Active Surveillance (AS) – A prostate cancer management strategy for newly diagnosed low risk patients. Its purpose is to hold off on radical (whole gland) treatment in order to avoid side effect risks. Best practice requires a baseline multiparametric MRI to confirm eligibility. Patients on AS will monitor their disease via PSA and mpMRI scans at prescribed intervals, and must be psychologically comfortable living with cancer in their bodies. Healthy lifestyle changes are recommended.

Androgen – A class of hormones that develop the male reproductive system and produce male physical characteristics. The primary androgen is testosterone, which also influences sex drive (libido).

Androgen Deprivation Therapy (ADT or “chemical castration”) – A prostate cancer treatment to deprive cancer cells of the testosterone that fuels them. It works by reducing the amount of androgen in the body, or by blocking the way androgens work. Side effects include impotence, low sex drive, hot flashes, loss of muscle mass, and thinning bones. ADT may be recommended for men undergoing radiation treatment, and in men with advanced prostate cancer. It is not curative but can delay tumor growth and progression. It is not a first-line treatment for men with early stage prostate cancer.

Benign Prostatic Hyperplasia (BPH) – An aging-related non-cancerous enlargement of the prostate gland. Though not dangerous, BPH can lead to urination problems because it narrows the urethra (tube the carries urine out from the bladder) where it passes through the prostate gland. If symptoms of urinary difficulty occur, a doctor should be seen because other conditions, including prostate cancer, cause similar signs.

Benign Tumor – A non-cancerous growth that does not spread to other parts of the body, but which can have symptoms similar to cancer.

Biopsy – A minimally invasive, image guided procedure in which hollow needles are used to extract tissue samples from an organ in order to diagnose cancer. Conventional prostate biopsies are guided by transrectal ultrasound (TRUS) and typically take 12-14 systematic but random needle samples. A new method, uses real-time magnetic resonance imaging (MRI) to identify suspicious areas, then guide a minimum number of needles into the densest core of the area. This method greatly increases diagnostic accuracy while reducing the risk of TRUS biopsy side effects.

Brachytherapy – A prostate cancer treatment involving permanent implantation of radioactive “seeds” or pellets the size of rice grains. Exposing prostate cancer cells to radioactivity gradually impairs their DNA and makes it difficult to reproduce. Cancer cells are more vulnerable to radiation’s effect than healthy cells, but as with all radiation, the scatter effect can lead to late-onset side effects.

Chronic prostatitis – An inflammation or swelling of the prostate gland that repeatedly comes back. It may be caused by a bacterial infection, but sometimes diagnostic tests are unable to identify a specific organism. If bacterial in origin, antibiotics are prescribed, but even bacterial prostatitis can return.

Clear margins – Areas of normal tissue that surrounds cancerous tissue. In prostate cancer, the term comes from examining glands removed during prostatectomy (surgery) to ensure that the edges (margins) of the prostate capsule have no evidence of tumor activity. The term also applies to tumor ablation (destruction). For example, after Focal Laser Ablation, a multiparametric MRI scan is immediately performed to confirm that the margins of the ablation zone show no sign of tumor cells.

Digital Rectal Examination (DRE) – A common screening practice to detect prostate cancer. A doctor inserts a gloved, lubricated finger in the rectum to feel the surface of the prostate on the other side of the rectal wall. If an unusual lump or enlargement is felt, a biopsy may be recommended. However, the DRE has limitations since it cannot access the entire gland surface.

Focal Laser Ablation (FLA) – A minimally invasive, outpatient MRI-guided procedure developed by Dr. Dan Sperling. Under MRI guidance, a laser optic fiber is inserted into the core of a prostate cancer tumor. When activated, the laser light at the fiber tip generates lethal heat that precisely destroys the tumor plus a margin of safety, while normal tissue is spared. Side effect risks are minimal-to-zero. Patients are pre-qualified by mpMRI and biopsy, and must be willing to comply with follow-up protocols.

