0 What is cancer?
---- 전립선암 안내
01 ----
The body is made up of trillions of living cells.
Normal body cells grow, divide into new cells, and die in an
orderly fashion.
During the early years of a person's life, normal cells divide
faster to allow the person to grow.
After the person becomes an adult,
most cells divide only to replace worn-out or dying cells or to
repair injuries.
Cancer begins when cells in a part of the body
start to grow out of control.
There are many kinds of cancer, but they all start because of
out-of-control growth of abnormal cells.
Cancer cell growth is different from normal cell growth.
Instead of dying,
cancer cells continue to grow and form new, abnormal cells.
Cancer cells can also invade (grow into) other tissues,
something that normal cells cannot do.
Growing out of control and invading other tissues are what
makes a cell a cancer cell.
Cells become cancer cells because of damage to DNA.
DNA is in every cell and directs all its actions.
In a normal cell, when DNA gets damaged the cell either repairs
the damage or the cell dies.
In cancer cells, the
damaged DNA is not repaired, but the cell doesn’t die like it should.
Instead, this cell goes on making new cells that the body does
not need.
These new cells will all have the same damaged DNA as the first
cell does.
People can inherit damaged DNA, but most DNA damage is caused
by mistakes that happen
while the normal cell is reproducing or by something in our
environment.
Sometimes the cause of the DNA damage is something obvious,
like cigarette smoking.
But often no clear cause is found.
In most cases the cancer cells form a tumor.
Some cancers, like leukemia, rarely form tumors.
Instead, these cancer cells involve the blood and blood-forming
organs and circulate through
other tissues where they grow.
Cancer cells often travel to other parts of the body,
where they begin to grow and form new tumors that replace
normal tissue.
This process is called metastasis.
It happens when the
cancer cells get into the bloodstream or lymph vessels of our body.
No matter where a cancer may spread, it is always named for the
place where it started.
For example, breast cancer that has spread to the liver is
still called breast cancer, not liver
cancer.
Likewise, prostate cancer that has spread to the bone is metastatic prostate
cancer, not bone cancer.
Different types of cancer can behave very differently.
For example, lung cancer and breast cancer are very different
diseases.
They grow at different rates and respond to different
treatments.
That is why people with cancer need treatment that
is aimed at their particular kind of cancer.
Not all tumors are cancerous.
Tumors that aren’t cancer are called benign.
Benign tumors can cause problems – they can grow very large and
press on healthy organs and tissues.
But they cannot grow into (invade) other tissues.
Because they can’t invade, they also can’t spread to other
parts of the body (metastasize).
These tumors are almost
never life threatening.
1 What is prostate
cancer?
To understand prostate cancer,
it helps to know something about the prostate and nearby
structures in the body.
About the prostate
The prostate is a gland found only in males.
It is located in front of the rectum and below the urinary
bladder.
The size of the prostate varies with age.
In younger men, it is about the size of a walnut, but it can be
much larger in older men.
The prostate's job is to make some of the fluid that protects
and nourishes sperm cells in semen,
making the semen more liquid.
Just behind the prostate are glands called seminal
vesicles 정낭
that make most of the fluid for semen.
The urethra
요도, which
is the tube that carries urine and semen out of the body through the penis,
goes through the center of the prostate.
The prostate starts to develop before birth.
It grows rapidly during puberty 사춘기, fueled by male hormones
(남성홀몬 called androgens)
in the body.
The main androgen, testosterone,
is made in the testicles 고환.
The enzyme 5-alpha
reductase 환원제
converts testosterone into dihydrotestosterone (DHT).
DHT
is the main hormone that signals the prostate to grow.
The prostate usually stays at about the same size or grows
slowly in adults,
as long as male hormones are present.
Benign
prostatic
hyperplasia (전립선 비대증)
The inner part of the prostate (around the urethra) often keeps
growing as men get older,
which can lead to a common condition called benign
prostatic hyperplasia (BPH).
In BPH, the prostate tissue can
press on the urethra (요도의 압박),
leading to problems passing urine.
BPH is not cancer
and does not develop into cancer.
But it can be a serious medical problem for some men.
If it requires treatment,
medicines can often be used to shrink the size of the prostate
or to relax the muscles in it,
which usually helps with urine flow.
If medicines aren't helpful, some type of surgery,
such as a transurethral
resection of the prostate (TURP 경요도전립선절제술) may be needed.
(See the "Surgery
for prostate cancer" section for a description of
this procedure.)
Prostate cancer
Several types of cells are found in the prostate, but almost
all prostate
cancers develop
from the gland cells.
Gland cells make the prostate fluid that is added to the semen.
The medical term for a cancer that starts in gland cells is adenocarcinoma.(아데노카르시노마)
Other types of cancer can also start in the prostate gland,
including sarcomas,
small cell carcinomas,
and transitional cell
carcinomas.
But these types of
prostate cancer
are so rare that if you have
prostate cancer
it is almost certain to be an adenocarcinoma.
The rest of this document refers only to prostate
adenocarcinoma.
Some prostate cancers can grow and spread quickly, but most
grow slowly.
In fact, autopsy 사체해부학 studies show that many older men (and
even some younger men)
who died of other diseases also had prostate cancer that never
affected them during their lives.
In many cases neither they nor their doctors even knew they had
it.
Possible pre-cancerous conditions of the prostate 암발병의 전조가능성
Some doctors believe that prostate cancer starts out as a
pre-cancerous condition,
although this is not yet known for sure.
Prostatic intraepithelial neoplasia
(PIN전립선상피조직내종양)
In this condition, there are changes in how the prostate gland
cells look under the microscope,
but the abnormal cells don't look like they are growing into
other parts of the prostate (like cancer cells would).
Based on how abnormal the patterns of cells look, they are
classified as:
-
Low-grade PIN: the
patterns of prostate cells appear almost normal
-
High-grade PIN: the
patterns of cells look more abnormal
-
PIN begins to appear in the prostates of some men as early as
their 20s.
Almost half of all men
have PIN by the time they reach 50.
Many men begin to develop low-grade PIN at an early age but do
not necessarily develop prostate cancer.
The importance of low-grade PIN in relation to prostate cancer
is still unclear.
If a finding of low-grade PIN is reported on a prostate biopsy,
the follow-up for patients is usually the same as if nothing
abnormal was seen.
If high-grade PIN has
been found on your prostate biopsy,
there is about a 20% to
30% chance that you also have cancer in another area of your prostate.
This is why doctors often watch men with high-grade PIN
carefully and
may advise them to have a repeat prostate biopsy,
especially if the original biopsy did not take samples from all
parts of the prostate.
Proliferative inflammatory atrophy (PIA
염증성위축증)
This is another finding that may be noted on a prostate biopsy.
In PIA, the prostate cells look smaller than normal, and there are signs of
inflammation in the area.
