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What is PSA, and what is a PSA test?

PSA stands for prostate-specific antigen; it is a protein produced by the prostate gland. It is produced both by normal as well as malignant prostate gland cells. The PSA test is a blood test which measures the amount or level of PSA in a man’s blood. Because the PSA level tends to be elevated when a man has prostate cancer, the PSA test has been viewed as an important, but not completely determinative, indicator for the presence of prostate cancer. The final determination of whether prostate cancer is present will depend on the outcome of a digital rectal exam (DRE), possibly imaging tests, and ultimately on a prostate biopsy.

Multiple tests are generally required because other, benign conditions can also cause elevated PSA levels. Two of these frequently occurring, non-cancerous conditions include prostatitis (inflammation of the prostate) and benign prostatic hyperplasia (BPH) (enlargement of the prostate). Presence of either of these does not rule out the existence of cancer, however, so further tests will still be called for to make a final diagnosis.

Does the PSA test determine whether cancer exists?

At one time, the PSA test, together with the DRE, were considered as providing a close to definitive determination of the existence of cancer. PSA results above 4.0ng/mL were regarded as “elevated” and would indicate the need for a prostate biopsy to make a final determination of the presence or absence of cancer.

More recent studies have cast some doubt on that iron-clad sureness. More recent research has demonstrated that some men with PSA levels below 4.0 ng/mL can have cancer, and that many men with elevated levels of PSA do not have cancer. So: what to do? While there are conflicting studies, the overall results indicate that, in general, the higher the PSA level, the greater the risk for cancer. Also, an ongoing, steady rise in PSA level over time is an indicator of elevated prostate cancer risk.

Because of these findings, the new wisdom is “watch and wait.” That is, if the PSA level is “elevated”, the new wisdom is to do PSA tests at regular intervals to see if it remains elevated, or if it continues to rise. If it does, then further tests may be called for, such as a DRE to check for a suspicious lump, and/or imaging tests such as a transrectal ultrasound, x-rays, or cystoscopy.

A final diagnosis still requires a prostate biopsy. This is a surgical procedure during which several samples of prostate tissue are extracted via insertion and withdrawal of hollow needles into the prostate gland. The extracted tissue samples are examined by a pathologist in a laboratory to determine whether or not cancerous cells exist in the prostate.

Does the PSA test have any limitations?

The primary limitation of the PSA test is that even when the PSA level is elevated, and a biopsy is performed, only 25% of men turn out to have prostate cancer. In other words, the PSA test is accurate only 25% of the time. So, by itself, the PSA test is simply not enough. More tests are required to make a final, accurate determination.

Further, sometimes small, slow-growing cancerous tumors are detected. They grow so slowly that they only rarely threaten the patient’s life. Sometimes these tumors are treated unnecessarily via surgery or radiation treatment; this is called “overtreatment”. In this case the patient is subjected unnecessarily to the risks of serious, life-altering side-effects such as urinary incontinence (difficulty or inability to control urine flow), bowel function problems, erectile dysfunction (E.D.), which means difficulty having or maintaining erections, or having erections that are inadequate for sex.

Sometimes, the PSA test can yield what are called “false-positive” results, which means that the PSA level result appears to indicate a significant risk of cancer, but in fact no cancer is present. This can subject the patient and his family unnecessarily to high levels of anxiety and can cause the patient to undergo unnecessary follow-up procedures such as a biopsy, which can bring serious side-effects such as pain, bleeding, and infections.

The opposite case can also happen, which is called a “false-negative” result. In this case, the PSA test levels are low, indicating that no cancer is present, when in fact a cancerous tumor is present. This can give the patient and his family false reassurance and a plan for no further treatment, when in fact the patient requires further treatment.

As you might have concluded, the PSA test situation, in isolation, is complex and somewhat cloudy. It is all-important that you find a top-notch urologist and prostate oncologist to have on your treatment team, and they need to be intimately familiar with the state-of-the-art research findings as well as treatment options. Only through consultation with both doctors will you be able to come up with an appropriate diagnosis procedure and comprehensive treatment plan.

You may have heard of immunotherapy, and at least understand that it represents a huge advancement in the treatment of cancer. You may also know that, in broad terms, immunotherapy works by helping the patient’s own immune system work more effectively in finding, attacking, and killing cancer cells. To learn more about what immunotherapy is, and how it works, click here.

Because immunotherapy simply trains the patient’s immune system to work more effectively, you might also think that immunotherapy has no side effects. What we are finding, however, is that that belief is incorrect. Immunotherapy does have a spectrum of side effects. Immunotherapy patients experience side effects approximately 5-10% of the time, and these cases of side effects are life-threatening around 1-2% of the time. Being forewarned is forearmed, so let’s explore the types of immunotherapy side effects that can occur.

