Studying a Masters in Public Health

Studying a Masters in Public Health

Public health degrees are generally taught with an international overview, focusing on the various ways in which public health professionals have become indispensable worldwide. Often this work overlaps national borders, as public health leaders and researchers develop methods to prevent disease, develop reforms, and promote health and well-being.

Public health degrees offer students the chance to gain an in-depth understanding of the complex and varied nature of public health issues affecting people today. This opens up opportunities to enter public health careers focused on making real differences to people’s quality – and length – of life. If you have a passion for public health and want to help reduce health risks worldwide, this could be the degree for you.

Many public health degrees are focused on equipping students with quantitative analytical skills, while maintaining an interdisciplinary focus. The subject often overlaps with other subjects, including sociology, psychology, economics, statistics, and politics/international relations.

Masters in Public Health degrees are typically offered as either MPH or MSc qualifications, and may be one or two years long depending on which country you study in. They are often structured with a combination of core modules and optional modules, allowing for specialization.

Read Further: https://www.topuniversities.com/courses/medicine-related-studies/grad/guide

Description Of Public Health Studies

Description Of Public Health Studies

Public health deals with the health of the community and aims to prevent diseases through organised actions, information resources and education efforts. It deals with physical and mental health, social well-being improvement, particularly in these areas such as waste disposal, water supply, food safety or water pollution. Public health degrees cover multidisciplinary approaches teaching biostatistics, health services and epidemiology. It also deals with these sub-fields: community health, behavioural health, health of economics, occupational health public policy and environmental health.

Graduates of Bachelors and Masters in public health will acquire skills that involve management for different strategies like: strategies for health promotion and protection, strategies for disease prevention and more. Students have to be able to realize a complete analysis regarding a public health issue, they have to know to make proper recommendations for a public health policy or a public health program development.

Career paths after graduating Public Health discipline include: health department administration, public nursing, public health communication, public health planning, emergency coordination, epidemiology, pharmaceuticals, and others.

Breast cancer: Symptoms, risk factors, and treatment

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Breast cancer: Symptoms, risk factors, and treatment

By Christian Nordqvist

An early diagnosis of breast cancer increases the chance of recovery.

Breast cancer is the most common invasive cancer in women, and the second main cause of cancer death in women, after lung cancer.

Advances in screening and treatment have improved survival rates dramatically since 1989. There are around 3.1 million breast cancer survivors in the United States (U.S.). The chance of any woman dying from breast cancer is around 1 in 37, or 2.7 percent.

In 2017, around 252, 710 new diagnoses of breast cancer are expected in women, and around 40,610 women are likely to die from the disease.

Awareness of the symptoms and the need for screening are important ways of reducing the risk.

Breast cancer can affect men too, but this article will focus on breast cancer in women.

Contents of this article:

What is breast cancer?
Symptoms
10 risk factors
Diagnosis
Treatment
Prevention and outlook

Fast facts on breast cancer:

• Here are some key points about breast cancer. More detail is in the main article.
• Breast cancer is the most common cancer among women.
• Symptoms include a lump or thickening of the breast, and changes to the skin or the nipple.
• Risk factors can be genetic, but some lifestyle factors, such as alcohol intake, make it more likely to happen.
• A range of treatments is available, including surgery, radiation therapy, and chemotherapy.
• Many breast lumps are not cancerous, but any woman who is concerned about a lump or change should see a doctor.

What is breast cancer?
After puberty, a woman's breast consists of fat, connective tissue, and thousands of lobules, tiny glands that produce milk for breast-feeding. Tiny tubes, or ducts, carry the milk toward the nipple.

In cancer, the body's cells multiply uncontrollably. It is the excessive cell growth that causes cancer.

Breast cancer can be:

Ductal carcinoma: This begins in the milk duct and is the most common type.
Lobular carcinoma: This starts in the lobules.
Invasive breast cancer is when the cancer cells break out from inside the lobules or ducts and invade nearby tissue, increasing the chance of spreading to other parts of the body.