Gleason score – A numeric scale that rates prostate biopsy samples from 2-5 according to aggression level. The higher the number, the more aggressive the cells. Under a microscope, the cancer seen in each needle specimen is assigned a sum of two numbers (e.g. Gleason 3+3 – 6). The first number is given to the largest percentage of cancer per specimen, and the second number is given to the next largest percentage. Thus, Gleason 4+3 = 7 is more aggressive than Gleason 3+4 = 7, because the first 4 indicates a larger amount of aggressive cancer. Treatment options are determined by the highest aggression.

High Intensity Focused Ultrasound (HIFU) – A noninvasive method of ablating prostate cancer tumors using focused soundwaves (ultrasound) to create lethal heat in targeted tumors. Patients must be qualified for HIFU based on gland size and presence of hard calcifications in the gland. Some patients may require a TURP (“reaming out”) prior to HIFU.

Hormone therapy – See Androgen Deprivation Therapy above

Impotence -The inability to achieve and sustain an erection firm enough for penetration. There are several causes of impotence, including a result of prostate cancer treatment that damages the nerves that are responsible for erection. There are many effective treatments. A correct diagnosis is important, because impotence due to reduced blood flow may be an early warning sign of heart disease.

Immunotherapy – Prostate cancer treatment that activates or boosts an individual patient’s immune system to defend against prostate cancer. It is currently used only in cases of advanced or metastatic prostate cancer, or in clinical trials. FDA-approved methods may be used alone or with chemotherapy, and have been shown to extend life expectancy.

Magnetic Resonance Imaging (MRI) -A method of medical imaging that measures the response of the atomic nuclei of body tissues to high-frequency radio waves when placed in a strong magnetic field. Depending on the field strength of the magnet (measured as Tesla or simply T) today’s MRI technology produces very high definition, 3-dimensional images of internal structures, including bone, soft tissue, blood vessels and even nerves. MRI scans are harmless due to no radiation. See Multiparametric MRI.

Metastasis – The spread of cancer from its original source to local, regional, or remote parts of the body. Metastatic prostate cancer can be managed with treatment, but is not curable.

Multiparametric MRI (mpMRI) – A specialized method of MRI scans that uses two or more imaging sequences (parameters) to characterize tissue features that reveal cancer activity. These primarily include T1 and T2 weighted (anatomic imaging reveals suspicious masses), Diffusion Weighted Imaging (restricted motion of water molecules reveals cancerous density), and Contrast Enhanced Imaging (unusual blood flow indicates chaotic blood vessels that feed tumors). When performed on a powerful 3 Tesla magnet, it is considered the “Cadillac” of prostate imaging.

Prostate – A walnut-sized gland of the male reproductive system positioned directly below the bladder. The prostate secretes prostate fluid, one of the components of semen, and its muscles help propel the ejaculation of semen. The urethra (tube that carries urine from the bladder to exit the penis) passes directly through the prostate gland, so prostate cancer treatments risk damaging urinary function.

Prostate Cancer – A disease in which normal prostate cells develop mutations that allow them to grow out of control. If detected and treated early, it is highly curable. As with all cancers, though, prostate cancer has the potential to spread (metastasize) to other parts of the body, at which point it is no longer curable but can be managed with treatment. Most prostate cancer is thought to grow slowly, but about 15% of cell lines are potentially dangerous. If prostate cancer is suspected based on a high PSA, abnormal DRE, or other risk factors, a multiparametric MRI scan should be done before a biopsy to help determine if cancer is present, how aggressive it appears, and where to target biopsy needles.

Prostate Specific Antigen (PSA) – Prostate specific antigen is a term for proteins on the surface of all prostate cells (including prostate cancer cells) that are shed into the bloodstream in small amounts. These proteins are harmless, and a blood test can analyze the amount. An increase in PSA acts as a “biomarker” because it indicates that some disturbance of the prostate has caused it to shed more protein. Although PSA blood tests are a common method to screen for prostate cancer, it is imperfect because any disturbance can cause PSA to rise (e.g. infection, inflammation, BPH, prostate cancer, even such activity as riding a bike or having sex). To rule prostate cancer in or out, additional information is needed , such as further PSA analysis of its variants, and multiparametric MRI imaging.

Prostate Enlargement – See Benign Prostatic Hyperplasia

Prostatitis – Any inflammation of the prostate gland. Unlike chronic prostatitis, that occurs repeatedly, bacterial infection that causes the inflammation can be treated and is not expected to recur.