Most common side effects: Fatigue & Inflammation

Just like other kinds of cancer treatment, fatigue is one of the most common side effects. Feelings of overall low energy, and/or becoming exhausted quickly and easily when exertion is required, are very common side effects. This kind of physical debilitation can occur within just a few weeks of commencement of treatment but can sometimes not happen until several months – or even years – have passed. Generally, this side effect tends to get better with enough passage of time. However, while this side effect does generally improve with the passage of time, you may not return 100% to your former levels of overall energy or stamina levels. There may be some lingering, low-level fatigue that remains.

Immunotherapy medications can also cause a variety of inflammations throughout the body. Skin inflammation can manifest as a rash, feeling itchy, or as pigment changes, sometimes without a rash. Inflammation of the colon may occur, causing diarrhea and/or abdominal pain. Inflammation of the lungs can occur, causing chest pain and a cough.

Rarer side effects: Diabetes, Endocrine system problems, and Hypophysitis

Side-effects that more rarely occur include development of diabetes (a chronic condition that negatively impacts how the body processes glucose, or in more severe cases, progresses to the point that the pancreas produces little-to-no insulin, the critically important hormone which regulates the amount of glucose in the blood).

Another rarely occurring side effect is damage to the body’s endocrine system, responsible for how the body produces and regulates hormones – all hormones, not just insulin. Another rare, but more concerning side effect is the inflammation of the pituitary gland, known as hypophysitis. Hypophysitis manifests in many different ways, so a definitive diagnosis requires blood work. Symptoms include headache, fever, or fatigue.

Side effects do not depend on cancer type

The side effects described above do not generally depend on the patient’s type of cancer. Rather, they depend more on the type of immunotherapy medication prescribed for cancer treatment.

Management of side effects

Research has found that the most appropriate treatment for the various side effects that occur depends on the severity of the effect. Many patients receiving immunotherapy have already received chemotherapy, so they have most likely already experienced the milder side effects like fatigue, rash, and/or cough. As a result, they have already developed the necessary coping skills and/or method of treatment for them.

When it comes to diarrhea, however, treatment approach is critical. The most highly preferred treatment approach is modification of diet. Limiting dairy products can be very important in this case. The reason that dietary changes are preferred is that anti-diarrheal medications can cause severe, even life-threatening, complications. If the diarrhea problem is severe, your doctor may recommend a temporary cessation of immunotherapy, and replacement with an immunosuppressant. This can help to reduce the inflammation behind the diarrhea to a safer level, yielding improvement in diarrheal symptoms.

Patients who develop diabetes may also require a temporary pause on the immunotherapy drugs, combined with insulin medication treatment. In any case, the temporary pause can help the body to recover, heal, and reduce the severity and/or existence of unwanted side effects. The ultimate goal, however, is to resume immunotherapy treatment; to attack and kill the tumor’s cancer cells.

Side effects have nothing to do with immunotherapy effectiveness

Patients often believe that the presence and severity of side effects is also a measure of the effectiveness of the immunotherapy treatment. This is not true. Patients whose immunotherapy treatment is highly effective often experience no side effects. This can lead them to suspect that they are only receiving a placebo medication in a secret clinical trial, or that the immunotherapy medication isn’t working at all. This is simply not true. Remember: only 5-10% of immunotherapy patients experience any side effects. So, 90-95% of immunotherapy patients have no side effects whatsoever!

Self-awareness is critical

So, the most important advice you can receive relative to the presence or absence of side effects is heightened self (and body) awareness. Pay attention to what your body is trying to tell you, right from the get-go! Make sure that your doctor, as well as your pharmacist, spend lots (and lots) of time with you, going over all the possible side-effects associated with your immunotherapy medication, and make sure you fully understand everything they are saying to you. Ask as many questions as you feel you need to and do not assume that you are a “burden” to them. After all, this is your treatment, and this is your life! You are the one whose life and well-being are being affected. It is your responsibility to ensure that you are completely comfortable with every aspect of your treatment. It is your doctor’s responsibility to ensure that you are, indeed, fully comfortable with all aspects of your treatment.

What is head and neck cancer?

Head and neck cancer is a collective label for cancers that develop in various areas of the head and neck. Most often they start to develop in the thin layer of moist, mucosal tissues that line the nose, throat, and mouth. These thin layers of tissue are made up of flat squamous cells. Most of the cancers that develop in these moist tissues are known as squamous cell carcinomas of the head and neck. More uncommonly, cancer can develop in the salivary glands, but this article will focus on the squamous cell carcinomas of the head and neck.

What causes head and neck cancers?

The two most important risk factors for developing head and neck cancer are drinking alcohol and using tobacco (in any form), particularly cancers of the oral cavity, oropharynx, hypopharynx, and larynx. 75% or more of head and neck cancers stem from alcohol and tobacco consumption. Also, as people get older, their risk of developing head and neck cancers increases. The majority of head and neck cancers develop in people who are older than 45. Further, head and neck cancers are more common among men. The reasons for this are not fully understood.

