1. health and fitness
2. disease
3. cancer

GE Healthcare
TiP-TV™ Training in Partnership
Program Supplement and Test
for Imaging Professionals
US: Men’s Health
Publication Date: August 5, 2004
Revised/Reissued: August 12, 2005
Revised/Reissued: August 12, 2006
Revised/Reissued: January 20, 2011
1.0 ASRT-approved Category A CE Credit
imagination at work
GE Healthcare
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TABLE OF CONTENTS
Program Summary .......................................................................................................................................................................3
Continuing Education Credit and Video File Download................................................................................................4
Testicular Cancer ..........................................................................................................................................................................5
Testicular Cancer...................................................................................................................................................................6
Testicular Cancer Testing...................................................................................................................................................7
Imaging......................................................................................................................................................................................8
Testicular Cancer Treatment ............................................................................................................................................9
Images..................................................................................................................................................................................... 10
Prostate Cancer.......................................................................................................................................................................... 12
Prostate Anatomy............................................................................................................................................................... 12
Prostate Diseases ............................................................................................................................................................... 13
Prostate Testing .................................................................................................................................................................. 14
Prostate Cancer Treatment............................................................................................................................................ 16
Appendix A: Lance Armstrong Foundation ............................................................................................................................ 18
Appendix B: Men’s Health Guidelines ....................................................................................................................................... 19
Appendix C: "Think Again" Answers ........................................................................................................................................... 23
Appendix D: Resources .................................................................................................................................................................... 23
Appendix E: Presenter Biographies ............................................................................................................................................ 24
Appendix F: Post-Test ....................................................................................................................................................................... 25
ICON LEARNING SYSTEMS NETTER IMAGE COPYRIGHT
Electronic files of Images created by Dr. Frank H. Netter or Images created in the style established by Dr. Frank
H. Netter from The Netter Collection of Medical Illustrations. Some graphics may have been adapted with
permission from the publisher, Icon Learning Systems.
Copyright 2004. Icon Learning Systems, LLC. A division of MediMedia USA, Inc. All rights reserved.
ICON LEARNING SYSTEMS NETTER IMAGE DISCLAIMER
The Netter images included in this program supplement were licensed from Icon Learning Systems for
illustration and educational purposes only. These images should not be used for diagnostic or clinical
purposes or for the treatment of any medical condition. There is no guarantee that these images do not
contain errors, incomplete, or out of date information.
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Program Summary
This page provides an overview of the program content and learning objectives. Please refer to the Table of
Contents for a detailed list of the topics covered. We encourage you to file a copy of this Program Summary
and the Table of Contents with your continuing education certificate. We also recommend you provide your
manager with a copy of this information as a record of your educational achievement.
Program Description
Often left undiagnosed due to fear and embarrassment, many of the men's health concerns that
sonographers deal with progress without detection. In 2003, the American Cancer Society estimated that
more than 220,000 new cases of prostate cancer and about 7,600 new cases of testicular cancer would be
diagnosed in the United States. This program looks at the latest in imaging technology and the advancements
in treatment of these and other diseases.
Program Objectives
By the end of this program, the viewer should be able to:
•
Review normal prostate and testicular anatomy.
•
Describe the etiology of prostate and testicular cancer.
•
Discuss what role ultrasound plays in the evaluation of male specific diseases.
•
Identify the different stages of prostate and testicular cancer through ultrasound imaging.
•
Discuss treatments of male specific cancer and other medical conditions.
Target Audience
Course objectives for this program specifically target diagnostic medical sonographers. While not limited to
this audience group, the technical content is most effective when applied to people with this training.
NOTE: Regardless of your imaging specialty, you may apply for continuing education credit. Refer to the
Continuing Education Credit page for additional information.
Continuing Education Credit
1.0 ASRT-approved Category A CE Credit
NOTE: Effective February 1, 2005, the ARDMS accepts credits for ASRT-approved CE activities. ARDMS
registrants may claim ASRT-approved Category A credit to meet their CE requirements. For more
information, visit: www.ardms.org
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Continuing Education Credit and Video File Download
Online Process for CE Credit (hls.gehealthcare.com)
In order to receive continuing education credit, you must log into the GE Healthcare Learning System (HLS)
and complete all of the required steps. Please refer to the online TiP-TV Quick Start User Guide (click the User
Guides link on the HLS Welcome page) for additional information on how to use the GE HLS as needed.
1. View the entire program video online or download the video file for later viewing (refer to the process
below). This supplement is not intended to replace watching the video.
2. Go to the GE HLS web site at hls.gehealthcare.com and complete the feedback form.
 NOTE: The Feedback Form link is not activated until the View Video Now module has been completed.
 This provides valuable information regarding your thoughts on the program’s quality and effectiveness.
3. Complete the program post-test without aids or assistance of any kind; this is an individual effort.
 You have up to three attempts to successfully complete the test with a minimum passing score of
75% (ASRT and CBRN approved programs) or 80% (SNM-approved programs).
 The post-test measures knowledge gained and/or provides a self-assessment on a specific topic.
4. Upon successful completion of the online CE information, you can instantly print a certificate.
Video Download Process
For programs with an original start date of September 1, 2008 or later, the GE HLS includes an option to
download the TiP-TV program video file. You can then watch the program on your personal computer or
transfer the video file to your portable video player for viewing.
NOTE: Please refer to the TiP-TV Video Download Quick Start Guide for complete details (click the User Guides
link on the GE HLS Welcome page).
1. With the desired program in your GE HLS Learning Plan, launch the program content to view the Online
Content Structure. In the Video Download (Optional) area, click the Download Video to View Later link.