Radiation Therapy (RT) – A cancer treatment in which beams of radiation are directed at tumors in the body in order to cause cancer cells to die off. Prolonged radiation exposure is needed in order to be effective, which is why patients must go for daily treatments for several weeks. Cancer cells are more vulnerable to radiation than healthy cells. Radiation therapy for prostate cancer may be used as a first-line (primary) treatment for localized low-risk disease, as an adjunct to hormone therapy for disease that has grown beyond the gland, as a treatment for recurrent cancer in the prostate bed after prostatectomy, or as a supplemental local treatment for metastatic prostate tumors to other parts of the body. There are different types of beam radiation, and today’s treatments are designed to have less scatter effect that can damage healthy cells.

Radical Prostatectomy (RP) – A surgical procedure to completely remove the prostate gland. Advances in laparascopic and robotic-assisted RP have made the surgery less invasive than the traditional open surgery, so recovery is easier and faster. However, there are still risks of urinary and sexual side effects. Multiparametric MRI is useful to qualify patients before surgery (to ensure the tumor has not penetrated the prostate margin) and to help plan nerve-sparing RP.

Recurrence – When cancer returns after treatment, it is called recurrence. Recurrence may result from the presence of hidden or microscopic cancer cells that were left or had undetectably left the gland at the time of treatment. There are many treatments to control recurrence, and the earlier it is suspected, the sooner treatment can begin for greatest effectiveness.

Testosterone – The primary male hormone that develops the reproductive system and male physical characteristics, as well as contributes to sex drive. Testosterone circulates in the bloodstream, usually “bound” to other molecules. One form (free or unbound testosterone) is more easily taken up by cells than the others. Testosterone is not known to cause prostate cancer, but is considered to “fuel” existing prostate cancer. See also Androgen and Androgen Deprivation Therapy.

Testosterone Replacement Therapy (TRT) – A treatment for an aging-related condition called low testosterone (low T), which can cause symptoms of fatigue, loss of sex drive, loss of muscle mass, etc. When properly diagnosed by a blood test, a patient can receive supplemental testosterone to quickly reverse symptoms. TRT for prostate cancer patients is controversial, since testosterone is commonly held to “fuel” prostate cancer. New evidence suggests that prostate cancer patients can safely take TRT provided they are monitored at regular intervals with blood tests plus multiparametric MRI.

Transrectal Ultrasound of the Prostate (TRUS) – Ultrasound is generally used by urologists for prostate gland imaging. It is delivered by a slender wand inserted in the rectum, and reveals two different views of the prostate gland (front-to-back and side-to-side). These images allow the urologist to measure the volume of the gland and guide prostate procedures such as a needle biopsy. Similar to the ultrasound used to monitor pregnancy, the images show the size and shape of the gland but no internal detail. Therefore, systematic TRUS-guided prostate biopsies using 12-14 needles are essentially blind because TRUS does not reveal cancerous activity within the gland.

Tumor – An abnormal thickening or lump of tissue anywhere in the body, not caused by an infection but to unusual cell activity. Tumors can be either benign (non-malignant, in which case they may continue to grow in place but do not spread elsewhere) or cancerous (malignant), meaning they can spread. See Benign Tumor.

Ultrasound – Soundwaves at a frequency not able to be detected by human hearing. Soundwaves that travel through liquid can “bounce back” or echo when they hit a solid object. These echoes can be picked up by a special receiver and converted to images on a computer monitor. This principle helped develop underwater sonar, and have been adapted for medical imaging within the body. Imaging ultrasound is harmless, so it is safe to use to monitor pregnancy or detect certain disease conditions.

Urinary Incontinence – The inability to hold one’s urine (e.g. leaking, dribbling). Incontinence may occur as a result of a physical condition, aging, or as a side effect of prostate cancer treatment. Consult a doctor as soon as possible when symptoms appear since early intervention is most effective.

Watchful Waiting (WW) – A simple prostate cancer management strategy that relies on periodic PSA tests to indicate increased cancer activity. Today, Active Surveillance has largely taken the place of WW. However, if a prostate cancer patient has a PSA below 10, and less than 10 years life expectancy, WW may be recommended as the least burdensome way to monitor his disease.