Gross Overtreatment

Active Surveillance An approach to managing early prostate cancer (PC), which affords a window on its natural history, and is an ideal setting for identifying and evaluating biomarkers of PC behavior. It is essentially watchful waiting with a protocol of serial digital rectal exams, measurement of PSA levels and re-biopsy at intervals.

Adenocarcinoma A cancer that develops in the lining or inner surface of an organ. More than 95% of prostate cancers are adenocarcinomas.

Adjuvant Treatment Treatment that is added to increase effectiveness of a primary therapy, i.e. radiation, to radical prostatectomy (RP) or chemotherapy after surgery.

Adrenal Glands Two glands located above the kidneys that produce small amounts of the male hormone testosterone as well as other hormones.

Alkaline Phosphatase An enzyme active in an alkaline medium such as blood plasma or serum, bone, kidney, spleen, lungs, etc. which can be used to detect bone or liver metastasis.

Analog A man-made compound similar to the one manufactured by the body. Examples are LH-RH analogues lupron depot, luprolide acetate and zoladex; examples of antiandrogen analogues are flutamide and its Canadian version, euflex.

Androgen Hormone Any hormone that produces male physical characteristics. In men the main hormone is testosterone.

Antiandrogen Drug A drug that blocks the activity of an androgen hormone (testosterone from the adrenal glands) by blocking the androgen receptor sites in target organ cells.

Antibody A protein substance in the body produced in response to an antigen to provide immunity.

Antigen A biological substance, such as a vaccine or foreign protein, that produces an immunological response by producing antibodies.

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. When cancer is in its early stages it may develop and grow without symptoms.

Autologous Transfusion When one donates blood for himself prior to an operation in case he will need it during his operation.

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 Prostatic Hypertrophy (BPH) A non-cancerous condition in which the prostate swells because of an increase in the size of the constituent cells and causes the same symptoms. In both BPH's there may be an above normal PSA reading as with individuals with prostatitis and prostatic infarction (a sudden blockage of the blood supply to a portion of the prostate gland).

Benign Tumors Non-cancerous tumors that do no spread to other areas of the body.

Biological Therapy Also known as biotherapy or immunotherapy, is a new form of cancer treatment based on the knowledge and tools of modern molecular biology, immunology, and genetics.

Biopsy The removal and microscopic examination of a sample of tissue to ascertain if cancer is present. It is the most important procedure in diagnosing cancer. In the tradition "true cut" biopsy or spring loaded biopsy gun, a large hollow needle removes a core or plug of the tissue. In a fine needle aspiration, the tissue is aspirated, or sucked out, of the suspected area.

Bladder Catheterization Passage 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. It appears cloudy on x-rays with an added layer look when compared to unaffected bone.

Blood Chemistry Analysis of multiple components in the blood serum including tests to evaluate function of the liver and kidneys, minerals, cholesterol, etc.; important because abnormal values can indicate spread of cancer or side effects of any treatments.

Blood Count Examination of a blood specimen in which the number of white blood cells (which protect against infection), red blood cells (which transports oxygen) and platelets (necessary for clotting blood) are determined.

Blood Urea Nitrogen (BUN) A blood test that helps measure kidney function.

Bone Marrow Soft tissue in bone cavities; produces blood cells.

Cancer Unregulated or abnormal cell growth. Cancerous cells build up to form a tumor, which can then spread to other parts of the body.

Capsule The layer of cells around an organ such as the prostate.

Carcinoma Cancer that begins in the tissues that line or cover an organ.

Castrate-sensitive prostate cancer Prostate cancer that does respond to hormone therapy or removal of the testicles (or Orchiectomy).

Castrate-resistant prostate cancer Prostate cancer that still grows even after hormone therapy or removal of the testicles. Also called hormone resistant or ADT-resistant prostate cancer.

Cell Saver Blood Blood recovered during an operation and transfused back into the patient.

Chemotherapy Treatment of cancer with certain chemicals that interfere with cell division not only of cancer cells, but all young and dividing cells of the body, such as blood cells. 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 patients, usually to evaluate a new treatment.

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.