2. Save the video file on your personal computer, using your existing video download software.
3. View the program on your personal computer or transfer it to your portable video player for later viewing.
4. After viewing the entire program, log into the HLS and complete the CE activities as noted above.
Continuing Education Credit Eligibility — Important Notice!
A GE Healthcare TiP-TV course may be available in several different formats, such as an online web course or
CD/DVD. You may be able to receive CE credit only once for a particular course, regardless of the format in
which it was viewed. If you have already received credit for a course, you are encouraged to contact your CE
certification organization (ARRT, NMTCB, ARDMS, CBRN, etc.) to determine if you can repeat this course for
CE credit.
Thank you for choosing GE Healthcare as your continuing education partner. We hope you will
join us for other TiP-TV programs in the future. For more details and program schedule
information, please visit our education web site (www.gehealthcare.com/education).
Please forward any questions or comments to: geeducation@ge.com
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Testicular Cancer
"Testicular cancer, if diagnosed early and treated appropriately, can be cured in the vast
majority of cases. Depending on the extent of the tumor and the type of the tumor at
presentation, upwards of 98% of young men can be rendered long-term cures with this tumor.
So, it is important to make the appropriate diagnosis as early as possible and institute the
appropriate therapy. Now, how do we do that? I think one of the really important components
of the healthcare team is the sonographer."
– Dr. William See
As the male sex glands, the testicles are the main source of the hormone testosterone in men and are
responsible for the production of sperm – between 50 to 100 million sperm per milliliter (ml) of semen. The
testicles or testes reside within several layers of connective and supporting tissues of the scrotum. Sensitive to
body temperature, the muscle tissue within the scrotum allows for the testicles to be closer or farther away
from the core temperature of the body. They need to maintain a 3 to 5 degree lower temperature for effective
sperm production. Sperm quantity and quality can be adversely affected by an increase in temperature of
only a few degrees.
Emerging from each testicle is a series of tightly coiled tubules and ducts that carry sperm (Figure 1). After
meiosis in the seminiferous tubules, which produces about 1,500 sperm per second per testicle, it takes about
70 days for sperm to mature in the testicles. When semi motile, they then travel about 20 days through the
epididymis, which is about 6 meters in length, to continue their maturity for several more days. The vas
deferens or ductus deferens transport the sperm to be stored in the seminal vesicles posterior to the bladder
and prostate.
Figure 1 Coronal Section of Testicle and Ducts
Vas deferens
Efferent
ductules
Rete testis
Aberrant ductule
{ Head
Epididymis
Body
Tail
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Septa
Tunica
albuginea
Lobules
(seminiferous
tubules)
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Testicular Cancer
The American Cancer Society (ACS) estimates that about 8,980 new
cases of testicular cancer will be diagnosed in the United States in
2004. Of those cases, the ACS estimates that 360 men will die of
testicular cancer, which is 24.9% of those diagnosed. Testicular cancer
can occur in males from the late teens through the mid 50s (years of
age). Risk factors include: cryptorchidism, Klinefelter’s syndrome,
personal history, and family history.
There are different types of cells within the testes:
•
Germ cells
•
Stroma cells
Each type may develop into a different form of cancer. More than 90%
of testicular cancers develop in certain germ cells, the cells that are
responsible for producing sperm. Germ cell tumors (GCT) can be either
seminomas or nonseminomas.
RISK FACTORS FOR
TESTICULAR CANCER
•
Cryptorchidism:
Undescended testicle(s).
•
Klinefelter’s syndrome: A
genetic disorder caused by
an extra X chromosome.
•
Personal history: History of
previous testicular cancer.
•
Family history: Having a
brother or father with
testicular cancer.
Seminomas
Seminomas occur in men in the age range of 35 to 55 years, grow slowly, and tend not to metastasize. Stroma
cells, found in supportive and hormone-producing tissues of the testes, may form tumors referred to as
gonadal stromal tumors. Stroma tumors may often be benign if localized to the testes. If they do metastasize
elsewhere in the body, they tend to be resistant to radiation and chemotherapy treatment.
Stroma tumors are composed of two types of cells:
•
Leydig cells, which are responsible for producing the male hormone androgen and can produce the
female hormone estrogen.
•
Sertoli cells, which nourish the sperm-producing germ cells.
Stroma tumors tend to stay within the testes as they grow, but in rare cases can metastasize and can be
resistant to treatment other than surgery.
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Nonseminomas
Nonseminomas occur in younger men in the age range of late teens to late 30s and early 40s, and include the
faster spreading forms of testicular cancer. These tumors grow in an arrangement resembling a human
embryo with rounded sacs and layered outer membranes. Metastases of these types of tumors tend to spread
to the lungs, bone, and brain.
Table 1 Types and Characteristics of Nonseminomas
Nonseminoma
Characteristics
Embryonal carcinomas
Rapid-growing and can spread
Yolk sac carcinomas
Most common in young boys
Choriocarcinomas
Aggressive but rare
Teratomas
Comprised of three layers
Mature teratomas
Less likely to spread
Immature teratomas
Can spread and relapse
Teratomas with malignant transformation
Resemble tumors found elsewhere in the body
Secondary Testicular Tumors
A cancer that starts in another part of the body and then spreads to the testicles is referred to as a secondary
testicular tumor. The most common secondary testicular cancer is lymphoma. Lymphoma is more common
than primary testicular cancer types among men older than age 50.
Testicular Cancer Testing
During a consultation, the physician obtains a patient history and performs a physical examination that
includes the testicles and the abdomen. Part of the diagnosis is to rule out conditions that are not testicular
cancer, but may present with similar symptoms.
The following need to be ruled out during the initial examination:
•
Epididymitis (inflammation or infection of the surface of the epididymis).
•
Hydrocele (an accumulation of fluid in the testicle).