PIA is not cancer, but researchers believe that PIA may
sometimes lead to high-grade PIN,
or perhaps to prostate cancer directly.
2 What are the key statistics about prostate cancer?
Other than skin
cancer, prostate cancer is the most common
cancer in American men.
The American Cancer Society’s estimates for prostate cancer in
the United States for 2013 are:
-
About 238,590 new cases of prostate cancer will be diagnosed
-
About 29,720 men will die of prostate cancer
About 1 man in 6 will be diagnosed with prostate cancer during
his lifetime.
Prostate cancer occurs mainly in older men.
About 6 cases in 10 are diagnosed in men aged 65 or older, and
it is rare before age 40.
The average age at the
time of diagnosis is about 67.
Prostate cancer is the second leading cause
of cancer death
in American men, behind only lung
cancer.
About 1 man in 36 will die of prostate cancer.
Prostate cancer can be a serious disease, but most men
diagnosed with prostate cancer do not die from it.
In fact, more than 2.5 million men in the United States who
have been diagnosed with prostate cancer
at some point are still alive today.
For statistics related to survival, see the section "Survival
rates for prostate cancer."
3 What are the risk factors for prostate cancer?(위험인자)
A risk factor is anything that affects your chance of getting a
disease such as cancer.
Different cancers have different risk factors.
Some
risk factors, like smoking, can be changed.
Others, like a person's age or family
history, can't be changed.
But risk factors don't tell us everything.
Many people with one or more risk factors never get cancer,
while others who get cancer may have had few or no known risk
factors.
We don't yet completely understand the causes of prostate
cancer,
but researchers have found several factors that might change
the risk of getting it.
For some of these factors, the link to prostate cancer risk is
not yet clear
Age
Prostate cancer is very rare in men younger than 40,
but the chance of having prostate cancer rises rapidly after
age 50.
About 6 in 10 cases of prostate cancer are found in men over
the age of 65.
Race/ethnicity
Prostate cancer occurs more often in African-American men and
Jamaican men of African ancestry than in men of other races.
African-American
men are also more likely to be diagnosed at an advanced stage,
and are more than twice as likely to die of prostate cancer as
white men.
Prostate cancer occurs less often in Asian-American and
Hispanic/Latino men than in non-Hispanic whites.
The reasons for these racial and ethnic differences are not
clear.
Nationality
Prostate cancer is most common in North America, northwestern
Europe, Australia, and on Caribbean islands.
It is less common in Asia, Africa, Central America, and South
America.
The reasons for this are not clear.
More intensive screening in some developed countries probably
accounts for at least part of this difference,
but other factors such as lifestyle differences (diet, etc.)
are likely to be important as well.
For example,
men of Asian descent
living in the United States have a lower risk of prostate cancer than white
Americans,
but their risk is
higher than that of men of similar backgrounds living in Asia.
Family history
Prostate cancer seems to run in some families,
which suggests that in some cases there may be an inherited or
genetic factor.
Having a father or brother with prostate cancer more than
doubles a man's risk of developing this disease.
(The risk is higher for men who have a
brother with the disease than
for those with an affected father.)
The risk is much higher for men with several affected
relatives,
particularly if their relatives were
young at the time the cancer
was found.
Genes
Scientists have found several inherited gene changes that seem
to raise prostate cancer risk,
but they probably account for only a small number of cases
overall.
Genetic testing for most of these gene changes is not yet
available.
Some inherited gene changes raise the risk for more than one
type of cancer.
For example, inherited mutations
(돌연변이) of the BRCA1 or BRCA2 genes
are the reason
that breast and ovarian cancers are much more common in some
families.
Mutations in these genes may also increase prostate cancer risk
in some men,
but they account for a very small percentage of prostate cancer
cases.
Recently, some common gene variations have been linked to a
higher risk of prostate cancer.
Studies to confirm this are needed to see
if testing for the gene variants will be useful in predicting
(예측) prostate cancer risk.
For more on some of the gene changes linked to prostate cancer,
see
“Do
we know what causes prostate cancer?”
Diet
The exact role of diet in prostate cancer is not clear, but
several factors have been studied.
Men who eat a lot of red meat or high-fat dairy products appear
to have a slightly
higher chance of getting prostate cancer.
These men also tend to eat fewer fruits and vegetables.
Doctors are not
sure which of these factors is responsible for raising the risk.
Some studies have suggested that men who consume a lot of
calcium (through food or supplements)
may have a higher risk of developing prostate cancer.
Dairy foods (which are
often high in calcium) might also increase risk.
Most studies have not
found such a link with the levels of calcium found in the average diet,
and it's important to
note that calcium is known to have other important health benefits.
Obesity
Most studies have not found that being obese (very
overweight) is linked with a higher risk of
getting prostate cancer overall.
Some studies have found that obese men have a lower risk of
getting a low-grade (less dangerous)
form of the disease, but a higher risk of getting more
aggressive prostate cancer.
The reasons for this
are not clear.
Some studies have also found that obese men may be at greater
risk
for having more advanced prostate cancer and of dying from
prostate cancer, but not all
studies have found this.
Smoking
Most studies have not found a link between smoking and the risk
of developing prostate cancer.
Some recent research has linked smoking to a possible small
increase in the risk of death from prostate cancer,
but this is a new finding that will need to be confirmed by
other studies.
Workplace exposures
There is some evidence that firefighters are exposed to
substances that may increase risk.
Inflammation of the prostate
Some studies have suggested that prostatitis (전립선염
inflammation of the prostate gland) may be linked to
an increased risk of prostate cancer, but other studies have
not found such a link.
Inflammation is often seen in samples of prostate tissue that
also contain cancer.
The link between the two is
not yet clear, but this is an
active area of research.
Sexually transmitted infections 성병
Researchers have looked to see if sexually transmitted
infections (like gonorrhea 임질 or chlamydia 클라미디아)
might increase the risk of prostate cancer, possibly because
they may lead to inflammation of the prostate.
So far, studies have not agreed, and no firm conclusions have
been reached.
Vasectomy 정관수술
Some earlier studies had suggested that men who have had a
vasectomy (minor surgery to make men infertile)
– especially those younger than 35 at the time of the procedure
– may have a slightly increased risk for prostate cancer.
But most recent studies have not found any increased risk among
men who have had this operation.
Fear of an increased risk of prostate cancer should not be a
reason to avoid a vasectomy.
4 Do we know what causes prostate cancer?전립선암발생원인
We do not know exactly what causes prostate cancer.
But
researchers have found some risk factors and are trying to learn just
how
these factors cause prostate cells to become cancerous
(see section "What
are the risk factors for prostate cancer?").
On a basic level, prostate cancer is caused by
changes in the DNA of a prostate cell.