Comorbidity Two or more conditions occurring at the same time. For example, if an individual has diabetes and prostate cancer, both conditions are considered comorbidities in that individual. Comorbidities can result from independent factors or can develop as a result of one another or a common factor.

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. Useful in evaluating soft tissue organs.

Creatinine A blood test involving normal metabolic waste in the body to indicate kidney function.

Cryosurgery or Cryoablation Minimally invasive computer-guided lethal freeze of all or part of the prostate using argon gas. Medicare-approved for primary and salvage treatment of localized prostate cancer. 89-92% success in 7-8 year studies.

Cystoscopic Examination An examination of the urethra and urinary bladder with a cystoscope. A cystoscope is an instrument having a narrow tube with light at one end of an opening so the physician can observe what the light reveals.

Digital Rectal Examination (DRE) A procedure in which a physician inserts a finger in the rectum to examine the area as well as the prostate gland for signs of cancer.

DNA A nucleic acid found in cell nucleus that is the carrier of genetic information.

DNA Ploidy Analysis through Flow Cytometry An objective analysis of prostate cancer cells from a biopsy that enables a more accurate determination of cellular characteristics. You should request this from your doctor before the biopsy to insure sufficient tissue sample. This test compares the number of chromosomes and the DNA in a normal cell. If the cell has two sets of chromosomes and the DNA is normal the cells is called diploid and is normally slower growing. If the cell has more DNA than a normal cell, it is classified aneuploid and has a potential for faster growth. Other combinations that require immediate attention are any combination of aneuploid and/or tetraploid (polyploid), which have the potential to become fast growing. This test is often referred to as the ploidy test and may be valuable because it may assist in determining treatment options.

DNA Ploidy Analysis Through Static Cytometry A recent pathological development that may determine the ploidy patterns from a much smaller sample of tissue as obtained from a fine needle aspiration biopsy.

Double - Blind Study A controlled experiment in which neither the patient nor the attending physician knows whether the patient is getting one or another drug or dose. In a single - blind study only the patient doesn't know which of the several treatments he is receiving.

Drug "Interaction" Any mechanism by which one drug may interact with the action(s) of another drug.

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

Efficacious (Efficacy) The capability of producing the desired effect i.e. hormonal therapy reducing the PSA of an individual.

Endocrinologist A specialist of the 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 you voluntarily contract when you want to stop urinating. This sphincter acts as an involuntary mechanism of continence following a radial prostatectomy. The prostatic urethra ends at the external urethral sphincter muscle.

False Negative Report The swelling or accumulation of fluid in a part of the body. A negative result when in reality it is positive in nature.

False Positive Report A positive result when in reality it is negative in nature.

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.

Flutamide (Eulexin) An anti-androgen medication that may be prescribed with an LHRH analog or an orchiectomy in combination hormonal therapy.

Foley Catheter A self-retaining tube placed through the urethra into the bladder for continuous urinary drainage.

Frozen Section A technique in which tissue is removed 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.

Gleason Score A subjective method of measuring the differentiation of cells to classify tumors by their microscopic appearance and how aggressively cancer cells may multiply. This system divides prostate cancer into five histologic 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.

Gynecomastia A tender enlargement of the breasts.

Hematuria Blood in the urine.

Hormonally Independent Cells Cancer cells that are not affected by hormones.

Hormone Therapy (HT) The use of medication or surgery to prevent cancer cells from getting the hormones needed to grow. In prostate cancer this means the hormone testosterone.

Hyperthermia of the Prostate The use of heat, generally microwave, to shrink the prostate and shrink BPH without damaging the surrounding tissue. This protocol has been extensively used England and France with a machine named The Prostatron. Hyperthermia of the prostate gland is not presently DDA approved in the United States although it is being investigated.

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.

Informed Consent Consent given by a patient after learning about and understanding fully the purpose and other aspects of a clinical trial or any medical procedure.

Interferon A body protein capable of affecting antibody production in the body and can be a modulator of the immune system of an individual.

Interleukin A protein substance in the blood that helps the body's immune system fight infection and cancer.

Investigational New Drug A drug allowed by the Food and Drug Administration (FDA) to be used in clinical trials, but not approved for sale to the general public.