•
Lymphoma (cancer of the lymphatic system).
•
Spermatocele (a cyst on the surface of the testicle that contains sperm).
•
Varicocele (enlarged veins in the testicle).
•
Testicular torsion (twisting of the testicle).
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"Epididymitis is the most common cause of an intrascrotal mass lesion in the testicular cancer
age group. Now, epididymitis means an infection or an inflammation of the epididymis, which
is a structure adjacent to the testicle. In the face of that inflammation, there's some edema,
some swelling, often some tenderness, and it's difficult under those circumstances to get a
truly accurate examination. The patient may be sensitive.
"At the same time, epididymitis is the most common misdiagnosis for patients that, in fact,
have an underlying testicular tumor. In that the ultrasonographer can distinguish a testicular
process from a paratesticular process, in other words something in the testicle vs. something
in the epididymis, it is really crucial to the appropriate treatment of that patient. The treatment
for epididymitis is antibiotics and the treatment for testicular cancer, at the first cut, is perhaps
the surgical removal of the testis, and then chemotherapy or radiation or second surgery. So,
there are two very different treatments driven by a clear understanding of what the disease
process is that’s, in fact, being treated and was found by ultrasound."
- Dr. William See
Blood Tests
In diagnosing testicular cancer, a blood test can be ordered to look for traces of tumor markers. Blood tests
for tumor markers are usually not the sole means of diagnosis. Some cancer types do not generate tumor
makers and the blood tests may be accompanied by an ultrasound exam.
The following is a list of potential findings:
•
Proteins (alpha-feta protein levels can be raised by nonseminomas).
•
Hormones (human chorionic gonadotropin levels can be raised by seminomas and nonseminomas).
•
Enzymes (lactate dehydrogenase levels can be raised by advanced seminomas and nonseminomas).
THINK AGAIN...
How long does it take sperm to travel through the maze of ducts and tubules before it is mixed
with seminal fluid? ___________________________________________________________
What is the age range for patients with nonseminoma testicular cancer? __________________
Name the two types of cells in which seminoma tumors form. 1) ___________ 2) ___________
See Appendix C for answers.
Imaging
The importance of the ultrasound exam is to confirm physical examination findings and to establish the
intratesticular location of suspected scrotal lesions that cannot be determined by a physical exam.
Ultrasound is considered an extension of physical examination. Ultrasound evaluation of the testicles should
find normal sized, smoothly contoured, and homogeneously echo-textured testicles. Each testis and
epididymis should be examined in the transverse and longitudinal planes. Color Doppler can be used to
determine vascularity in the testes as well as within the vas deferens.
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When intratesticular neoplasm is suspected after physical examination, ultrasound can be used to
differentiate the lesion as intra- or extratesticular. Sonographic findings in the testicles are nonspecific and
require histologic examination of removed tissue (see "Orchiectomy" in the Testicular Cancer Treatment
section of this supplement).
Ultrasound is often the modality of choice to help diagnose the following testicular conditions:
•
Evaluation of scrotal masses.
•
Measurement of testicular size/volume.
•
Evaluation of scrotal pain or trauma.
•
Evaluation of testicular neoplasm.
•
Follow-up of patients with prior testicular neoplasm, leukemia, or lymphoma.
•
Assessment of testicular/epididymal infection and follow-up.
•
Searching for undescended testes.
Testicular Cancer Treatment
Orchiectomy
The removal of a testicle is often the only treatment of testicular cancer. Even if there is only suspicion of
malignant cells, the removal of the testicle will most likely be the decision of the doctor and the patient. Biopsy
of the testicles is generally not performed, as a precaution to keep potential malignant cells from spreading,
and the testicle needs to be removed if there are positive findings.
Certain portions of the surrounding lymph nodes may also be removed near the bladder or in the abdomen
during this procedure. A sperm sample is saved in advance and a prosthetic testicle may be implanted to
replace the removed anatomy. The removed testicle is then examined by a pathologist for malignancy. An
orchiectomy is also sometimes referred to as an "orchidectomy."
Chemotherapy
Chemotherapy may be an option if cancer cells have spread to the lymphatic system. It may also be offered
after any tumor removal surgery to kill any residual cancerous tissue.
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Images
Figure 2 Spermatocele in Scrotum
A firm, smooth, well-circumcised mass of the scrotum, a
spermatocele is a benign cystic accumulation of sperm. It
is often found in the head of the epididymis, the posterior
lateral border of the testicle.
Spermatoceles must be differentiated from hydroceles,
varicoceles, epididymal cysts, and other scrotal masses
during a physical exam. The location of the mass is a good
indicator of what the mass actually is. The mass can be
imaged well with ultrasound, but the only way to
differentiate a spermatocele from an epididymal cyst is to
aspirate and identify the presence of sperm.
Figure 3 Hydrocele
Hydroceles are located superior
and anterior to the testicles. They
are a collection of serous fluid that
results from a defect or irritation in
the tunica vaginalis of the scrotum.
Adult-onset hydrocele may be
secondary to orchitis or
epididymitis and may be due to
testicular torsion. Germ cell tumors
or tumors of the testicular adnexa
may also cause a hydrocele.
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Figure 4 Testicular Neoplasm
This ultrasound of the scrotum shows an
intratesticular mass. Typically, the diagnoses for
a solid intratesticular mass in a young patient
include seminoma and germ cell tumors. No
calcifications are visible.
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Prostate Cancer
"Ultrasonography plays a role in the care of the prostate cancer patient from diagnosis
through, in some circumstances, treatment… In both brachytherapy and cryosurgery, good
imaging and real-time ultrasonography are critical to the successful treatment within these
two modalities."