Non-invasive breast cancer is when the cancer is still inside its place of origin and has not broken out. However, these cells can eventually develop into invasive breast cancer.


Symptoms
The first symptoms of breast cancer are usually an area of thickened tissue in the breast, or a lump in the breast or in an armpit.

Other symptoms include:

a pain in the armpits or breast that does not change with the monthly cycle
pitting or redness of the skin of the breast, like the skin of an orange
a rash around or on one of the nipples
a discharge from a nipple, possibly containing blood
a sunken or inverted nipple
a change in the size or shape of the breast
peeling, flaking, or scaling of the skin on the breast or nipple
Most lumps are not cancerous, but women should have them checked by a health care professional.

10 risk factors
Breast cancer usually starts in the inner lining of milk ducts or the lobules that supply them with milk. From there, it can spread to other parts of the body.

The exact cause remains unclear, but some risk factors make it more likely. Some of these are preventable.

1. Age

The risk increases with age. At 20 years, the chance of developing breast cancer in the next decade is 0.6 percent. By the age of 70 years, this figure goes up to 3.84 percent.

2. Genetics

If a close relative has or has had, breast cancer, the risk is higher.

Women who carry the BRCA1 and BRCA2 genes have a higher risk of developing breast cancer, ovarian cancer or both. These genes can be inherited. TP53 is another gene that is linked to a greater breast cancer risk.

3. A history of breast cancer or breast lumps

Women who have had breast cancer before are more likely to have it again, compared with those who have no history of the disease.

Having some types of benign, or non-cancerous breast lumps increases the chance of developing cancer later on. Examples include atypical ductal hyperplasia or lobular carcinoma in situ.

4. Dense breast tissue

Breast cancer is more likely to develop in higher density breast tissue.

5. Estrogen exposure and breast-feeding

Being exposed to estrogen for a longer period appears to increase the risk of breast cancer.

This could be due to starting periods earlier or entering menopause later than average. Between these times, estrogen levels are higher.

Breast-feeding, especially for over 1 year, appears to reduce the chance of developing breast cancer, possibly because pregnancy followed by breastfeeding reduces exposure to estrogen.

6. Body weight

Women who are overweight or have obesity after menopause may have a higher risk of developing breast cancer, possibly due to higher levels of estrogen. High sugar intake may also be a factor.

7. Alcohol consumption

A higher rate of regular alcohol consumption appears to play a role. Studies have shown that women who consume more than 3 drinks a day have a 1.5 times higher risk.

8. Radiation exposure

Undergoing radiation treatment for a cancer that is not breast cancer increases the risk of breast cancer later in life.

9. Hormone treatments

The use of hormone replacement therapy (HRT) and oral birth control pills have been linked to breast cancer, due to increased levels of estrogen.

10. Occupational hazards

In 2012, researchers concluded that exposure to certain carcinogens and endocrine disruptors, for example in the workplace, could be linked to breast cancer.

In 2007, scientists suggested that working night shifts could increase the risk of breast cancer, but more recent research concludes this is unlikely.

Cosmetic implants and breast cancer survival

Women with cosmetic breast implants who are diagnosed with breast cancer have a higher risk of dying from the disease and a 25 percent higher chance of being diagnosed at a later stage, compared with women without implants.

This could be due to due to the implants masking cancer during screening, or because the implants bring about changes in breast tissue. More research is needed.


Diagnosis
A diagnosis often occurs as the result of routine screening, or when a woman approaches her doctor after detecting symptoms.

Some diagnostic tests and procedures help to confirm a diagnosis.

Breast exam

The physician will check the patient's breasts for lumps and other symptoms.

The patient will be asked to sit or stand with her arms in different positions, such as above her head and by her sides.

Imaging tests

A mammogram is a type of x-ray commonly used for initial breast cancer screening. It produces images that can help detect any lumps or abnormalities.

