Glossary of Prostate Terminology 1. PSA: A protein produced by the prostate that may be found in an increased amount in the blood of men who have prostate cancer, benign prostatic hyperplasia (BPH), or infection or inflammation of the prostate. 2. % Free PSA: PSA exists in two forms in the blood, either bound to protein or unbound ("free"). Measuring both the bound and free form can better predict risk. 3. Active surveillance: Active surveillance is an option offered to patients with very low-risk prostate cancer (low grade, low stage, localized disease). Patients are monitored carefully over time for signs of disease progression. A PSA blood test and digital rectal exam (DRE) and prostate biopsy are performed at physician-specified intervals. Signs of disease progression will trigger immediate active treatment. 4. Androgen: A type of hormone that promotes the development and maintenance of male sex characteristics. 5. Bone scan: A technique to create images of bones on a computer screen or on film. A small amount of radioactive material is injected into a blood vessel and travels through the bloodstream; it collects in the bones and is detected by a scanner. 6. BPH (Benign Prostatic Hyperplasia): A benign (non-cancerous) condition in which an overgrowth of prostate tissue pushes against the urethra and the bladder, blocking the flow of urine. 7. Brachytherapy: A procedure in which radioactive material sealed in needles, seeds, wires, or catheters is placed directly into or near a tumor. Also called internal radiation, implant radiation, or interstitial radiation therapy 8. Color Doppler Ultrasound: Transrectal ultrasound (TRUS) examination of the prostate is the established technique used to obtain systematic core biopsies of prostatic tissue for histological examination. The objective of color Doppler is not only to improve cancer detection rates, but also to act as a prognostic indicator, since increased color Doppler blood flow tends to indicate more aggressive tumors with higher Gleason grades as well as higher risk of recurrence.[ 9. Dihyrotestosterone: Also known as 5-alpha-dihydrotestosterone, it is the male hormone which is actually active in the prostate; it is made when an enzyme 5-alpha-reductase transforms testosterone to DHT which stimulates the growth of the prostate. 10. DRE: An examination in which a doctor inserts a lubricated, gloved finger into the rectum to feel for abnormalities in the prostate. 11. Dutasteride (Avodart): Dutasteride is used to treat symptoms of BPH and may reduce the chance of developing acute urinary retention (sudden inability to urinate). Dutasteride may also decrease the chance that prostate surgery will be needed. It works by blocking the production of a natural substance that enlarges the prostate. 12. External beam radiation: A form of radiation therapy in which the radiation is delivered by a machine pointed at the area to be radiated. May be known as external beam radiation (EBR, XBR), external beam radiation therapy (EBRT, XBRT). 13. Finasteride (Proscar): Finasteride is used to treat symptoms of BPH such as frequent and difficult urination and may reduce the chance of acute urinary retention (sudden inability to urinate). It also may decrease the chance that prostate surgery will be needed. 14. Gleason score: A system of grading prostate cancer cells based on how they look under a microscope. Gleason scores range from 2 to 10 and indicate how likely it is that a tumor will spread. A low Gleason score means the cancer cells are similar to normal prostate cells and are less likely to spread; a high Gleason score means the cancer cells are very different from normal and are more likely to spread. 15. Hormone therapy: Treatment that adds, blocks, or removes hormones. To slow or stop the growth of certain cancers (such as prostate and breast cancer), synthetic hormones or other drugs may be given to block the body's natural hormones. Also called hormonal therapy, hormone treatment, or endocrine therapy. 16. Immunotherapy: Immunotherapy is a type of treatment that boosts or restores the immune system to fight cancer, infections and other diseases. There a several different agents used for immunotherapy; Provenge is one example. 17. IMRT: (Intensity Modulated Radiation Therapy): A type of 3-dimensional radiation therapy that uses cmputer-generated images to show the size and shape of the tumor. Thin beams of radiation of different intensities are aimed at the tumor from many angles. This type of radiation therapy reduces the damage to healthy tissue near the tumor. 18. Lupron: Most prostate cancer cells depend on testosterone to grow. Although it is not a cure for advanced prostate cancer, Lupron suppresses the production of testosterone, which slows the growth of prostate cancer cells. 19. Multiparametric MRI: A procedure in which radio waves and a powerful magnet linked to a computer are used to create detailed pictures of the prostate. These pictures can show the difference between normal and diseased tissue. MRI makes better images of organs and soft tissue than other scanning techniques, such as CT or X-ray. Multiparametric magnetic resonance imaging currently is a promising technique for meeting the requirements of an imaging test that may be able to discriminate clinically significant cancer from areas with no cancer or clinically insignificant cancer within the prostate. 