- Dr. William See
Prostate Anatomy
Located in the pelvic cavity and inferior to the
bladder and posterior to the pubic bone, the
prostate is about the size of a walnut and
surrounds the urethra. Its function is involved in
the reproductive process of ejaculation; the
prostate gland produces seminal fluid and is the
entry point for sperm that have been stored in the
seminal vesicles through the ejaculatory ducts.
While it functions as a gland, it is comprised of
about one-third muscle tissue that contracts
during ejaculation.
Figure 5 Coronal Section of Prostate
Bladder
Prostate
Ejaculatory
duct
Urethra
Penis
The Prostate
•
Produces seminal fluid.
•
Composed of gland and muscle tissue.
•
Adjacent to the rectum.
•
Surrounds the urethra.
The prostate is not involved in normal
urination function. Muscle tissue in the
bladder controls the flow of normal urination.
Figure 6 Sagittal Plane of Prostate and Pelvic Region
Pelvic bone
Bladder
Urethra
Seminal
vesicle
Prostate
Rectum
Ejaculatory
duct
Penis
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Prostate Diseases
Prostate Cancer
Prostate cancer typically begins as abnormal gland cell growth
contained within the glandular body as prostatic intraepithelial
neoplasia (PIN) and then may advance into an adenocarcinoma. The
American Cancer Society estimates that 230,900 men will be diagnosed
with prostate cancer in 2004, and 29,900 men will actually die from it. In
other words, close to 13% of those diagnosed with prostate cancer do
in fact die from it. Lung cancer fatalities are the only form of
cancer-caused death higher than prostate cancer.
Autopsies have shown that a large portion of elderly men who had died
from other causes also had some stage of prostate cancer with no
apparent symptoms. Prostate cancer can grow very slowly in some
men, but it can also grow quite rapidly in others. Many men in their 70s
and 80s who are diagnosed with early stages of prostate cancer may
not require any radical treatment because they may not live as long as
it would take for the cancer to reach its end stages. The primary risk
factors include: age, race, nationality, diet, inactivity, and family history.
Prostatitis
RISK FACTORS FOR
PROSTATE CANCER
•
Age: 1 in 6 men eventually
gets prostate cancer in his
lifetime.
•
Race: African-American
men.
•
Nationality: North America
and northwestern Europe.
•
Diet: Diets high in red
meats or fatty dairy foods
and low in fruits,
vegetables, soy, and
grains.
•
Inactivity: Low levels of
exercise and being
overweight.
•
Family history: Father,
brother, and/or uncle with
history of prostate cancer.
Prostatitis is an acute or chronic bacterial inflammation of the prostate
gland. It may also be caused by nonbacterial inflammation, but the cause is difficult to diagnose. Indications
of prostatitis include pelvic, perineal, lower abdominal, and testicular pain.
BPH AND AGE
•
More than half of men over
the age of 50 years develop
benign prostatic
hyperplasia.
•
By the age of 80, about 80%
of men have BPH.
•
However, only 40% to 50%
of men actually develop any
symptoms due to their BPH.
Benign Prostatic Hyperplasia (BPH)
Commonly known as an "enlarged prostate," benign prostatic
hyperplasia is a noncancerous growth of prostate tissue. While BPH is
not a precursor to prostate cancer, it can occur parallel with malignant
growth. BPH may exhibit similar symptoms to prostate cancer. The
chance of developing BPH increases with age.
A typical symptom of BPH is complications with urination. As the
prostate expands, it interferes with the normal flow of urine through the
urethra. This causes the patient to strain to empty his bladder or have
to urinate more frequently.
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Prostatic Abscess
Although rare, due in part to strong antibiotics used to treat other illnesses, abscess of the prostate may still
be found in some human immunodeficiency virus (HIV) positive patients. Other risk factors include:
•
Diabetes mellitus
•
Urethral treatment procedures
•
Catheterization
•
Prostatitis
•
Men between 50 and 60 years old
•
BPH
•
Bladder neck obstruction
•
Urine tract infection along prostatic ducts
Notes:
Prostate Testing
Prostate Specific Antigen (PSA)
TYPES OF PSA TESTS
•
Percent free-PSA ratio:
Compares the amount of
unbound PSA in the blood
by itself with the bound PSA
amount that is attached to
other blood proteins.
•
Age-specific PSA reference
range: A PSA range
compared to the results of
men in the same age group.
•
PSA density: Determined by
dividing the PSA level by the
volume of the prostate. This
test is in conjunction with a
transrectal ultrasound
exam to obtain the volume
of the prostate.
•
PSA velocity: Measures how
quickly the PSA rises over a
period of time, usually over
several months.
Produced by both normal and cancerous prostate cells, prostate
specific antigen can be detected in the blood. PSA in the blood often
increases when prostate cancer grows or when other prostate
diseases are present, such as benign prostatic hyperplasia and
prostatitis, an inflammation of the prostate.
The normal range for a PSA test is generally between 0 and 4
nanograms per milliliter (ng/ml). If the results are in the high range,
greater than 10 ng/ml, then a biopsy may be required to accurately
diagnose prostate cancer. Depending on the situation, any of four
types of PSA tests can be used in the diagnostic process.
Digital Rectal Examination (DRE)
During a DRE, the doctor inserts a lubricated, gloved finger into the
patient's rectum to feel for lumps, enlargements, irregularities, or areas
of hardness that might be consistent with prostate cancer. Most of the
prostate can be examined during a DRE, including the area where most
prostate cancers are found, but not the entire gland. It is typical to have
a PSA test along with a DRE.
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Gleason Scoring System
This common prostate cancer scoring or grading system assigns numbers to cancerous prostate tissue and is
performed on malignant biopsy samples. The Gleason grades range from 1 through 5, comparing how the
cancer cells resemble normal prostate cells for the patient. If the cancerous cells resemble the normal
prostate tissue very closely and are well-differentiated, they get a Gleason of 1.