A suspicious result can be followed up by further diagnosis. However, mammography sometimes shows up a suspicious area that is not cancer. This can lead to unnecessary stress and sometimes interventions.

An ultrasound scan can help differentiate between a solid mass or a fluid-filled cyst.

An MRI scan involves injecting a dye into the patient, so find out how far the cancer has spread.

Biopsy

A sample of tissue is surgically removed for laboratory analysis. This can show whether the cells are cancerous, and, if so, which type of cancer it is, including whether or not the cancer is hormone-sensitive.

Diagnosis also involves staging the cancer, to establish:

• the size of a tumor
• how far it has spread
• whether it is invasive or non-invasive
• whether it has metastasized, or spread to other parts of the body
• Staging will affect the chances of recovery and will help decide on the best treatment options.

Treatment
Treatment will depend on:

• Chemotherapy can be an option for breast cancer.
• Chemotherapy can be an option for breast cancer.
• the type of breast cancer
• the stage of the cancer
• sensitivity to hormones
• the patient's age, overall health, and preferences

The main options include:

• radiation therapy
• surgery
• biological therapy, or targeted drug therapy
• hormone therapy
• chemotherapy
• Factors affecting the choice will include the stage of the cancer, other medical conditions, and individual preference.

Surgery

If surgery is needed, the choice will depend on the diagnosis and the individual.

Lumpectomy: Removing the tumor and a small margin of healthy tissue around it can help prevent the spread of the cancer. This may be an option if the tumor is small and likely to be easy to separate from the surrounding tissue.

Mastectomy: Simple mastectomy involves removing the lobules, ducts, fatty tissue, nipple, areola, and some skin. Radical mastectomy removes muscle from the chest wall and the lymph nodes in the armpit as well.

Sentinel node biopsy: Removing one lymph node can stop the cancer spreading, because if breast cancer reaches a lymph node, it can spread further through the lymphatic system into other parts of the body.

Axillary lymph node dissection: If there are cancer cells on a node called the sentinel node, the surgeon may recommend removing several nymph nodes in the armpit to prevent the spread of disease.

Reconstruction: Following breast surgery, reconstruction can recreate the breast so that it looks similar to the other breast. This can be done at the same time as a mastectomy, or at a later date. The surgeon may use a breast implant, or tissue from another part of the patient's body.

Radiation therapy

Controlled doses of radiation are targeted at the tumor to destroy the cancer cells. Used from around a month after surgery, along with chemotherapy, it can kill any remaining cancer cells.

Each session lasts a few minutes, and the patient may need three to five sessions per week for 3 to 6 weeks, depending on the aim and the extent of the cancer.

The type of breast cancer will dictate what type of radiation therapy, if any, is most suitable.

Adverse effects include fatigue, lymphedema, darkening of the breast skin, and irritation of the breast skin.

Chemotherapy

Medications known as cytotoxic drugs may be used to kill cancer cells, if there is a high risk of recurrence or spread. This is called adjuvant chemotherapy.

If the tumor is large, chemotherapy may be administered before surgery to shrink the tumor and make its removal easier. This is called neo-adjuvant chemotherapy.

Chemotherapy can also treat cancer that has metastasized, or spread to other parts of the body, and it can reduce some symptoms, especially in the later stages.

It may be used to reduce estrogen production, as estrogen can encourage the growth of some breast cancers.

Adverse effects include nausea, vomiting, loss of appetite, fatigue, sore mouth, hair loss, and a slightly higher susceptibility to infections. Medications can help control many of these.

Hormone blocking therapy

Hormone blocking therapy is used to prevent recurrence in hormone-sensitive breast cancers. These are often referred to as estrogen receptive (ER) positive and progesterone receptor (PR) positive cancers.

Hormone blocking therapy is normally used after surgery, but it may sometimes be used beforehand to shrink the tumor.

It may be the only option for patients who cannot undergo surgery, chemotherapy, or radiotherapy.

The effects normally last for up to 5 years after surgery. The treatment will have no effect on cancers that are not sensitive to hormones.