In recent years, scientists have made great progress in
understanding how certain changes in DNA
can cause normal prostate cells to grow abnormally and form
cancers.
DNA is the chemical
that makes up our genes, the instructions for nearly everything our
cells do.
We usually look like our parents because they are the source of
our DNA.
However, DNA affects more than how we look.
Some genes control when our cells grow, divide into new cells,
and die.
Certain genes that tell cells to grow and divide are called oncogenes
종양발생.
Others that normally slow down cell division or cause cells to die at the
right time are called
tumor
suppressor genes 종양발생억제인자.
Cancer can be caused in part by
DNA changes (mutations 변이) that turn on oncogenes
or turn off tumor suppressor
genes.
DNA changes can either be inherited from a parent or can be
acquired during a person's lifetime.
Inherited DNA mutations 유전자변이
Researchers have found that inherited DNA changes in certain
genes may cause
about 5% to 10% of prostate
cancers.
Several mutated genes have been found that may be responsible
for a man's inherited tendency
to develop prostate cancer.
One of these is
called HPC1 (Hereditary Prostate Cancer
Gene 1).
But there are many other
gene mutations유전자변이 that may
account for some cases
of hereditary prostate cancer.
None of these is a major cause, and more research on these
genes is being done.
Genetic tests are not yet available.
Men with BRCA1 or BRCA2 gene
changes may also have an increased prostate cancer risk.
Mutations in these
genes more commonly cause breast 유방and ovarian 난소cancer in women.
But inherited BRCA changes
probably account for only a very small number of prostate cancers.
DNA mutations acquired during a man's lifetime
Most DNA mutations related to prostate cancer seem to develop
during a man's life
rather than having been inherited.
Every time a cell prepares to divide into 2 new cells, it must
copy its DNA.
This process is not
perfect, and sometimes errors occur, leaving flawed결점 DNA in the new cell.
It is not clear how often these DNA changes might be random
events,
and how often they may be influenced by other factors (diet, hormone
levels, etc.).
In general, the more quickly prostate cells grow and divide,
the more chances there are for mutations to occur.
Therefore, anything that speeds up this process may make
prostate cancer more likely.
The development of prostate cancer may be linked to
increased levels of certain hormones.
High levels of
androgens (male hormones, such as testosterone) promote prostate cell growth,
and may contribute to
prostate cancer risk in some men.
Some researchers have noted that men with high levels of
another hormone,
insulin-like growth
factor-1 (IGF-1), are more likely to get prostate cancer.
IGF-1 is similar to insulin, but it affects cell growth, not
sugar metabolism.
However, other studies have
not found a link between IGF-1
and prostate cancer.
Further research is needed to make sense of these findings.
As mentioned in the "What
are the risk factors for prostate cancer?" section,
some studies have found that inflammation may contribute to
prostate cancer.
One theory is that inflammation may lead to cell DNA damage,
which might in turn push a cell closer to becoming cancerous.
More research in this area is needed.
Exposure to radiation or
cancer-causing chemicals may cause DNA mutations in many organs of the body,
but these factors have not been proven to be important causes
of mutations in prostate cells.
5 Can prostate cancer be prevented? 예방
The exact cause of prostate cancer is
not known,
so at this time it is not possible to prevent most cases of the
disease.
Many risk
factors such
as age, race, and family history cannot be controlled.
But based on what we do know,
there are some things you can do that might lower your risk of
prostate cancer.
Body weight, physical activity, and diet
The effects of body
weight, physical
activity, and diet on
prostate cancer risk are not clear,
but there may be things you can do that might lower your risk.
Some studies have found that men who are overweight may have a
slightly lower risk of prostate cancer overall,
but a higher risk of
prostate cancers that are likely to be fatal.
Studies have found that men who get regular physical activity
have a slightly lower risk of prostate cancer.
Vigorous왕성한 activity may have a greater effect, especially on
the risk of advanced prostate cancer.
Several studies have suggested that diets high in certain
vegetables
(including tomatoes,
cruciferous vegetables 평짓과채소, soy, beans, and
other legumes 콩과식물)
or fish may be linked with a lower risk of prostate cancer,
especially more advanced cancers.
Examples of cruciferous
vegetables include cabbage, broccoli, and cauliflower.
Although not all studies agree,
several have found a
higher risk of prostate cancer in men who have diets high in calcium.
There may also be an increased risk from consuming
dairy foods.
For now, the best advice about diet and activity to possibly
reduce the risk of prostate cancer is to:
-
Eat at least 2½ cups of a wide variety of vegetables and
fruits each day.
-
Be physically active.
-
Stay at a healthy
weight.
It may also be sensible to limit calcium supplements and to not
get too much calcium in the diet.
(This does not mean that men who are being treated
for prostate
cancer should not take
calcium supplements if their doctor recommends them.)
For more information,
see the American
Cancer Society Guidelines on Nutrition and Physical Activity for Cancer
Prevention.
Vitamin, mineral, and other supplements
Some earlier studies suggested that taking certain vitamin or
mineral supplements might lower prostate cancer risk.
Of special interest
were vitamin E and the mineral selenium.
To study the possible effects of selenium and vitamin E on
prostate cancer risk,
doctors conducted the Selenium and Vitamin E Cancer Prevention
Trial (SELECT).
Men in this large study took one or both of these supplements
or an inactive placebo each day for about 5 years.
Neither vitamin E nor selenium was found to lower prostate
cancer risk in this study.
In fact, men taking the
vitamin E supplements were later found to have a slightly higher risk of
prostate cancer.
Taking any supplements can have
both risks and benefits.
Before starting vitamins or other supplements, talk with your
doctor.
Several studies are now looking at
the possible effects of soy
proteins (called isoflavones 이소플라본)
on prostate cancer risk.
The results of these studies are not yet available.
Medicines 약물
Some drugs may help reduce the risk of prostate cancer.
5-alpha reductase inhibitors
알파 5 차단제
5-alpha reductase is the enzyme in the body
that changes
testosterone into dihydrotestosterone (DHT),
the main hormone that causes the
prostate to grow.
Drugs called 5-alpha reductase
inhibitors 억제 block the enzyme
and prevent the formation of DHT.
Two 5-alpha reductase inhibitors are already in use to treat
benign prostatic hyperplasia (BPH),
a non-cancerous growth of the prostate:
-
Finasteride (Proscar?)
-
Dutasteride (Avodart?)
Large studies of both of these drugs have been done to see
if they might also be useful in lowering prostate cancer risk.
In these studies, men taking either drug were
less likely to develop prostate
cancer
after several years than men getting an inactive placebo.
When the results were looked at more closely,
the men who took these drugs had
fewer cases of prostate cancers that
were low-grade,
but slightly more cases
of prostate cancer that were intermediate or high-grade.
The grade of a cancer is based on how it looks under the
microscope.
