A to Z Entries

taken from Small Gland, Big Problem 4th Edition
by Professor Roger Kirby, Health Press 2011

5-alpha-reductase inhibitors

one of the two types of drug usually prescribed for BPH. They work by blocking the conversion of testosterone to another substance, DHT, which appears to stimulate overgrowth of prostate tissue.

Active surveillance

careful follow-up of low-risk cancer with PSA testing, MRI and repeat biopsy, which allows treatment to be avoided or postponed.

Adjuvant therapy

a treatment that enhances the effectiveness of another therapy.

Advanced

cancer is described as advanced when it has spread beyond the site where it started. Prostate cancer is described as being locally advanced when it has invaded parts of the body around the prostate. When the cancer has begun to spread to more distant sites, such as the bones, it is no longer localized and so is referred to as advanced.

Alpha-blockers

one of the two types of drug usually prescribed for BPH. They work by helping to relax muscles in the bladder and prostate, which in turn helps to reduce the obstruction to the urinary tract caused by an enlarged prostate.

Angiogenesis

the development of a blood supply. As a tumour grows, the formation of a blood supply is vital to cancer cells so that they can survive and divide. Researchers are currently developing drugs that could hinder angiogenesis, and so stop cancers growing.

Anti-androgens

drugs that may be prescribed to combat prostate cancer. They work by blocking the action of testosterone, which appears to stimulate the growth of prostate cancer.

Anticholinergic agents

drugs sometimes used to control urinary urgency and frequency associated with BPH.

Benign

non-cancerous; an area of unregulated tissue growth that does not have the capacity to invade surrounding healthy tissue or metastasize.

Biopsy

a sample of tissue taken from the body. Biopsies of prostate tissue are checked under a microscope for signs of cancer.

Bone scan

a means of seeing whether the cancer has spread to the bones. It involves injecting the patient with a radioactive material that then spreads around the body and then capturing the image a few hours later. The final pattern of distribution will highlight any areas where cancer may be developing.

Botox

Botulinum toxin or Botox is an injectable medicine used extensively by cosmetic surgeons to reduce wrinkles on the face. Recently, early studies have shown that Botox injected into the prostate can improve the symptoms of BPH.

BPH (benign prostatic hyperplasia)

a non-cancerous condition that causes the prostate to become enlarged, which may lead to difficulty with urination.

Brachytherapy

a type of radiotherapy for prostate cancer in which radioactive pellets are implanted into the prostate.

Cancerous

refers to unregulated tissue growth that has developed the ability to invade surrounding healthy tissue.

Catheter

a narrow tube inserted into the penis and up into the bladder to drain urine away. A catheter may be inserted during an operation so that the bladder does not fill with urine while the surgeon is working on it. It may be left in place for some time afterwards so that the patient can pass urine while his urethra and bladder heal. Sometimes catheters are also inserted via the penis so that fluid can be passed into the bladder; for example, see ‘Urodynamics’.

Cavernous nerves

the nerves involved in sexual arousal and erection that lie close to the prostate. They may be disturbed during radical prostatectomy.

Cells

tiny, specialized units from which the body is built. Healthy cells grow and divide as part of their normal lifecycle; in cancer, these processes get out of control because the usual mechanisms that keep them in check have broken down.

Chemotherapy

the use of drugs to destroy cancer cells.

Conformal radiotherapy

a type of radiotherapy that conforms to the shape of the prostate and thereby reduces the radiation dose to nearby tissues.

Continence

the ability to maintain control over bladder and bowel emptying.

CT scanning

a method of using sequential X-rays to build up a three-dimensional picture of the body. CT stands for ‘computed tomography’.

CyberKnife

a robotically controlled form of giving radiation treatment to the prostate.

Cystoscopy

the use of a telescope, inserted through the penis, to examine the inside of the bladder.

Da Vinci

the brand name of the robot used by surgeons to facilitate robotic radical prostatectomy.

DHT

the male hormone testosterone can be converted in the body to DHT, which is thought to stimulate the growth of prostate tissue. DHT stands for ‘dihydrotestosterone’.

Differentiated (as in ‘well, moderately well or poorly differentiated’)

a term used to describe healthy organized tissue. As cancer invades, the tissue structure becomes disorganized or de-differentiated, and looks less and less like normal tissue.

Digital rectal examination

a procedure that allows the doctor to assess the size and texture of the patient’s prostate gland. It involves placing a finger into the patient’s back passage (rectum) and feeling (palpating) the gland. It is sometimes referred to as a DRE.