Another important risk factor for head and neck cancers is the human papillomavirus (HPV). HPV is most commonly known for causing cervical cancer, among others. HPV is particularly implicated in cancers that involve the base of the tongue and the tonsils. HPV-related head and neck cancers generally have a better prognosis (chance of recovery) than those stemming from alcohol and tobacco use.

What are the symptoms of head and neck cancer?

As noted earlier, head and neck cancers can develop in a variety of locations. Because of this, there are also a large variety of symptoms that may indicate developing head and neck cancers. These include symptoms such as:

Difficulty and/or pain when swallowing
A lump or a sore that does not heal
A lump in the neck
A sore throat or pain in the neck that does not go away
Changes in the voice or increased hoarseness of the voice
A white or red patch on the lining of the mouth, the tongue, or the gums
Trouble breathing or speaking
Sinuses that are blocked and do not clear
Chronic sinus infections that do not respond to antibiotics
Bleeding through the nose
Frequent headaches

It is important to note, however, that these symptoms can also be associated with other, less serious conditions. So, make sure that you first consult with your primary care physician or dentist to determine whether or not your symptoms are due to a less serious, non-cancerous condition or illness.

How are head and neck cancers diagnosed?

If less serious conditions are ruled out, and your doctor suspects that head and neck cancer is possible, the first steps in diagnosing it include an evaluation of your complete medical history, and possibly of your family’s history of cancer. Next will be a detailed physical examination of the entire head and neck area, including the mouth, throat and nasal passages, and possibly other diagnostic tests will be ordered. Ultimately, however, a conclusive diagnosis of head and neck cancer will require surgical removal and examination of a small sample of tissue (a biopsy) under the microscope.

Determining how advanced the cancer is (known as the Stage) will require further studies such as X-ray, other imaging studies such as computed tomography (CT scan) or a positron emission tomography (PET) scan, and laboratory tests. Determining the Stage (extent) of the cancer will aid your doctor or health care team in making an appropriate, effective treatment plan recommendation.

How are head and neck cancers treated?

Appropriate treatment depends on the exact nature of the cancerous tumor, and factors unique to the individual. These factors include the size of the tumor, its exact location, the stage (extent) of the cancer, and on the individual’s general health and age. Treatments for head and neck cancer include surgery, radiation therapy/treatments, chemotherapy, immunotherapy, and targeted therapy. It will often require a combination of more than one treatment. Effective treatment generally will involve an entire team of healthcare professionals, including doctors, nutritionists, and others.

What are the side effects of treatment?

The side effects of treatment for head and neck cancer depends on the type/location of the cancer, and on the type of treatment(s) followed. The most common side effects of radiation therapy can include fatigue, weight loss, difficulty and/or pain with swallowing, mouth sores, dry mouth, thickened saliva, redness and irritation. The common side effects of chemotherapy can include low blood counts, nausea, and changes or loss in taste (some foods may taste different, or be tasteless, after treatment). Loss of taste can have a negative effect on nutrition and needs to be watched carefully. Nausea generally improves soon after the chemotherapy treatments are over. Fatigue and problems with swallowing may take longer to get better.

Surgical removal of the tumor can change the patient’s ability to talk, swallow, or chew. The surgery may also cause swelling of the neck and/or face; however, the swelling generally dissipates after a few weeks. If lymph nodes were removed, this may cause additional swelling, which could last much longer. If the removed lymph nodes are in the neck, the neck and shoulder may become stiff and/or weak. If surgery includes removal of the larynx (laryngectomy) or involved other parts of the neck, the throat and neck may feel numb.

Long-term recovery requires the involvement of a competent team of medical professionals, not only in the treatment of cancer but also in managing recovery. Besides doctors, this team can include speech pathologists, dentists, dental hygienists, and dietitians/ nutritionists. They all play important roles in helping manage treatment side effects, both short and long-term. The patient may also choose to seek professional counseling and join a support group to aid in recovery.

Over many decades our understanding of how cancer starts and spreads has steadily improved. However, many myths and misconceptions about cancer remain and can be widespread. Here we try to dispel some of these myths that might cause you undue stress and lead you down the wrong road when learning about cancer.

Does Sugar Make Cancer Grow Faster?

Nope. While we do know that cancer cells “eat” (consume) more sugar than normal cells, there is no scientific evidence that eating more sugar will make your cancer worse, nor that eating less sugar will cause the cancer to grow more slowly. BUT – this is important – excess sugar consumption, which is epidemic in the United States, can increase the level of risk for gaining weight, and we know that obesity is a high risk factor for diabetes and for developing certain kinds of cancer. So, while sugar in itself does not cause cancer, is contributes to the development of conditions that can increase its risk and should be consumed within limits

How About Artificial Sweeteners (Chemicals)?