Examples include:

• tamoxifen
• aromatase inhibitors
• ovarian ablation or suppression
• a luteinising hormone-releasing hormone agonist (LHRHa) drug called Goserelin, to suppress the ovaries
• Hormone treatment may affect a woman's future fertility.

Biological treatment

Targeted drugs destroy specific types of breast cancer. Examples include trastuzumab (Herceptin), lapatinib (Tykerb), and bevacizumab (Avastin). These drugs are all used for different purposes.

Treatments for breast and other cancers can have severe adverse effects.

The patient should discuss with a doctor the risks involved and ways to minimize the negative effects, when deciding on treatment.


Prevention and outlook
There is no sure way to prevent breast cancer, but some lifestyle decisions can significantly reduce the risk of breast and other types of cancer.

These include:

avoiding excess alcohol consumption
following a healthy diet with plenty of fresh fruit and vegetables
getting enough exercise
maintaining a healthy body mass index (BMI)
Women should think carefully about their options for breast-feeding and the use of HRT following menopause, as these can affect the risk.

Preventive surgery is an option for women at high risk.

Outlook

With treatment, a woman who receives a diagnosis of stage 0 or stage 1 breast cancer has an almost almost 100 percent chance of surviving for at least 5 years.

If the diagnosis is made at stage 4, the chance of surviving another 5 years is around 22 percent.

Regular checks and screening can help detect symptoms early. Women should discuss their options with a doctor.
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Source: http://www.medicalnewstoday.com/articles/37136.php

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Understanding Prostate Changes: A Health Guide for Men

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“This information helped me to talk with my doctor about prostate changes and conditions.”

You may be having prostate problems and want to learn more about prostate cancer symptoms and risk factors, the PSA screening test, and conditions that are not cancer such as an enlarged prostate (BPH) and prostatitis.

You may want to print out this booklet. The PDF has practical lists, tips, and medical images to help you learn more and talk with your doctor.

ON THIS PAGE

• About the Prostate
• Prostate Changes That Are Not Cancer
• Prostate Cancer
• Tests Used to Check the Prostate
• Talking With Your Doctor

About the Prostate

ENLARGE

The prostate is a small gland in men. It is part of the male reproductive system. The prostate is about the size and shape of a walnut. It sits low in the pelvis, below the bladder and just in front of the rectum. The prostate helps make semen, the milky fluid that carries sperm from the testicles through the penis when a man ejaculates. The prostate surrounds part of the urethra, a tube that carries urine out of the bladder and through the penis.

How the Prostate Changes As You Age

Because the prostate gland tends to grow larger with age, it may squeeze the urethra and cause problems in passing urine. Sometimes men in their 30s and 40s may begin to have these urinary symptoms and need medical attention. For others, symptoms aren't noticed until much later in life. An infection or a tumor can also make the prostate larger. Be sure to tell your doctor if you have any of the urinary symptoms listed below.

Tell your doctor if you have these urinary symptoms:

• Are passing urine more during the day
• Have an urgent need to pass urine
• Have less urine flow
• Feel burning when you pass urine
• Need to get up many times during the night to pass urine

Growing older raises your risk of prostate problems. The three most common prostate problems are inflammation (prostatitis), enlarged prostate (BPH, or benign prostatic hyperplasia), and prostate cancer.

One change does not lead to another. For example, having prostatitis or an enlarged prostate does not increase your risk of prostate cancer. It is also possible for you to have more than one condition at the same time.

Prostate Changes That Are Not Cancer

Prostatitis

Prostatitis is an inflammation of the prostate gland that may result from a bacterial infection. It affects at least half of all men at some time during their lives. Having this condition does not increase your risk of any other prostate disease.