On the other end of the scale, a Gleason grade of 5 indicates that the cells appear fairly irregular and different
from the normal prostate cells, are poorly differentiated, and are considered fast-growing. Two grades are
assigned to the most commonly appearing patterns of representative cells and are then added together to
determine the Gleason score ranging from 2 to 10.
BIOPSY IN CONJUNCTION WITH PSA AND DRE
The PSA and DRE cannot diagnose prostate cancer alone. Abnormal results of a PSA or DRE only
indicate that further testing is needed and the doctor may order a biopsy.
A biopsy is a procedure in which the doctor uses a transrectal ultrasound transducer to scan and guide
a needle into the prostate to take small samples of tissue from several areas. These tissues are then
examined histologically for the presence of malignant cells and to establish a Gleason score.
Transrectal Ultrasound (TRUS)
With the prostate located adjacent to the rectum, transrectal ultrasound is an efficient way to image the
prostate gland. Volume measurements can be obtained that are then applied in the Gleason scoring method.
Transrectal ultrasound is also used as a biopsy needle guide. Typically, the transducer is in the 4 to 10
megahertz (MHz) frequency range.
THINK AGAIN...
What structure does the prostate completely surround? ______________________________
What is the typical age of men who have prostate cancer? __________________________
How life-threatening is BPH? _____________________________________________________
Which PSA test also needs a transrectal ultrasound examination? _____________________
See Appendix C for answers.
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Prostate Cancer Treatment
Transurethral Resection of the Prostate (TURP)
A surgical procedure used to treat the constricting results of BPH, transurethral resection of the prostate
removes part of the prostate gland surrounding the urethra. An electrical wire loop tool is passed into the
penis and through the urethra to the location of the prostate gland. The wire is electrified to cut the tissue. A
biopsy sample of the prostate tissue removed during TURP is then examined for malignancy.
Radical Prostatectomy
Radical prostatectomy is a surgical procedure performed to remove the entire cancerous prostate gland. This
procedure is effective when the malignant tumor is localized near the prostate gland and has not
metastasized to other areas of the body. The seminal vesicles and the vas deferens are then reattached to
maintain normal function.
Focused Pulse Ultrasound
French researchers recently conducted
a study on the effects of a few seconds
of concentrated ultrasound to obliterate
a tumor – without invasive surgery. Their
study showed less collateral damage
from the procedure and reduced nerve
damage side effects, such as impotency
and incontinence.
© 2004 General Electric Company. All rights reserved.
FOCUSED PULSE ULTRASOUND TRIAL RESULTS
A recent trial of 243 prostate cancer patients showed that use of
focused pulse ultrasound to treat prostate tumors resulted in:
•
An 80% success rate in eradicating tumors.
•
Half the incidence of impotence typically associated with
surgical removal.
•
Three times less incontinence when compared to surgical
removal.
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Hormone Therapy
Testosterone is an androgen sex hormone produced by
the testicles and, to a lesser extent, in the adrenal glands.
Testosterone encourages the growth of prostate tumors.
Suppression of this hormone through hormonal therapy
can control localized prostate cancer tumors and help in
disease management of growth to other areas of the
body.
Hormone therapy is not a cure, however, and only can
benefit patients for a few years. Hormone therapy may be
prescribed before (or after) other treatment options, such
as radiotherapy, to shrink the tumor so there is less area
to be treated.
Both pituitary down-regulators and anti-androgens are
used in hormone therapy. Each type of hormone
treatment has its own side effects, length of use, and
result expectations.
Chemotherapy
Anti-cancer drugs to kill cancer cells are typically not the
primary therapy for prostate cancer, especially for the
earlier stages. They may be effective if the tumor has
spread beyond the prostate gland or in combination with
other therapies. Chemotherapy may slow down the
growth of spreading tumors, but it has had limited success
treating advanced stages of prostate cancer.
Program Supplement and Test
PRIMARY TYPES OF HORMONE
THERAPY
The primary types of hormone therapy are
pituitary down-regulators and
anti-androgens.
•
Pituitary down-regulators work by
forcing the pituitary gland in the brain
to stop signaling the testes from
producing testosterone.
•
Anti-androgens attach to receptor
proteins on the surface of cancer cells
in the prostate and block testosterone
from entering and encouraging
malignant cell growth.
Applying both of these hormonal therapies
for advanced disease treatment is
considered a complete androgen blockade
(CAB).
Another means of hormone therapy is
removing the testicles altogether by a
bilateral orchiectomy (see "Orchiectomy" in
the Testicular Cancer Treatment section of
this supplement). With the testicles
removed, the majority of testosterone
production is eliminated. Anti-androgen
hormonal therapy may also be combined
with an orchiectomy.
Radiotherapy
Radiotherapy, or radiation therapy, for prostate cancer is given by external beam radiation that is applied
daily for 4 to 6 weeks. Hormonal therapy may be prescribed to reduce the tumor size before radiotherapy is
administered. There is a moderate rate of impotence as a side effect. There is a high rate of success for the
first 10 years after treatment.
Brachytherapy
Brachytherapy is the insertion of small radioactive pellet implants right into the prostate tumor mass. It has
been as effective as conventional radiotherapy. One advantage over other radiotherapy is that a higher
radiation dose can be administered with less adverse effects, and the patient does not need the typical daily
radiation therapy for 4 to 6 weeks. There is still a moderate rate of impotence as a side effect.
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Appendix A: Lance Armstrong Foundation
Reproduced with permission from the Lance Armstrong Foundation (LAF); all content is from the LAF web
site: www.laf.org
Lance Armstrong’s Story
"Before cancer I just lived. Now I live strong."