Intermediate and high-grade cancers are more likely to grow and
spread than low-grade cancers.
Over the long term, though, this didn’t seem to affect death
rates - both groups of men had similar survival.
These drugs can cause sexual side effects like lowered sexual
desire and impotence.
But they can help with problems from BPH such as
trouble
urinating 소변장애.
Although these drugs are safe, they aren’t approved by the FDA
to prevent prostate cancer.
Right now, it isn’t clear that taking finasteride
or dutasteride just to lower prostate cancer risk is very helpful.
Still, men who want to know more about these drugs should
discuss them with their doctors.
Other drugs 기타약물
Other drugs and dietary supplements that may help lower
prostate cancer risk are now being tested in clinical trials.
No other drug or supplement has been found to be helpful in
studies large enough
to allow experts to recommend they should be given to men.
6 Signs and symptoms of
prostate cancer 징조와 증상
Early prostate cancer usually causes no symptoms.
Advanced prostate
cancers can
cause some symptoms, such as:
-
Problems passing urine
소변의 문제, including a slow or weak urinary stream or the need to
urinate more often,
-
especially at night.
-
Blood in the urine (hematuria
혈뇨)
-
Trouble getting an erection (impotence
발기부전)
-
Pain in the hips, back (spine), chest (ribs), or other areas
from cancer spread to bones 골통증
-
Weakness or numbness in the legs or feet
발과다리의 문제,
-
or even loss of bladder or
bowel control from cancer pressing on the spinal cord.좌골신경통
Other diseases can also cause many of these same symptoms.
For example, trouble passing urine is much more often caused by benign prostatic hyperplasia (BPH)
than cancer.
Still, it is important to tell your doctor
if you have any of these problems so that the cause can be
found and treated, if needed.
7 How is prostate cancer diagnosed? 검사와 진단(**매우중요)
Most prostate cancers are first found during screening with
a prostate-specific antigen (PSA) blood test and or
a digital rectal exam (DRE).
(See "Can
prostate cancer be found early?")
Early prostate
cancers usually do not cause symptoms,
but more advanced cancers are sometimes first found because of
symptoms they cause.
Whether cancer is suspected based on screening tests or
symptoms,
the actual diagnosis
can only be made with a prostate biopsy.
Medical history and physical exam
If your doctor suspects you might have prostate cancer,
he or she will ask you about any symptoms you are having,
such as any urinary or sexual problems,
and how long you have had them.
Your doctor may also ask about bone pain, which could be a sign
that the cancer might have spread to your bones.
Your doctor will also physically examine you, including doing a
digital rectal exam (DRE 직장수지검사),
during which a gloved, lubricated finger is inserted into the
rectum to feel for any bumps or hard
areas
on the prostate that might be cancer.
If you do have cancer, the DRE can sometimes help tell if it is
only on one side of the prostate,
if it is on both sides,
or if it is likely to have spread beyond the prostate to nearby
tissues.
Your doctor may also examine other areas of your body to see if
the cancer has spread.
He or she will then order some tests.
PSA blood test
전립선특이항원 검사
The prostate-specific antigen (전립선특이항원 PSA) blood test is used mainly
to try to find prostate cancer
early in men without symptoms (see "Can
prostate cancer be found early?").
But it is also one of the first tests done in men who have
symptoms that might be caused by prostate cancer.
The PSA test can also be useful if prostate cancer has already
been diagnosed.
-
In men just diagnosed with prostate cancer,
-
the PSA test can be used together with physical exam results
and tumor grade
-
(from the biopsy, described further on) to help decide
-
if other tests (such as CT scans or bone scans) are needed.
-
The PSA test is a part of staging and
can help tell if your cancer is likely to be still confined to the prostate
gland.
-
If your PSA level is very high, your cancer has probably spread
beyond the prostate.
-
This may affect your treatment
options, since some forms of therapy (such as surgeryand radiation)
-
are not likely to be helpful if the cancer has spread to the
lymph nodes, bones, or other organs.
PSA tests are also an important part of monitoring prostate
cancer during and after treatment
(see
"Following
PSA levels during and after treatment").
Transrectal ultrasound (TRUS
경직장초음파영상검사)
Transrectal ultrasound (TRUS) uses sound waves to make an image
of the prostate on a video screen.
For this test, a small probe that gives off sound waves is
placed into the rectum.
The sound waves enter the prostate and create echoes that are
picked up by the probe.
A computer turns the pattern of echoes into a
black and white image of the prostate.
The procedure often takes less than 10 minutes and is done in a
doctor's office or outpatient clinic.
The ultrasound probe is about the width of a finger and is
lubricated before it is placed in your rectum.
You will feel some pressure when the probe is inserted, but it
is usually not painful.
The area may be numbed before the procedure.
TRUS is often used to look at the prostate when a man has a
high PSA level or has an abnormal DRE.
It is also used during
a prostate biopsy to guide the needles into the right area of the
prostate.
TRUS is useful in other situations as well.
It can be used to
measure the size of the prostate gland,
which can help determine the PSA
density (described in "Can
prostate cancer be found early?")
and may also
affect which treatment options a man has.
TRUS is also used as a guide during
some forms of treatment such as brachytherapy
(internal radiation therapy) or cryosurgery.
Prostate biopsy 전립선 조직검사
If certain symptoms or the results of early
detection tests –
a PSA blood test and/or DRE
– suggest that you might have prostate cancer,
your doctor will do a prostate biopsy to find out.
A biopsy is a procedure in which a sample of body tissue is
removed and then looked at under a microscope.
A core
needle biopsy is
the main method used to diagnose prostate cancer.
It is usually done by a
urologist 비뇨기과의사, a surgeon who treats cancers of the genital and
urinary tract,
which includes the
prostate gland 전립선 선조직.
Using transrectal ultrasound to "see" the prostate gland, the
doctor quickly inserts a thin,
hollow needle through the wall of the rectum into the prostate
gland.
When the needle is pulled out it removes a small cylinder
(core) of prostate tissue.
This is repeated from 8 to18 times, but most urologists will
take about 12 samples.
Though the procedure sounds painful,
it usually causes only a brief uncomfortable sensation
because it is done with a special spring-loaded biopsy
instrument.
The device inserts and removes the needle in a fraction of a
second.
Most doctors who do the biopsy will numb the area first by
injecting a local anesthetic alongside the prostate.
You might want to ask your doctor if he or she plans to do
this.
The biopsy itself takes about 10 minutes and is usually done in
the doctor's office.
You will likely be given antibiotics to take before the biopsy
and
possibly for a day or 2 after to reduce the risk of infection.
For a few days after the procedure,
you may feel some soreness in the area and will probably notice
blood in your urine.
You may also have some light bleeding from your rectum,
especially if you have hemorrhoids 치질.