First-degree relative

a close relative (parent, sibling or child). Prostate cancer may run in families, and more than 30 genes have now been identified that confer prostate cancer susceptibility.

Gland

a group of cells with the specialized function of making a particular fluid or secretion. The fluid made in the prostate gland mixes with the jelly-like sperm to make semen, which can then be ejaculated.

Gleason score

a number from 2 to 10 that is used as an indicator of how aggressive the patient’s cancer is. The score is derived from an assessment (Gleason grade) of two areas of a sample (biopsy) of prostate tissue (e.g. 3 + 4 = 7).

Grade

how the prostate tissue appears under a microscope. The more aggressive the cancer, the less it looks like normal prostate tissue. The Gleason grading system uses a scale of 1-5, with 5 indicating the most aggressive-looking cancer.

GreenLight laser prostatectomy

a technique that vaporizes the obstructing prostate tissue to improve urinary flow with minimal risk of bleeding.

HIFU (high-intensity focused ultrasound)

a new technique that focuses ultrasound waves on prostate cancer cells. More research is needed before it can be regarded as a mainstream treatment; it is currently available only as part of a clinical trial.

Holmium laser enucleation of the prostate (HoLEP)

a technique that cuts away the prostate bloodlessly. The tissue is then cut into tiny pieces and removed from the bladder by suction.

Hormone-relapsed prostate cancer

prostate cancer that has responded initially to hormone therapy but is beginning to grow again with a consequent rise in PSA values.

Hormones

usually described as ‘chemical messengers’, these substances can influence processes at different sites in the body. Testosterone is a well-known hormone that influences many aspects of ‘maleness’.

Hormone therapy

the use of drugs to block the stimulatory effects of testosterone on the growth of prostate tissue. Technically, orchidectomy can also be described as hormone therapy, as the testicles are removed so that testosterone is no longer produced.

Immunotherapy

Provenge (sipuleucel-T) therapy involves taking the patient’s white blood cells and treating them to make them attack prostate cancer cells. It is not available in the UK at the time of writing.

Impotence (or erectile dysfunction)

a state in which a rigid erection cannot be achieved and/or maintained.

Intensity modulated radiotherapy (IMRT)

a type of radiotherapy that can target high doses of radiation to a very specific area of the body thereby reducing the dose of radiation to normal tissues nearby.

Laser prostatectomy

a new technique to treat obstruction due to BPH that involves almost no blood loss.

LHRH analogues

drugs used in hormone therapy for prostate cancer. They work by switching off testosterone production. LHRH stands for ‘luteinizing hormone releasing hormone’.

LHRH antagonist

another type of drug used in hormone therapy. An LHRH antagonist blocks the production of testosterone without producing the temporary surge in male hormone production at the beginning of treatment that can occur with LHRH analogues.

LUTS

lower urinary tract symptoms. The term used to describe the range of symptoms associated with BPH.

Lymphatic system

a network of vessels that drain fluid (lymph) from the body’s organs so that it can be filtered and returned to the blood. It also works as part of the immune system.

Lymph nodes

these occur at intervals throughout the lymphatic system and act as filters, so cells such as cancer cells tend to accumulate at these points. A well-known example of the lymph nodes (or ‘glands’) lie in the neck just below the jaw; these tend to become swollen during flu-type illnesses.

Malignant

refers to unregulated tissue growth that has developed the ability to invade surrounding healthy tissue.

Maximal androgen blockade

the use of LHRH analogues and long-term anti-androgens to help slow the progression of prostate cancer.

Metastases

deposits of cancer distant from the site of the original cancer. A cancer has the ability to metastasize when cells can break off from the primary tumour and establish secondary tumours at other sites.

MRI

a means of building up a three-dimensional picture of the body using magnetic fields. MRI stands for ‘magnetic resonance imaging’.

Oncologist

a doctor who specializes in the medical treatment of cancer.

Open prostatectomy

an operation for BPH that involves removing the central part of the prostate. Access is gained via an incision through the abdominal wall.

Orchidectomy

an operation for prostate cancer in which both testicles are removed from the scrotum so that testosterone production ceases.

Palliative care

this becomes important in the later stages of cancer where the aim of the medical team is to make the patient pain-free and as comfortable as possible.

Pathologist

a doctor who examines tissue samples microscopically to obtain information to help with diagnosis and treatment.

PCA3

prostate cancer antigen 3. A genetic marker for prostate cancer found in the urine after vigorous massage of the prostate gland.

Pelvic pain syndrome

a state in which pain apparently comes from the prostate or surrounding area but there does not appear to be any inflammation or infection.