-- Lance Armstrong
At age 25, Lance Armstrong was one of the world's best cyclists. He proved it by
winning the World Championships, the Tour Du Pont, and multiple Tour de France
stages. Lance Armstrong seemed invincible, and the future ahead was bright indeed.
Then they told him he had cancer.
Next to the challenge he now faced, bike racing seemed insignificant. The diagnosis
was testicular cancer, the most common cancer in men aged 15 to 35 years. If detected early, its cure rate is
a promising 90%. Like most young, healthy men, Lance ignored the warning signs, and never imagined the
seriousness of his condition. Going untreated, the cancer had spread to Lance's abdomen, lungs, and brain.
His chances dimmed.
Then, with a combination of physical conditioning and a strong support system, Lance's competitive spirit
took over. He declared himself not a cancer victim, but a cancer survivor hell bent on living strong. He took an
active role in educating himself about his disease and the treatment. Armed with knowledge and confidence
in medicine, he underwent aggressive treatment and beat the disease.
During treatment, before his recovery, before he even knew his own fate, he created the Lance Armstrong
Foundation. This marked the beginning of Lance Armstrong's life as a leader for cancer survivors and a world
representative for the cancer community.
Although Lance Armstrong's victories in the 1999–2003 Tours de France are sweet, the battle against cancer
has just begun – not just for him – but for all cancer survivors and people just like him who think cancer could
not affect them. Lance Armstrong plans to lead this fight, and he hopes that you join him. This is a life he owes
to cancer. This is a choice to live strong.
Facts about Lance's Cancer Diagnosis and Treatment
•
Lance was diagnosed with an aggressive form of testicular cancer, containing 60% choriocarcinoma, 40%
embryonal and less than 1% teratoma.
•
Lance's treatment lasted from October to December 1996.
•
Lance underwent two surgeries, one to remove his cancerous testicle and another to remove two
cancerous lesions on his brain.
•
Lance received one round of BEP (Bleomycin, Etoposide and Platinol) chemotherapy, followed by three
rounds of VIP chemotherapy (Ifostamide, Etoposide and Platinol.)
•
Lance's cancer in the lungs and brain was a result of spreading from the original testicular cancer. As a
result, his treatment protocols were to combat that specific strain of cancer. Different cancers originating
from different sources in the body will likely require other treatments than the one described above for
Lance.
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Lance was treated at Indiana University Medical Center by Drs. Larry Einhorn and Craig Nichols. (Dr.
Einhorn can be reached at the Indiana University Medical Center at 317/274-8157; Dr. Nichols at the
Oregon Cancer Center at 503/494-8311.)
The Lance Armstrong Foundation
The Lance Armstrong Foundation (LAF) believes that in your battle with cancer, knowledge is power and
attitude is everything. Founded in 1997 by cancer survivor and cycling champion Lance Armstrong, the LAF
provides the practical information and tools people living with cancer need to live strong. We serve our
mission through four core program areas:
•
Education – The LAF informs cancer patients, health care professionals and the public about the physical,
emotional and practical issues that people face in their battle with cancer. We provide the information and
resources people need to live strong.
•
Advocacy – The LAF represents people living with cancer on Capitol Hill. We are increasing awareness,
encouraging the government to take action, and addressing the health policy concerns of people battling
cancer and their families.
•
Public Health – The LAF plans, develops and funds programs that provide after-treatment support and
services for people living with cancer and their families.
•
Research – The LAF supports scientific and clinical research that seeks to better understand cancer's
physical, emotional and practical effects, and the challenge of living with the disease.
Today there are nearly 10 million people living with cancer. Through these four program areas, LAF provides
the practical information and tools that people need to battle cancer and live strong.
The Lance Armstrong Foundation is a registered 501(c)(3) nonprofit organization located in Austin, Texas.
Appendix B: Men’s Health Guidelines
Men: Stay Healthy at Any Age
Checklist for Your Next Checkup
What can you do to stay healthy and prevent disease? You can get certain screening tests, take preventive
medicine if you need it, and practice healthy behaviors.
Top health experts from the U.S. Preventive Services Task Force suggest that when you go for your next
checkup, talk to your doctor or nurse about how you can stay healthy no matter what your age.
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Screening Tests: What You Need and When
Screening tests, such as colorectal cancer tests, can find diseases early when they are easier to treat. Some
men need certain screening tests earlier, or more often, than others. Talk to your doctor about which of the
tests listed below are right for you, when you should have them, and how often. The Task Force has made the
following recommendations, based on scientific evidence, about which screening tests you should have.
•
Cholesterol Checks: Have your cholesterol checked at least every 5 years, starting at age 35. If you smoke,
have diabetes, or if heart disease runs in your family, start having your cholesterol checked at age 20.
•
Blood Pressure: Have your blood pressure checked at least every 2 years.
•
Colorectal Cancer Tests: Begin regular screening for colorectal cancer starting at age 50. Your doctor can
help you decide which test is right for you. How often you need to be tested will depend on which test you
have.
•
Diabetes Tests: Have a test to screen for diabetes if you have high blood pressure or high cholesterol.
•
Depression: If you've felt "down," sad, or hopeless, and have felt little interest or pleasure in doing things
for 2 weeks straight, talk to your doctor about whether he or she can screen you for depression.
•
Sexually Transmitted Diseases: Talk to your doctor to see whether you should be screened for sexually
transmitted diseases, such as human immunodeficiency virus (HIV).
•
Prostate Cancer Screening: Talk to your doctor about the possible benefits and harms of prostate cancer
screening if you are considering having a prostate specific antigen (PSA) test or digital rectal examination
(DRE).
Should You Take Medicines to Prevent Disease?