Symptoms of prostatitis

• Trouble passing urine
• A burning or stinging feeling or pain when passing urine
• Strong, frequent urge to pass urine, even when there is only a small amount of urine
• Chills and high fever
• Low back pain or body aches
• Pain low in the belly, groin, or behind the scrotum
• Rectal pressure or pain
• Urethral discharge with bowel movements
• Genital and rectal throbbing
• Sexual problems and loss of sex drive
• Painful ejaculation (sexual climax)

Several tests, such as DRE and a urine test, can be done to see if you have prostatitis. Correct diagnosis of your exact type of prostatitis is key to getting the best treatment. Even if you have no symptoms you should follow your doctor's advice to complete treatment.

Types of Prostatitis and Treatments

• Acute bacterial prostatitis: This type is caused by a bacterial infection and comes on suddenly (acute). Symptoms include severe chills and fever. There is often blood in the urine. Your PSA level (see PSA test) may be higher than normal. You must go to the doctor's office or emergency room for treatment. It's the least common of the four types, yet it's the easiest to diagnose and treat.
  Most cases can be cured with a high dose of antibiotics, taken for 7 to 14 days, and then lower doses for several weeks. You may also need drugs to help with pain or discomfort. If your PSA level was high, it will likely return to normal once the infection is cleared up.
• Chronic bacterial prostatitis: Also caused by bacteria, this type of prostatitis doesn't come on suddenly, but it can be bothersome. The only symptom you may have is bladder infections that keep coming back. The cause may be a defect in the prostate that lets bacteria collect in the urinary tract.
  Antibiotic treatment over a longer period of time is best for this type. Treatment lasts from 4 to 12 weeks. This type of treatment clears up about 60 percent of cases. Long-term, low-dose antibiotics may help relieve symptoms in cases that won't clear up.
• Chronic prostatitis or chronic pelvic pain syndrome: This disorder is the most common but least understood type of prostatitis. Found in men of any age from late teens to the elderly, its symptoms can come and go without warning. There can be pain or discomfort in the groin or bladder area. Infection-fighting cells are often present, even though no bacteria can be found.
  There are several different treatments for this problem, based on your symptoms. These include anti-inflammatory medications and other pain control treatments, such as warm baths. Other medicines, such as alpha-blockers, may also be given. Alpha-blockers relax muscle tissue in the prostate to make passing urine easier. Some men are treated with antibiotics in case the symptoms are caused by an undetected infection.
• Asymptomatic inflammatory prostatitis: You don't have symptoms with this condition. It is often found when you are undergoing tests for other conditions, such as to determine the cause of infertility or to look for prostate cancer. If you have this form of prostatitis, your PSA test may show a higher number than normal.
  Men with this condition are usually not treated, but a repeat PSA test will usually be done if the PSA number is high.

Enlarged Prostate (BPH)

BPH stands for benign prostatic hyperplasia. Benign means "not cancer," and hyperplasiameans abnormal cell growth. The result is that the prostate becomes enlarged. BPH is not linked to cancer and does not increase your risk of getting prostate cancer—yet the symptoms for BPH and prostate cancer can be similar.

ENLARGE

Urine flow in a normal (left) and enlarged (right) prostate. In diagram on the left, urine flows freely. On the right, urine flow is affected because the enlarged prostate is pressing on the bladder and urethra.

Symptoms of BPH

• Trouble starting a urine stream or making more than a dribble
• Passing urine often, especially at night
• Feeling that the bladder has not fully emptied
• A strong or sudden urge to pass urine
• Weak or slow urine stream
• Stopping and starting again several times while passing urine
• Pushing or straining to begin passing urine

At its worst, BPH can lead to: a weak bladder, backflow of urine causing bladder or kidneyinfections, complete block in the flow of urine and kidney failure.

The prostate gland is about the size of a walnut when a man is in his 20s. By the time he is 40, it may have grown slightly larger, to the size of an apricot. By age 60, it may be the size of a lemon. The enlarged prostate can press against the bladder and the urethra. This can slow down or block urine flow. Some men might find it hard to start a urine stream, even though they feel the need to go. Once the urine stream has started, it may be hard to stop. Other men may feel like they need to pass urine all the time, or they are awakened during sleep with the sudden need to pass urine. Early BPH symptoms take many years to turn into bothersome problems. These early symptoms are a cue to see your doctor.