Perineum

the area around and between the scrotum and anus.

Peripheral zone

the part of the prostate gland in which prostate cancer usually starts to develop. It is also the part that usually becomes inflamed in prostatitis.

Phytotherapy

the use of plant extracts to combat illness, such as BPH.

PIN (prostatic intraepithelial neoplasia)

the earliest stage in uncontrolled cell growth. It is not cancer, but can be a forerunner to it.

Plasma button prostatectomy

a new form of prostate operation for BPH. The tissue is vaporized rather than cut away (resected), which reduced bleeding.

Prostatodynia

a state in which pain apparently comes from the prostate or surrounding area but there does not appear to be any inflammation or infection.

PSA (prostate-specific antigen)

a substance made in the prostate gland that helps to liquefy the jelly-like sperm. If the prostate tissue becomes damaged or disrupted, as is particularly the case with prostate cancer, PSA leaks out into the bloodstream. As a consequence, blood levels of PSA tend to be higher among men with prostate cancer. A normal PSA value is usually taken as being below 4 ng/mL (‘nanograms per millilitre’), but cancer can be present when values are lower than this. Conversely, a raised PSA is not always indicative of cancer.

Radical prostatectomy

an operation for prostate cancer in which the prostate, seminal vesicles and a sample of some nearby lymph nodes are removed. It is an option in fit men and only when the urologist believes that the cancer is still confined to the prostate.

Radiotherapy

the use of radiation to kill cancer cells. With external-beam radiotherapy, the radiation is generated from an external source and focused onto the area of the prostate. See also ‘Brachytherapy’.

Recurrence

when the cancer begins to grow again after a period of dormancy.

Retrograde ejaculation

this occurs following some types of surgery on the prostate. Instead of semen passing out through the penis during orgasm, it passes into the bladder, from which it passes out of the body when the man urinates.

Risk factor

a personal characteristic that increases the likelihood of getting a certain disease. The effect of a modifiable risk factor, such as a high-fat diet or smoking, can be reduced or overcome, in contrast to a non-modifiable risk factor such as belonging to an older age group or having a first-degree relative with the disease.

Robotic radical prostatectomy

a new way of performing a laparoscopic radical prostatectomy that employs the da Vinci robot, which offers ten times magnification and three-dimensional vision, enabling very precise dissection of the prostate and preservation of the cavernous nerves.

Scrotum

the sac containing the testicles.

Seminal vesicles

storage vessels for sperm. They lie just behind the prostate and may be affected by prostate cancer as it spreads.

Staging system

a method used to assess and describe how far the cancer has spread. The tumour nodes metastases (TNM) system is commonly used in the UK.

Testicles (or testes)

glands that make sperm and testosterone.

Testosterone

the androgen hormone responsible for the development of many male characteristics. It has a role in stimulating growth of prostate tissue, so some of the drugs for prostate cancer and BPH work by disrupting its production or effect.

Tissue

a collection of cells organized into a structure that performs a specific function.

Transition zone

the part of the prostate in which BPH usually develops.

TRUS (transrectal ultrasonography)

an ultrasound method that allows the prostate to be seen. It involves inserting a lubricated ultrasound probe into the rectum, and is often used during brachytherapy and biopsy procedures so that the radiotherapist or doctor can see the exact position of the patient’s prostate.

TUIP (transurethral incision of the prostate)

an operation for BPH in which small nicks are made in the neck of the bladder and in the prostate to relieve the pressure on the urethra.

TURP (transurethral resection of the prostate)

an operation for BPH in which the middle of the enlarged prostate is cut away piecemeal using an instrument inserted up through the penis.

Ultrasound

a method of forming images using high-frequency sound waves.

Ureter

one of two tubes that carry urine from the kidney to the bladder.

Urethra

the tube that runs from the bladder to the tip of the penis, through which urine passes out from the body.

Urodynamics

a test to check how the bladder is functioning and whether the urine flow is blocked. It involves passing a fluid that will show up on scanning of the bladder (via a catheter) and then recording the movement of this fluid while the patient urinates.

Uroflowmetry (urine flow test)

a test to measure the speed of urine output over time. It involves the patient passing urine into a specialized receptacle called a flow meter.

Urologist

a doctor who has specialized in disorders affecting the kidney, bladder and, in men, the prostate.

Vas deferens

a tube that carries sperm from the testis to the prostate gland.

Vasopressin analogues

drugs that may be prescribed to reduce the need to pass urine at night.

Watchful waiting

this involves delaying treatment until symptoms develop. The follow-up is less intense than that with active surveillance.