Nope. Scientists have conducted extensive research into this question and have discovered no evidence that artificial sweeteners cause cancer or cause it to grow faster. Studies have been done on aspartame (Equal®, NutraSweet®); sucralose (Splenda®); saccharin (Sweet ‘N Low®, Sweet Twin®, NectaSweet®); neotame; acesulfame potassium (Sunett®, Sweet One®) and cyclamate and found no evidence of cancer causation. All of these sugar substitutes (except cyclamate) have been approved by the Food and Drug administration.

Does My Attitude Help or Hinder Cancer Growth or Recovery?

A diagnosis of cancer can lead to a wide spectrum of emotions which are all perfectly normal. While your attitude doesn’t directly affect the growth or regression of a tumor, it can be very important in upkeeping physical activity (exercise), nutritional intake, and also maintaining a strong social support network which in turn can make an impact on how treatment is managed. We do know that with a positive attitude the treatment process can be easier to adjust to and can potentially make recovery itself better as well.

Can Biopsy or Surgery of a Cancerous Tumor Cause It to Spread?

Thankfully, the chance of that happening is exceedingly low. Nowadays, surgeons utilize methods and protocols and take many steps to ensure that that does not happen. As an example, if surgeons need to remove tissue from more than one place in the body, they use separate sterilized tools for each location to prevent this very thing from happening.

Is It Possible to “Catch” Cancer?

Not in general. Cancer is not contagious. You can’t “catch” it from another person and it doesn’t spread from person to person like a virus or bacterial illness. Remember, cancer is caused by a genetic mutation. The only exception to this is in the case of an organ transplant where the donor had cancer in that organ. This however doesn’t happen anymore since organ donors are screened for cancer and those organs cannot be donated.

There are certain viruses and bacteria (e.g. human papillomavirus, or HPV, and bacteria such as Helicobacter pylori) that can eventually lead to certain types of cancer. In some cases, like with HPV, there can be person to person transmission of the virus itself but not the cancer that it can lead to

Can My Cell Phone Give Me Cancer?

No, based on the scientific research studies done thus far. Cancer is due to genetic mutation and cell phone’s emission of low-frequency energy does not cause genetic mutations.

Can Power Lines Cause Cancer?

Once again, no, according to all the research done thus far. Just like cell phones, power lines emit low-frequency magnetic energy, and like cell phones, that magnetic energy does not cause genetic mutations. Besides, power lines are well-shielded and weakened by walls in homes or elsewhere.

Do Herbal Remedies Cure Cancer?

Contrary to certain belief systems that are widespread today, there are NO herbal products that cure cancer. There are a few studies that suggest that some herbal remedies may help patients to cope with cancer; however, they do not cure it. Before taking any herbal remedies, discuss it with your oncologist as some herbal products may in fact interfere with the effectiveness of chemotherapy or radiation therapy.

Can I inherit cancer?

90 – 95% of cancers develop because of cellular genetic mutations that take place during the patient’s lifetime – in other words, they are not inherited. They develop from the natural process of aging, or through repeated exposure to a carcinogenic substance in the environment, such as tobacco smoke. However, around 5 – 10% of cancers do result from inheriting a genetic mutation from a parent. In such relatively rare cases, multiple family members may develop the same type of cancer due to the inheritance of the harmful mutated gene from a parent. These are called “inherited” or “familial” cancers. Examples of this can be seen with breast and colon cancers.

Can Deodorants/Antiperspirants Cause Cancer?

In short, no. There is no scientific evidence that links the active ingredients in deodorants and antiperspirants to genetic changes resulting in cancer.

Does Hair Dye Cause Cancer?

To date, there is no scientific evidence that personal use of hair dye increases the risk of cancer. There are studies, however, suggesting that hairdressers/barbers who are more regularly and routinely exposed to hair dye in large quantities may have a greater risk of developing bladder cancer.

If Nobody in My Family Has Cancer, Am I Protected?

No. Remember that cancer develops from spontaneous genetic mutations that occur throughout life due to aging and repeated exposure to certain environmental factors, such as too much sun radiation, smoking tobacco, repeated exposure to dangerous chemicals, how you eat, whether or not you exercise, and simply the process of aging.

Is Cancer Practically a Death Sentence?

Not so fast. That may have been true during decades and centuries gone by. However, starting around the 1990’s, the likelihood of dying from cancer has steadily become less and less. For thyroid, breast and prostate cancers, the survival rate is now 90 percent or better. And the overall survival rate for all cancers combined has increased to around 67 percent.

Of course, this is aggregate data. In any individual case, several factors will alter those statistics, such as the rate of growth of the cancer cells, the degree to which the cancer has spread throughout the body, the availability of certain treatments, and your general health profile.

Sources:
National Cancer Institute: “Common Cancer Myths and Misconceptions”

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