•
Aspirin: Talk to your doctor about taking aspirin to prevent heart disease if you are older than 40, or if you
are younger than 40 and have high blood pressure, high cholesterol, diabetes, or if you smoke.
•
Immunizations: Stay up-to-date with your immunizations:
•
Have a flu shot every year starting at age 50.
•
Have a tetanus-diphtheria shot every 10 years.
•
Have a pneumonia shot once at age 65 (you may need it earlier if you have certain health problems, such
as lung disease).
•
Talk to your doctor to see whether you need hepatitis B shots.
What Else Can You Do To Stay Healthy?
Don't Smoke. But if you do smoke, talk to your doctor about quitting. You can take medicine and get
counseling to help you quit. Make a plan and set a quit date. Tell your family, friends, and co-workers you are
quitting. Ask for their support.
Eat a Healthy Diet. Eat a variety of foods, including fruit, vegetables, animal or vegetable protein (such as
meat, fish, chicken, eggs, beans, lentils, tofu, or tempeh) and grains (such as rice). Limit the amount of
saturated fat you eat.
Be Physically Active. Walk, dance, ride a bike, rake leaves, or do any other physical activity you enjoy. Start
small and work up to a total of 20–30 minutes most days of the week.
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Stay at a Healthy Weight. Balance the number of calories you eat with the number you burn off by your
activities. Remember to watch portion sizes. Talk to your doctor if you have questions about what or how
much to eat.
Drink Alcohol Only in Moderation. If you drink alcohol, have no more than 2 drinks a day. A standard drink is
one 12-ounce bottle of beer or wine cooler, one 5-ounce glass of wine, or 1.5 ounces of 80-proof distilled
spirits.
Screening Test Checklist
Take this checklist with you to your doctor's office and fill it out when you have had any of the tests listed
below. Talk to your doctor about when you should have these tests next, and note the month and year in the
right-hand column.
Also, talk to your doctor about which of the other tests listed below you should have in the future and when
you need them.
The last time I had the following
screening test was: (mm/yy)
I should schedule my next test
for: (mm/yy)
Cholesterol
Blood pressure
Colorectal cancer
Sexually transmitted
diseases
Prostate cancer
More Information
For more information on staying healthy, order the following free publications in the Put Prevention Into
Practice (PPIP) program from the Agency for Healthcare Research and Quality (call the AHRQ Publications
Clearinghouse at 1-800-358-9295), or find them at: www.ahrq.gov/clinic/ppipix.htm
More copies of this fact sheet, Men: Stay Healthy at Any Age – Checklist for Your Next Checkup (in English and
Spanish), Publication Nos. APPIP 03-0011 and APPIP 03-0013, February 2004.
The Pocket Guide to Good Health for Adults (in English and Spanish), Publication Nos. APPIP 03-0001 and
APPIP 03-0010, May 2003.
The Pocket Guide to Staying Healthy at 50+ (in English and Spanish), Publication Nos. AHRQ 04-IP001-A and
AHRQ 04-IP001-B, January 2000. Revised November 2003.
The information in this fact sheet is based on research from the U.S. Department of Health and Human
Services (HHS) and the U.S. Preventive Services Task Force (USPSTF), the leading independent panel of
private-sector experts in prevention and primary care. The Task Force conducts rigorous scientific
assessments of the effectiveness of a broad range of clinical preventive services. Its recommendations are
considered the "gold standard" for preventive services delivered in the clinical setting. Additional details about
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the recommendations can be obtained from the U.S. Department of Health and Human Services Agency for
Healthcare Research and Quality U.S. Preventive Services Task Force Web site
(www.ahrq.gov/clinic/uspstfix.htm) or by calling the AHRQ Publications Clearinghouse (1-800-358-9295).
The Put Prevention Into Practice (PPIP) program of the Agency for Healthcare Research and Quality is designed
to increase the appropriate use of clinical preventive services, such as screening tests, chemoprevention and
immunizations, and counseling. The PPIP program is based on the recommendations of the U.S. Preventive
Services Task Force. PPIP tools and resources enable doctors and other health care providers to determine
which preventive services their patients should receive and make it easier for patients to understand and
keep track of their preventive care.
U.S. Department of Health and Human Services
Agency for Healthcare Research and Quality
AHRQ Publication No. APPIP 03-0011
Current as of February 2004
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Appendix C: "Think Again" Answers
THINK AGAIN... (Page 8)
Q: How long does it take sperm to travel through the maze of ducts and tubules before it is mixed with seminal
fluid?
A: About 100 days
Q: What is the age range for patients with nonseminoma testicular cancer?
A: Between 18 and 50 years old
Q: Name the two types of cells in which seminoma tumors form.
A: 1) Germ 2) Stroma
THINK AGAIN... (Page 15)
Q: What structure does the prostate completely surround?
A: The urethra
Q: What is the typical age of men who have prostate cancer?
A: Between 70 and 80 years old
Q: How life-threatening is BPH?
A: Benign prostate hyperplasia is non life-threatening
Q: Which PSA test also needs a transrectal ultrasound examination?
A: PSA density
Appendix D: Resources
American Cancer Society, Inc. http://www.cancer.org © 2004
AstraZeneca Pharmaceuticals LP. http://www.prostateinfo.com 12/03. © 2004
Chapelon, Jean-Yves. "Ultrasound is kinder prostate cancer treatment." French Institute of Health and Medical
Research in Paris. NewScientist.com 2/16/04. © Reed Business Information Ltd.
Healthcommunities.com, Inc. http://www.oncologychannel.com 3/09/2004. © 2004
University of Pittsburgh Medical Center. http://www.upmccancercenters.com 10/2/03. © 2004
NOTE: The Internet is an ever-evolving environment and links are subject to change without notice.