Many men also see some blood in their semen 정액 or have rust
colored semen,
which can last for several weeks after the biopsy, depending on
how frequently you ejaculate 사정.
Your biopsy samples will be sent to a lab,
where a pathologist (
병리학자 a
doctor who specializes in diagnosing disease in tissue samples) will look at
them under a microscope to see if they contain cancer cells.
If cancer is
present, the pathologist will also assign it a grade (see
the next section).
Getting the results usually takes at least 1 to 3 days, but it
can take longer.
Even taking many samples,
biopsies can still sometimes
miss a
cancer if none of the biopsy needles pass through it.
This is known as a
"false negative" result.
If your doctor still strongly suspects you have
prostate cancer (due to a very high PSA level, for example)
a repeat biopsy
may be needed to help be sure.
Grading prostate cancer
Pathologists grade prostate cancers according to the Gleason
system.
This system assigns a Gleason grade,
using numbers from 1 to 5 based on how much the cells in the
cancerous tissue look like normal prostate tissue.
-
If the cancerous tissue looks much like normal prostate
tissue, a grade of 1 is assigned.
-
If the cancer cells and their growth patterns look very
abnormal, it is called a grade
5 tumor.
-
Grades 2 through 4 have features in between these extremes.
Today, most biopsies are grade 3 or higher, and grades 1 and 2
are not often used.
Since prostate cancers often have areas with different grades,
a grade is assigned to the 2 areas that make up most of the cancer.
These 2
grades are added together to yield the Gleason
score (also called the Gleason sum).
The Gleason score can
be between 2 and 10, but most biopsies are at least a 6.
There are some exceptions to this rule.
If the highest grade takes up most (95% or more) of the biopsy,
the grade for that area is counted twice as the Gleason score.
Also, if 3 grades are present in a biopsy core, the highest
grade is always included in the Gleason score,
even if most of the core is taken up by areas of cancer with
lower grades.
-
Cancers
with a Gleason score of 6 or less are often called well-differentiated or low-grade.
-
Cancers
with a Gleason score of 7 may be called moderately
differentiated or intermediate-grade.
-
Cancers with Gleason scores of 8 to 10 may be called poorly
differentiated or high-grade.
The higher the Gleason score, the more likely it is that your
cancer will grow and spread quickly.
Other information in a biopsy report
------
조직검사보고서에서 주목할 내용들
Along with the grade of the cancer (if it is present),
the pathologist's report also often contains other pieces of
information that may give a better idea of the scope
of the cancer. These can include:
-
The number of biopsy core samples that contain cancer (for
example, "5 out of 10")
-
The percentage of cancer in each of the cores
80%max
-
Whether the cancer is on one side (left or right) of the
prostate or both sides (bilateral)
Suspicious results
의심스런결과
Sometimes when the pathologist looks at the prostate cells
under the microscope,
they don't look cancerous, but they're not quite normal,
either.
These results are often reported as suspicious
의심스런.
Prostatic intraepithelial neoplasia (PIN 전립선상피내종양):
In PIN, there are changes in how the prostate cells look under
the microscope,
but the abnormal cells don't look like they've grown into other
parts of the prostate (like cancer cells would).
PIN is often divided
into low-grade and-high grade.
Many men begin to develop low-grade PIN at an early age but do
not necessarily develop prostate cancer.
The importance of low-grade PIN in relation to prostate cancer
is still unclear.
If a finding of low-grade PIN is reported on a prostate biopsy,
the follow-up for patients is usually the same as if nothing
abnormal was seen.
If high-grade PIN is found on a biopsy,
there is about a 20% to 30% chance that cancer may already be
present somewhere else in the prostate gland.
This is why doctors often watch men with high-grade PIN
carefully and may advise a repeat prostate biopsy,
especially if the original biopsy did not take samples from all
parts of the prostate.
Atypical small acinar proliferation (ASAP비정형소형꽈리증식):
This
is sometimes just called atypia
(비정형).
In ASAP, the cells look like they might be cancerous when
viewed under the microscope,
but there are too few of them to be sure.
If ASAP is found, there's a
high chance that cancer is also
present in the prostate,
which is why many doctors recommend getting a repeat biopsy
within a few months.
Proliferative inflammatory atrophy (PIA 전립선염증성위축증):
In
PIA, the prostate cells look smaller than normal, and there are signs of
inflammation염증 in the area.
PIA is not cancer,
but researchers believe that PIA
may sometimes lead to high-grade PIN or to prostate cancer directly.
For more information about how biopsy results are reported,
see
the “Prostate
Pathology” section of our website.
Imaging tests to look for prostate cancer spread
If you are found to have prostate cancer, your doctor will use
your digital rectal exam (DRE 직장수지검사) results,
prostate-specific antigen (PSA
전립선특이항원) level,
and Gleason score
to figure out how likely it is that the cancer has spread outside your
prostate.
This information is used to decide if any imaging tests need to
be done to look for possible cancer spread in the body.
Imaging tests use x-rays, magnetic fields, sound waves,
or radioactive substances to create pictures of the inside of
your body.
Men with a normal DRE result, a low PSA, and a low Gleason
score may not need any other tests because the chance
that the cancer has spread is so low.
The imaging tests used most often to look for prostate cancer
spread include:
Bone scan 골스캔
If prostate cancer spreads to distant sites, it often goes to
the bones first.
(Even when prostate cancer spreads to the bone, it is still
prostate cancer, not bone cancer.)
A bone scan can help show whether cancer has reached the bones.
For this test, a small amount of low-level radioactive material
is injected into a vein (정맥주사
intravenously, or IV).
The substance settles in damaged areas of bone throughout the
body over the course of a couple of hours.
You then lie on a table for about 30 minutes while
a special camera detects the
radioactivity and creates
a picture of your
skeleton.
Areas of bone damage appear as "hot spots" on your skeleton –
that is, they attract the radioactivity.
Hot spots may suggest cancer in the
bone, but arthritis or other bone diseases can also cause hot spots.
To make
an accurate diagnosis, other imaging tests such as plain x-rays, CT or MRI
scans,
or even a bone biopsy might be needed.
The injection is the only uncomfortable part of the scanning
procedure.
The radioactive material is passed out of the body in the urine
over the next few days.
The amount of radioactivity used is very low, so it carries
very little risk to you or others.
But you still might want to ask your doctor if you should take
any special precautions after having this test.
Computed tomography (CT
컴퓨터단층촬영)
This test can sometimes help tell if prostate cancer has spread
into nearby lymph nodes.
Still, for newly diagnosed prostate cancers it isn’t
often needed if the cancer is likely to be confined 인접한 to
the prostate based on
other findings (DRE result, PSA level, and Gleason score).
If your prostate cancer has come back after treatment,
the CT scan can often tell whether
it is growing into other organs or
structures in your pelvis 치골.