Laparoscopic Lymphadenectomy The removal of pelvic lymph nodes with a laparoscope done through four (4) small incisions in the lower abdominal region.

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

Lupron Depot (Leuprolide) Monthly injection of a long-acting LHRH analog used in chemical castration and combination hormonal therapy. A three month longer acting depot injection is under investigation for FDA approval.

Luteinizing Hormone - Releasing Hormone (LH-RH or LHRH) A hormone that controls sex hormones in men and women.

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

Lymphangiogram An x-ray that makes use of special dye to determine whether cancer has spread to the lymph nodes.

Lymph Nodes Small bean-shaped structures scattered along the vessels of the lymphatic system. The nodes filter bacteria and cancer cells that may travel through the system.

Lytic Lesions As seen on x-rays, rarefied areas of bone that have been the site of destruction by cancer cells. It appears black on affected bones.

Magnetic Resonance Imaging (MRI) A picture produced by a computer and a high powered magnet that shows a detailed x-ray type image of a particular body part or region that can detect if the tumor has penetrated the prostate gland and/or invaded the seminal vesicles. It can also be used to evaluate whether lymph nodes are enlarged.

Malignant Tumors Cancerous tumors.

Metastasis The spread of cancer cells from one part of the body to another by way of the lymph system, blood stream or direct extension.

Metastatic Work Up Includes bone scans, bone x-rays, chest x-rays, blood PSA tests and probably blood acid phosphatase and alkaline phosphatase.

Metastron (Strontium 89 Chloride) A recently FDA approved non-narcotic radiopharmiceutical medication designed for the relief of bone pain associated with metastatic cancer.

Morbidity Relates to becoming less healthy or sick resulting from a treatment protocol i.e. incontinent or impotent from radical prostatectomy.

Neoplasm Abnormal growths of tissue that are also referred to as tumors. Neoplasms can be cancerous or non-cancerous (benign).

Nerve Sparing Technique A surgical technique during a radial prostatectomy where one or both of the neurovascular bundles controlling erections are spared. The utilization of this procedure is governed by the extent of the cancer.

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

Nucleic Acids Large molecules made up of chemical building blocks of nucleotides. The two nucleic acids are DNA and RNA (Deoxyribonucleic Acid and Ribonucleic Acid).

Nuclear Scan A procedure in which a weak radioactive material called a radioactive tracer is injected in the blood stream. The material is taken up by the body and a machine that looks like an x-ray machine moves over the area being tested and takes pictures.

Oncologist A medical doctor specializing in cancer.

Oncology The branch of medical science dealing with tumors.

Orchiectomy (Castration) The surgical removal of the testicles (see hormone therapy). Patient will be sterile and 50- 60% will become impotent.

Palliative Treatment Therapy that relieves symptoms, such as pain, but does not alter the course of the disease. Its primary purpose is to improve the quality of life.

Pancytopenia Decreased platelet, white cell and red blood count.

Pathologist A doctor who specializes in the diagnosis of disease by studying cells and tissues removed from the body.

PDQ A database available to physicians supported by NCI on the latest information on standard treatments and ongoing clinical trails for each type and stage of cancer.

Pelvic Node Dissection Removal of possible cancer carrying lymph nodes near the prostate for their evaluation just prior to a radical prostatectomy. If the lymph nodes are involved, the patient usually has an orchiectomy or hormonal therapy or both (see lymphadenectomy).

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.

Perineural invasion When cancer spreads in the space around a nerve or multiple nerves.

Perineal Prostatectomy An operation to remove the prostate gland from an opening between the anus and scrotum. The advantage is shorter hospital stay and less bleeding. The disadvantage is that the lymph nodes cannot be examined simultaneously. A separate lymphadectomy is required to examine the lymph nodes. This approach can also be used for the treatment of BPH and cryoprostatectomy.

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.

Primary cancer/recurrent cancer/second cancer Primary cancer is the location in the body where a specific cancer starts and is represented in the name of the cancer. Prostate cancer is a cancer that starts in the prostate gland. When the primary cancer is treated and then returns, it is called recurrent cancer. When an entirely different cancer unrelated to the primary cancer develops, this is called a second cancer.