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Appendix E: Presenter Biographies
William A. See, M.D. – Chairman of the Department of Urology, Medical College of Wisconsin, Milwaukee
Dr. See was recently appointed as Chairman of the new Department of Urology at the Medical College of
Wisconsin in Milwaukee, where he has been a professor of urology since 1999. He also serves as Chief of
Urology at the Froedtert Memorial Lutheran Hospital in Milwaukee.
He earned a bachelor’s of arts from Coe College, Iowa, graduating magna cum laude. His medical degree is
from the Pritzker School of Medicine at the University of Chicago, where he graduated cum laude.
Dr. See served his residencies at the University of Washington School of Medicine, Seattle, Washington, in the
Department of Surgery and Department of Urology. He served as Chief Resident of the Department of Urology
in 1987.
Dr. See is a nationally known cancer researcher and clinical expert in genitourinary cancer and urology. He is
currently the principal investigator in several ongoing research studies and sits on numerous university and
national committees.
Andrew Stonefield – GE Healthcare Ultrasound TiP-TV Program Manager
Andrew worked as a registered vascular sonographer with Medicalab, Inc. throughout New England and
acquired diverse experience in imaging technology and techniques. Following that position, he worked as an
applications consultant for MEDITECH, Inc., where he was responsible for the training of several hospital
teams in the United States and Canada in integrated radiology department software.
Andrew joined GE Healthcare as a contractor in 2000 and worked with the ultrasound marketing team
producing web content for various ultrasound products and service technical training programs. In 2002, he
became the Program Manager of Clinical Ultrasound TiP-TV programs and related eLearning products. In
addition, he has responsibility for product offerings for the GEMS IT, OEC, and Lunar businesses.
Andrew earned a bachelor’s degree in biology from Coastal Carolina University and is currently working on a
Master of Business Administration degree at the Keller Graduate School of Management. He has earned both
Telly and Communicator awards in broadcasting.
Special Contributor
Cindy Owen
Ultrasound Consultant/Vascular Specialist
Memphis, Tennessee
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Appendix F: Post-Test
US: Men’s Health
LMS Course Number: 2725
To be eligible for CE credit, you MUST view the video presentation first. Then complete the post-test on the GE
Healthcare Learning System (hls.gehealthcare.com) by the due date listed online.
1. Testicular cancer affects only older men.
a. True
b. False
2. The scrotal anatomy includes all of the following, EXCEPT _____.
a. gland tissue
b. muscle tissue
c. ducts and tubules
d. corpus cavernosum
3. The two types of testicular tissue cells that can form tumors are _____ and _____.
a. germ; stroma
b. squamous; ganglion
c. prostatic; hepatic
d. pelvic; penile
4. One of the major risk factors for testicular cancer is _____.
a. trauma
b. cryptorchidism
c. history of prostate cancer
d. incontinence
5. Ultrasound imaging is ideal in the diagnosis of testicular cancer because _____.
a. it is the gold standard in differentiating between benign and malignant tumors
b. it can establish the intratesticular location of suspected scrotal lesions that cannot be determined by a
physical exam
c. the exam is complete in only a few seconds
d. the prostate can also be scanned with the same probe while the patient is on the examining table
6. Epididymitis is _____.
a. an inflammation of the epididymis within the scrotum
b. a cancerous growth in the lymphatic system
c. fluid collection within the scrotum
d. an enlargement of the veins in the testicle
7. All of the following are possible treatment decisions a patient can make when diagnosed with prostate
cancer, EXCEPT _____.
a. do nothing and watch for worsening symptoms
b. receive brachytherapy
c. undergo a radical prostatectomy
d. get a vasectomy
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8. Biopsy of the testicles is NOT typically practiced because _____.
a. the patient would experience severe pain
b. there are no benign conditions, so the testicles have to be removed anyway
c. there is a concern about any malignant cells seeding surrounding lymph nodes and other tissues
d. biopsy studies cannot differentiate between benign and malignant testicular cells
9. The prostate surrounds which anatomical structure?
a. Ureter
b. Urethra
c. Vas deferens
d. Epididymis
10. The prostate is about the size of a _____.
a. kidney
b. grape
c. walnut
d. grapefruit
11. Muscle tissue in the _____ controls the flow of normal urination.
a. prostate
b. abdominal wall
c. pelvic floor
d. bladder
12. The function of the prostate includes all of the following, EXCEPT _____.
a. produces seminal fluid
b. contracts during ejaculation
c. facilitates normal urination
d. connects the seminal vesicles to the urethra
13. Benign prostatic hyperplasia (BPH) is a precursor to prostate cancer.
a. True
b. False
14. What is the leading risk factor for prostate cancer?
a. Alcohol abuse
b. Smoking
c. History of testicular cancer
d. Age
15. What is the major physical complication caused by BPH?
a. sterility
b. increased production of testosterone
c. difficulty urinating
d. impotence
16. Which of the following is NOT considered a primary risk factor for prostate cancer?
a. history of STD
b. age
c. race
d. inactivity
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17. Symptoms of _____ include pelvic, perineal, lower abdominal, and testicular pain.
a. prostatitis
b. renal calculi
c. BPH
d. early prostate cancer
18. Which prostate specific antigen (PSA) calculation incorporates an ultrasound volume measurement?
a. Percent free-PSA ratio
b. PSA velocity
c. Age-specific PSA reference range
d. PSA density
19. The principle hormone that promotes prostate tumor growth is _____.
a. testosterone
b. estrogen
c. adrenaline
d. melatonin
20. _____ cancer is the most common cancer in men aged 15 to 35 years.
a. Prostate
b. Male breast
c. Testicular
d. Bladder
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