20. Nerve sparing: A surgical technique during a 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 and the skill of the surgeon. 21. PCA 3: (Prostate CAncer gene 3) is a gene which is prostate cancer specific. Unlike prostate specific antigen (PSA), PCA3 is only produced by prostate cancer (PCa) cells and not affected by prostate size. It discriminates better than PSA between PCa and benign/non-cancerous prostate diseases such as benign prostatic hyperplasia (BPH, i.e. prostate enlargement) or prostatitis (infection of the prostate). Therefore, it is an additional tool in deciding if prostate biopsy is really needed. 22. PET scan: A PET scan uses a small amount of radioactive material (tracer). The tracer is given through a vein (IV), most often on the inside of your elbow. The tracer travels through your blood and collects in organs and tissues. This helps the radiologist see certain areas of concern more clearly. 23. Prostate gland: A walnut-sized gland in the male reproductive system just below the bladder. The prostate surrounds part of the urethra, the canal that empties the bladder, and produces a fluid that forms part of semen. 24. Prostate ultrasound: A procedure in which high-energy sound waves (ultrasound) are bounced off internal tissues or organs and make echoes. The echoes form a picture of body tissues called a sonogram. 25. Prostate volume/size: Usually expressed in ccвЂ™s (cubic centimeters). Size of the prostate is typically determined during a TRUS (trans-rectal ultrasound) of the prostate. It is needed to determine the PSA density of the prostate. 26. Prostatectomy: An operation to remove part or all of the prostate. Radical (or total) prostatectomy is the removal of the entire prostate and some of the tissue around it. 27. Prostatitis: Prostatitis is a condition that involves inflammation of the prostate and sometimes the area around it. There are several types of prostatitis, each with a range of symptoms. Some men with the disease will experience severe pain and others will not be bothered; and the rest fall in between the two. 28. PSA density: PSA is produced by prostate cells -- whether they are normal or cancerous. Men who have larger prostates, logically, have more prostate cells and, in general, produce more PSA regardless of whether they have cancer or not. To correct for this, the prostateвЂ™s volume is measured via transrectal prostate ultrasound. The PSA level is then divided by the size of the prostate to calculate the PSA density. 29. PSA doubling time: The time it takes for the PSA level in the blood to double. Doubling time may be an indicator of risk for aggressive prostate cancer, and that men with a short PSA doubling time may be at greater risk for aggressive disease that needs treatment than men with a longer doubling time. 30. PSA Velocity: PSA velocity is the rate at which your PSA level increases from year to year. PSA velocity may be an indicator of risk for aggressive prostate cancer, and that men with a rapidly rising PSA are at greater risk for aggressive disease that needs treatment than men with a slowly rising PSA. 31. Seminal vesicles: The seminal vesicles are a pair of tube-like glands. They are found behind the bladder of males. They make most of the content of semen (also called seminal fluid). About 70% of the seminal fluid in humans comes from the seminal vesicles. 32. Testosterone: Testosterone is a hormone made by your body. It is responsible for many sexual characteristics, like: п‚· Growth and maturation of the prostate and other male sex organs п‚· Development and distribution of male hair, such as facial hair п‚· Sex drive and sexual function But testosterone plays many other roles as well. Some additional effects of testosterone may include: п‚· п‚· п‚· Changes in body muscle mass and strength Changes in fat distribution Changes in mood and energy level 33. TRUS: Transrectal Ultrasound , also called prostate ultrasound, provides images of the prostate and surrounding tissue and allows the physician to examine the gland for abnormalities (e.g., enlarged prostate [BPH], prostate cancer). TRUS and prostate biopsy can be used to diagnose prostate cancer in patients with an abnormal digital rectal examination or elevated PSA level, to assess prostate volume, to detect inflammation of the prostate (e.g., prostatitis), and to help determine the cause of infertility (e.g., blockages caused by prostatic cysts). Transrectal ultrasound also can be used to deliver and monitor prostate cancer treatments such brachytherapy and cryotherapy. 34. TURP (Transurethral Resection of the Prostate): TURP is a type of prostate surgery done to relieve moderate to severe urinary symptoms caused by an enlarged prostate, a condition known as benign prostatic hyperplasia (BPH). During TURP, a combined visual and surgical instrument (resectoscope) is inserted through the tip of your penis and into the tube that carries urine from your bladder (urethra). The urethra is surrounded by the prostate. Using the resectoscope, your doctor trims away excess prostate tissue that's blocking urine flow and increases the size of the channel that allows you to empty your bladder. 35. Watchful waiting: Watchful waiting is sometimes used to describe a less intensive type of follow-up (as compared to Active Surveillance) that may mean fewer tests and relying more on changes in a man's symptoms to decide if treatment is needed.