Primary therapy/adjuvant therapy Primary therapy is the main treatment used for a condition, while an adjuvant therapy is added onto the primary treatment to either provide further support, address other symptoms, increase the effectiveness of the primary treatment, or prevent the cancer from coming back.

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 surrounds the neck of the bladder and approximately the first inch of the urethra. Its main function is to supply fluid for the sperm during ejaculation.

Prostate Specific Antigen (PSA) A blood test for the measurement of a substance produced by prostate gland cells. An elevated reading indicates an abnormal condition of the prostate gland, either benign or malignant requiring further investigation. 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. There are two PSA assays: The more commonly used is the Hybritech where a score of 0-4 is generally considered within the normal range. The other is called the Yang Pros - Check where a score of 0-2.5 is generally considered within the normal range. To convert from Hybritech to Yang Pros-Check you multiply your assay by .625. To convert from Yang Pros - Check to Hybritech you multiply your assay by 1.625.

Prostatic Intraepithelial Neoplasia (PIN), Proliferative Inflammatory Atrophy (PIA), and Atypical Small Acinar Proliferation (ASAP) Three common conditions found during a prostate biopsy. None of these are cancerous, but many believe that these are either pre-cancerous conditions, or are related to an increased risk of developing prostate cancer in the future.

Protocol The term used to describe an individual's treatment program.

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. Most men are able to have sexual intercourse after interstitial radiation. 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 An operation to remove the entire prostate gland and seminal vesicles through the lower abdomen.

Refractory A term commonly used to describe a situation where the disease is no longer controlled by current therapy. It amounts to disease progression.

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

Retrograde Ejaculation Semen going backwards into the bladder instead of through the urethra during a male orgasm. This is most often the case following a transurethral resection of the prostate gland (TURP) in the treatment of BPH.

Staging A medical term for the process of determining if a known cancer is still confined within 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. There are 2 systems for staging Prostate Cancer. The Whitmore-Jewett ranges from A to D with substages for more precise definition.

Survivorship care plan Typically created after an individual undergoes treatment for a condition, like cancer, that can lead to the need to tailor the lifestyle to prevent the condition from returning or progressing further. Aspects of a survivorship care plan include a schedule of follow-up appointments and tests, signs and symptoms of progression or recurrence to watch for, potential late-developing side effects of treatment, and other lifestyle recommendations such as exercise plans, special diets to adhere to, and more.

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) A test using sound wave echoes to create an image of an organ or gland to visually inspect for abnormal conditions like gland enlargement, nodules, penetration of tumor through capsule of the gland and/or invasion of seminal vesicles. 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) also known as Roto-Rooter Procedure 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. Many times unsuspected cancer cells are discovered during this procedure when removed tissue is examined by a pathologist. After this operation, semen released during sexual activity usually flows into the bladder rather than out the penis (retrograde ejaculation).

"Tumor Flare" When LHRH agonists may temporarily stimulate tumor growth and symptoms. To prevent this, doctors usually recommend taking the antiandrogen flutamide (eulexin) every eight hours beginning at least two days before the first lupron or zoladex injection.

Ultrasound (Ultrasonography) A non-invasive imaging modality utilizing high frequency sound waves for visualizing tissue. Trancretal Ultrasound is becoming a more prevalent tool in the diagnosis and treatment of prostate cancer.

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 is the first part of the urethra leading from 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 and sex organs of humans.

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

"Watchful Waiting" (No Treatment) A term used when a patient and/or physician monitors a potentially dangerous condition. A good example would be PSA monitoring of early stage A or B organ confined prostate cancer.

Whitmore-Jewett Staging Classifications of extent of prostate cancer disease are normally designated by the Whitmore Staging scale composed of alphabetical classifications a-d, followed by numerical prefixes 1-3. Examples would be A1, A2, B1, B2, B3, etc. to D1, D2, D3.

Zoladex (Goserelin Acetate) A monthly injection of an LHRH analog administered sub-cutaneously and used in chemical castration and in combination hormonal therapy.