The CT scan (also known as a CAT
scan) is a special kind of x-ray test that gives
detailed,
cross-sectional images of your body.
Instead of taking one picture, like a standard x-ray, a CT
scanner takes many pictures as it rotates around you.
A computer then combines these pictures into images of slices
of the part of your body being studied.
Unlike a regular x-ray,
a CT scan creates detailed images of the soft tissues in the body.
For some scans,
you may be asked to drink 1 or 2 pints of oral
contrast 조영제 before the first
set of pictures is taken.
This helps outline the intestine 장기 so that it looks different
from any tumors.
You may receive an IV (intravenous) line through which a
different kind of contrast is injected.
This helps better outline structures in your body.
The IV contrast can cause your body to feel
flushed (a feeling of warmth with some
redness of the skin 열기와 홍조).
A few people are allergic and get
hives 두드러기.
Rarely, more serious
reactions, like trouble breathing or low blood pressure, can occur.
Medicines can be given to prevent and treat allergic reactions,
so be sure to tell your doctor if
you have any allergies or have ever had a reaction to
any contrast material 조영제 used
for x-rays.
You will also need to drink enough liquid to have a full
bladder.
This will keep the bowel away from the area of the prostate
gland.
CT scans take longer than regular x-rays.
You need to lie still on a table while they are being done.
During the test, the table slides in and out of the scanner, a
ring-shaped machine that surrounds the table.
You might feel a bit confined by the ring while the pictures
are being taken.
CT scans are not as useful as magnetic resonance imaging (MRI)
for looking at the prostate gland itself.
Magnetic resonance imaging (MRI
자기공명영상)
MRI scans can be helpful in looking at prostate cancer.
They
can produce a very clear picture of the prostate and show whether the cancer
has spread outside
the prostate into the seminal vesicles
정낭 or other nearby
structures.
This information can be very important for your doctors in
planning your treatment.
But like CT scans, MRI scans may not provide useful information
about newly diagnosed prostate cancers
that are likely to be confined to the prostate based on other
factors.
MRI scans use radio waves and strong magnets instead of x-rays.
The energy from the radio waves is absorbed 흡수 by the body and
then released in a
pattern formed by the type of body tissue and by certain diseases.
A computer
translates the pattern into a very detailed image of parts of the body.
Like a
CT scan, a contrast material 조영물질
might be injected, but this is done less often.
Because the scanners use magnets, people with
pacemakers 심장보조기, certain heart
valves,
or other medical implants이식 may not be able to get an MRI.
MRI scans take longer than CT scans – often up to an hour.
During the scan, you need to lie still inside a narrow tube,
which is confining and can upset people who don't like enclosed
spaces.
The machine also makes clicking and buzzing noises.
Some places provide
headphones with music to block this noise out.
To improve the accuracy of the MRI, many doctors will place a
probe, called an endorectal
coil 내직장코일,
inside your rectum.
This must stay in place for 30 to 45 minutes and can be
uncomfortable.
If needed, medicine to make you
feel sleepy (sedation 진정제) can
be given before the scan.
ProstaScintTM scan
프로스타스킨트 스캔
Like the bone scan, the ProstaScint scan uses an injection of
low-level radioactive material to find cancer
that has spread beyond the prostate.
Both tests look for areas of the body where the radioactive
material collects, but they work in different ways.
While the radioactive material used for the bone scan is
attracted to bone,
the material for the ProstaScint scan is attracted to
prostate cells in the body.
It contains a monoclonal antibody
단세포 항체, a type of
man-made protein that recognizes and
sticks to a particular substance.
In this
case, the antibody sticks to prostate-specific membrane antigen (PSMA
전립선특이피막항체 ),
a
substance found at high levels in normal and cancerous prostate cells.
After the material is injected, you will be asked to lie on a
table while a special camera creates an image of the body.
This is usually done about half an hour after the injection and
again 3 to 5 days later.
This test can find prostate cancer cells in lymph nodes and
other soft (non-bone) organs,
although it is not as helpful for looking at the area around
the prostate itself.
The antibody only sticks to prostate cells, so
other cancers or benign problems
should not cause abnormal results.
But the test is not
always accurate, and the results can sometimes be
confusing.
Most doctors do not recommend this test for men who have just
been diagnosed with prostate cancer.
But it may be useful after treatment if
your blood PSA level begins to rise and other tests are not able to
find the exact location of your cancer.
Doctors may not order this test if they believe it will
not be helpful for a given
patient.
Lymph node biopsy 림프절 조직검사
In a lymph node biopsy, also known as lymph
node dissection or lymphadenectomy
림프절적출술,
one or more lymph nodes are removed to see if they contain
cancer cells.
This isn’t done very often for prostate cancer,
but can be done to find out whether the cancer has spread from
the prostate to nearby lymph nodes.
There are several ways to biopsy lymph nodes.
Surgical biopsy 외과적적출술
The surgeon may remove lymph nodes through an incision in
the
lower part of your abdomen 하복부.
This is often done in the same operation as
the
radical prostatectomy 근치적전립선적출술.
(See the section "Surgery
for prostate cancer" for information about radical
prostatectomy.)
If there is more than a very small chance that the cancer might
have spread
(based on factors such as a high PSA level or a high Gleason
score),
the surgeon may remove some lymph nodes
before attempting to remove the
prostate gland.
In some cases a pathologist will look at the nodes right away, while you are still under
anesthesia,
to help the surgeon decide whether to
continue with the radical prostatectomy.
This is called a frozen
section exam
because the tissue sample is frozen before thin slices are taken
to check under a microscope.
If the nodes contain
cancer, the operation might be stopped (leaving the prostate in place).
This would happen if the surgeon felt that removing the
prostate would be unlikely to
cure the cancer,
but would still probably result in serious
complications 합병증 or side effects 부작용.
But more often
(especially if the chance of cancer spread is low), a frozen section exam is
not done.
Instead the lymph nodes and the prostate are removed and are
then sent to the lab to be looked at.
The lab results are usually available several days after
surgery.
Laparoscopic biopsy
내시경조직검사 ?
A laparoscope is a long, slender tube with a small video camera
on the end that is inserted into
the
abdomen 복부 through a cut
about the size of the width of a finger.
It lets the surgeon see inside the abdomen and pelvis without
needing to make a large incision 절개.
Other small incisions
are made to insert long instruments to remove the lymph nodes.
The surgeon then removes the lymph nodes around the prostate
gland and sends them to the pathologist.
Because there are no large incisions, most people recover fully
in only 1 or 2 days,
and the operation leaves very small scars.
This procedure is not common, but it is sometimes used when
it's important to know if
the lymph nodes contain cancer but a radical
prostatectomy is not planned
(such as for certain men who choose treatment
with radiation
therapy).
