external sphincter muscle.


Urologist

A doctor who specializes in diseases of the urinary tract and male reproductive systems.


V

Vacuum-Tumescent-Enhancement Therapy

A mechanical non-surgical method of producing penal engorgement and rigidity sufficient for intercourse in most impotent patients.


W

“Watchful Waiting” (No Treatment)

See also “Watchful Waiting,” is an approach to a medical problem in which a patient and/or physician monitors a potentially dangerous condition, where time is allowed to pass before medical intervention or therapy is used. During this time, repeated testing may be performed. A good example would be PSA monitoring of early stage A or B organ confined prostate cancer.