Fine needle aspiration (FNA)
세침흡인술
If your lymph nodes appear enlarged on an imaging test (such as
a CT or MRI scan)
a specially trained radiologist may take a sample of cells
from an enlarged node by using a technique
called fine needle aspiration (FNA).
To do this, the doctor uses a CT scan image to guide a long,
thin needle through the skin in the lower abdomen and into the
enlarged node.
Before the needle is placed, your skin will be numbed with
local anesthesia 국소마취.
A syringe attached to the needle lets the doctor take a small
tissue sample from the node,
which is then sent to a pathologist to look for cancer cells.
You will be able to return home a few hours after the
procedure.
8 How is prostate cancer
staged 단계별 등급?
The stage (extent) of a cancer is one of the most important
factors in choosing treatment
options
and predicting 예측 a man's outlook.
The
stage is based on the prostate biopsy results (including the Gleason
score), the PSA level,
and any other exams or
tests that were done to find out how far the cancer has spread.
These tests
are described in the section "How
is prostate cancer diagnosed?"
The
AJCC
TNM staging system
A staging system is a standard way for the cancer care team to
describe how far a cancer has spread.
The most widely used staging system for
prostate cancer is
the American Joint Committee on Cancer (AJCC) TNM system.
The TNM system for prostate cancer is based on 5 key pieces of
information:
-
The extent of the primary tumor (T
category)
-
Whether the cancer has spread to nearby lymph nodes (N
category)
-
The absence or presence of distant metastasis (M
category)
-
The PSA level at the time of diagnosis
-
The Gleason score, based on the prostate biopsy (or surgery)
There are actually 2 types of staging for prostate cancer:
-
The clinical
stage is
your doctor's best estimate of the extent of your disease, based on the
results of
-
the physical exam (including DRE), lab tests, prostate biopsy,
and any imaging tests you have had.
-
If you have surgery, your doctors can also determine the pathologic
stage, which is based on the surgery
-
and
examination of the removed tissue.
-
This means that if you have surgery, the
stage of your cancer might actually change afterward
-
(if cancer was found in
a place it wasn't suspected, for example).
-
Pathologic staging is likely to
be more accurate than clinical staging,
-
as it allows your doctor to get a
firsthand impression of the extent of your disease.
-
This is one possible
advantage of having surgery (radical prostatectomy)
as opposed to
-
radiation
therapy or active
surveillance.
Both types of staging use the same categories (but the T1
category is not used for pathologic staging).
T categories (clinical
튜머)
There are 4 categories for describing the local extent of a
prostate tumor, ranging from T1 to T4.
Most of these have subcategories as well.
T1: Your
doctor can't feel the tumor or see it with imaging such as transrectal
ultrasound (TRUS ).
-
T1a: Cancer
is found incidentally (by accident) during a
transurethral resection of the
prostate
-
(TURP 경요도전립선시술) that was done for
benign prostatic hyperplasia (전립선비대증 BPH).
-
Cancer is in no more than 5% of the tissue removed.
-
T1b: Cancer is
found during a TURP but is in more than 5% of the tissue removed.
-
T1c: Cancer
is found by needle biopsy that was done because of an increased PSA.
T2: Your
doctor can feel the cancer with a digital rectal exam (DRE) or see it with
imaging such as
transrectal ultrasound, but
it still appears to be confined to
the prostate gland.
-
T2a: The
cancer is in one half or less of only one side (left or right) of your
prostate.
-
T2b: The
cancer is in more than half of only one side (left or right) of your
prostate.
-
T2c: The
cancer is in both sides of your prostate 나는 여기있소 !!!.
T3: The
cancer has begun to grow and spread
outside your prostate
and may have spread into the
seminal vesicles 정낭.
-
T3a: The
cancer extends outside the prostate but not to the seminal vesicles.
-
T3b: The
cancer has spread to the seminal vesicles.
T4: The
cancer has grown into tissues next to your prostate (other than the seminal
vesicles),
such as the
urethral sphincter (muscle that helps
control urination 괄약근), the rectum, the bladder,
and/or the wall of the
pelvis 골반.
N categories
(림프노드)
N categories describe whether the cancer has spread to nearby
(regional) lymph nodes.
NX: Nearby
lymph nodes were not assessed.
N0: The
cancer has not spread to any nearby lymph nodes.
N1: The
cancer has spread to one or more nearby lymph nodes in the
pelvis 골반.
M categories
(메타시스티스,전이)
M categories describe whether the cancer has spread to distant
parts of the body.
The most common sites of prostate cancer spread are to the
bones and to distant lymph nodes,
although it can also spread to other organs, such as the lungs
and liver.
M0: The
cancer has not spread past nearby lymph nodes.
M1: The
cancer has spread beyond the nearby lymph nodes.
-
M1a: The
cancer has spread to distant (outside of the pelvis) lymph nodes.
-
M1b: The
cancer has spread to the bones.
-
M1c: The
cancer has spread to other organs
such as lungs, liver, or brain
-
(with or without
spread to the bones).
Stage grouping 단계별 분류
Once the T, N, and M categories have been determined, this
information is combined,
along with the Gleason score and prostate-specific
antigen (PSA),
in a process called stage
grouping
If the Gleason score or PSA results are not available,
the stage can be based on the T, N, and M categories.
The
overall stage is expressed in Roman numerals from I (the least advanced) to IV
(the most advanced).
This is done to help determine treatment
options and
the outlook for survival or cure (prognosis
예측, 예후. ).
Stage I: One
of the following applies:
T1, N0, M0, Gleason score 6 or less, PSA less than 10:
The
doctor can't feel the tumor or see it with an imaging test such as transrectal
ultrasound (TRUS)
(it was either found during a transurethral resection or was
diagnosed by needle biopsy done for a high PSA) [T1].
The cancer is still
within the prostate and has not spread to nearby lymph nodes [N0] or elsewhere
in the body [M0].
The Gleason score is 6 or less and the PSA level is less
than 10.
OR
T2a, N0, M0, Gleason score 6 or less, PSA less than 10:
The
tumor can be felt by digital rectal exam or seen with imaging such as transrectal ultrasound(TRU)
and is in one half or less of only one side (left or
right) of your prostate [T2a].
The cancer is still within the prostate and has
not spread to nearby lymph nodes [N0] or elsewhere in the body [M0].
The
Gleason score is 6 or less and the PSA level is less than 10.
Stage IIA: One
of the following applies:
T1, N0, M0, Gleason score of 7, PSA less than 20:
The
doctor can't feel the tumor or see it with imaging such as transrectal
ultrasound (it was either found during
a transurethral resection or was
diagnosed by needle biopsy done for a high PSA level) [T1].
The cancer has not
spread to nearby lymph nodes [N0] or elsewhere in the body [M0].
The tumor has
a Gleason score of 7. The PSA level is less than 20.
OR
T1, N0, M0, Gleason score of 6 or less, PSA at least 10 but
less than 20:
The
doctor can't feel the tumor or see it with imaging such as transrectal
ultrasound (it was either found during a transurethral resection or was
diagnosed by needle biopsy done for a high PSA) [T1].
The cancer has not
spread to nearby lymph nodes [N0] or elsewhere in the body [M0].
The tumor has
a Gleason score of 6 or less. The PSA level is at least 10 but less than 20.
OR
T2a or T2b, N0, M0, Gleason score of 7 or less, PSA less than
20:
The
tumor can be felt by digital rectal exam or seen with imaging such as
transrectal ultrasound and
is in only one side of the prostate [T2a or T2b].
The cancer has not spread to nearby lymph nodes [N0] or elsewhere in the body
[M0].
It has a Gleason score of 7 or less. The PSA level is less than 20.
Stage IIB: One
of the following applies:
T2c, N0, M0, any Gleason score, any PSA:
The
tumor can be felt by digital rectal exam or seen with imaging such as
transrectal ultrasound
and is in both sides of the prostate [T2c].
The cancer
has not spread to nearby lymph nodes [N0] or elsewhere in the body [M0].
The
tumor can have any Gleason score and the PSA can be any value.
OR
T1 or T2, N0, M0, any Gleason score, PSA of 20 or more:
The
cancer has not yet begun to spread outside the prostate.
It may (or may not)
be felt by digital rectal exam or seen with imaging such as transrectal
ultrasound [T1 or T2].
The cancer has not spread to nearby lymph nodes [N0] or
elsewhere in the body [M0].
The tumor can have any Gleason score.
The PSA
level is at least 20.
OR
T1 or T2, N0, M0, Gleason score of 8 or higher, any PSA:
The cancer has not yet begun to spread outside the prostate.
It may (or may not) be felt by digital rectal exam or seen with imaging such as transrectal
ultrasound [T1 or T2].
The cancer has not spread to nearby lymph nodes [N0] or
elsewhere in the body [M0].
The Gleason score is 8 or higher. The PSA can be
any value.
Stage III:
T3, N0, M0, any Gleason score, any PSA:
The
cancer has begun to spread outside the prostate and may have spread to the
seminal vesicles [T3],
but it has not spread to nearby lymph nodes [N0] or
elsewhere in the body [M0].
The tumor can have any Gleason score and the PSA
can be any value.
Stage IV: One
of the following applies:
T4, N0, M0, any Gleason score, any PSA:
The
cancer has spread to tissues next to the prostate (other than the seminal
vesicles),
such as the urethral sphincter (괄약근 muscle that helps control
urination), rectum, bladder,
and/or the wall of the pelvis [T4].
The cancer
has not spread to nearby lymph nodes [N0] or elsewhere in the body [M0].
The
tumor can have any Gleason score and the PSA can be any value.
OR
Any T, N1, M0, any Gleason score, any PSA:
The
tumor may or may not be growing into tissues near the prostate [any T].
The
cancer has spread to nearby lymph nodes (N1) but has not spread elsewhere in
the body [M0].
The tumor can have any Gleason score and the PSA can be any
value.
OR
Any T, any N, M1, any Gleason score, any PSA:
The
cancer may or may not be growing into tissues near the prostate [any T] and
may or may not have spread to nearby lymph nodes [any N].
It has spread to
other, more distant sites in the body [M1].
The tumor can have any Gleason
score and the PSA can be any value.
Other staging systems
In addition to the TNM system, other systems have been used to
stage prostate cancer.
The Whitmore-Jewett system, which stages prostate
cancer as A, B, C, or D, was commonly used in the past,
but most prostate
specialists now use the TNM system.
If your doctors use the Whitmore-Jewett
system, ask them to translate it into the TNM system or
to explain how their staging will determine your treatment
options.
The D’Amico risk categories
The D’Amico system is not used to stage all cases of prostate
cancer like the AJCC system.
It is sometimes used to look at the risk that a
prostate cancer has spread outside the prostate.
This system uses the man’s PSA level, the Gleason score of the
cancer, and the T stage of the cancer to divide
men into 3 risk groups:
low, intermediate, and high.
Survival rates for prostate cancer
생존율 ?
Survival rates are often used by doctors as a standard way of
discussing a person's prognosis (outlook
예후).
Some patients with cancer may want
to know the survival statistics for people in similar situations,
while others
may not find the numbers helpful,
or may even not want to know them.
If you
would rather not read the survival rates, skip to the next
section.
The 5-year survival rate refers to the percentage of patients
who live at
least 5 years
after their cancer is diagnosed.
Of course, many of
these people live much longer than 5 years (and many are cured).
Five-year relative survival
rates, such as the numbers below, assume that some people will die of other
causes
and compare the observed survival with that expected for people
without the cancer.
This is a better way to see the impact of the cancer on
survival.
In order to get 5-year survival rates, doctors have to look at
people who were treated at least 5 years ago.
Improvements in detection and treatment since
then may result in a more favorable outlook for people
now being diagnosed with prostate cancer.
Survival rates are often based on previous outcomes of large
numbers of people who had the disease,
but they cannot predict what will
happen in any particular person's case.
Many other factors may affect a
person's outlook, such as the patient’s age and health, the treatment
received,
and how well the cancer responds to treatment.
Your doctor can tell
you how the numbers below may apply
to you,
as he or she is familiar with the aspects of your particular
situation.
According to the most recent data, when including all stages
of prostate cancer:
-
The relative 5-year survival rate is over 99%
-
The relative 10-year survival rate is 98%
-
The 15-year relative survival rate is 93%
Keep in mind that just as 5-year survival rates are based on
patients diagnosed
and first treated more than 5 years ago,
10-year survival rates are based on patients diagnosed more
than 10 years ago
(and 15-year survival rates are based on patients diagnosed at
least 15 years ago).
Survival rates by stage
단계별 생존율
The National Cancer Institute (NCI) maintains a large national
database on survival statistics for different
types of cancer.
This database
does not group cancers by AJCC stage,
but instead groups cancers into
local, regional, and distant stages.
-
Local stage means
that there is no sign that the cancer has spread outside of the prostate.
-
This corresponds to AJCC stages I and II.
-
About 4 out of 5 prostate cancers are found in this early
stage.
-
Regional stage means
the cancer has spread from the prostate to nearby areas.
-
This includes stage III cancers and the stage IV cancers that
haven't spread to distant parts of the body,
-
such as T4 tumors and cancers that have spread to nearby
lymph nodes (N1).
-
Distant stage includes
the rest of the stage IV cancers
-
– all cancers that have spread to distant lymph nodes, bones,
or other organs (M1).
5-year relative survival by stage at the time of diagnosis
9 How is prostate cancer treated? (치료)*** 다음에 계속됩니다