Treatments for BPH

Some men with BPH eventually find their symptoms to be bothersome enough to need treatment. BPH cannot be cured, but drugs or surgery can often relieve its symptoms. Talk with your doctor about the best choice for you. Your symptoms may change over time, so be sure to tell your doctor about any new changes.

Watchful waiting

Men with mild symptoms of BPH who do not find them bothersome often choose this approach. Watchful waiting means getting annual checkups. Treatment is started only if symptoms become too much of a problem.

If you choose watchful waiting, these simple steps may help lessen your symptoms:

• Limit drinking in the evening, especially drinks with alcohol or caffeine.
• Empty your bladder all the way when you pass urine.
• Use the restroom often. Don't wait for long periods without passing urine.

Some medications can make BPH symptoms worse, so talk with your doctor or pharmacist about any medicines you are taking such as:

• Over-the-counter cold and cough medicines (especially antihistamines)
• Tranquilizers
• Antidepressants
• Blood pressure medicine.

Drug Therapy

Many American men with mild to moderate BPH symptoms have chosen prescriptiondrugs over surgery since the early 1990s. Two main types of drugs are used. One type relaxes muscles near the prostate, and the other type shrinks the prostate gland. Some evidence shows that taking both drugs together may work best to keep BPH symptoms from getting worse.

• Alpha-blockers are drugs that help relax muscles near the prostate to relieve pressure and let urine flow more freely, but they don't shrink the size of the prostate. For many men, these drugs can improve urine flow and reduce the symptoms of BPH within days. Possible side effects include dizziness, headache, and fatigue.
• 5 alpha-reductase inhibitors are drugs that help shrink the prostate. They relieve symptoms by blocking the activity of an enzyme known as 5-alpha reductase. This enzyme changes the male hormone testosterone into dihydrotestosterone (DHT), which stimulates prostate growth. When the action of 5-alpha reductase is blocked, DHT production is lowered and prostate growth slows. This helps shrink the prostate, reduce blockage, and limit the need for surgery.

Taking these drugs can help increase urine flow and reduce your symptoms. You must continue to take these drugs to prevent symptoms from coming back. 5-alpha reductase inhibitors can cause the following side effects in a small percentage of men including: decreased interest in sex, trouble getting or keeping an erection, and smaller amount of semen with ejaculation.

It's important to note that taking these drugs may lower your PSA test number. There is also evidence that these drugs lower the risk of getting prostate cancer, but whether they can help lower the risk of dying from prostate cancer is still unclear.

Surgery

The number of prostate surgeries has gone down over the years. But operations for BPH are still among the most common surgeries for American men. Surgery is used when symptoms are severe or drug therapy has not worked well. Be sure to discuss options with your doctor and ask about the potential short- and long-term benefits and risks with each procedure.

Types of surgery for BPH include:

• TURP (transurethral resection of the prostate). The most common surgery for BPH, TURP accounts for 90 percent of all BPH surgeries. The doctor passes an instrument through the urethra and trims away extra prostate tissue. A spinal block (anesthesia) is used to numb the area. Tissue is sent to the laboratory to check for prostate cancer. TURP generally avoids the two main dangers linked to another type of surgery called open prostatectomy (complete removal of the prostate gland through a cut in the lower abdomen): including incontinence and/or impotence. However, TURP can have serious side effects, such as bleeding. In addition, men may have to stay in the hospital and need a catheter for a few days after surgery.
• TUIP (transurethral incision of the prostate). This surgery, which is similar to TURP, is used on slightly enlarged prostate glands. The surgeon places one or two small cuts in the prostate. This relieves pressure without trimming away tissue. It has a low risk of side effects. Like TURP, this treatment helps with urine flow by widening the urethra.
• TUNA (transurethral needle ablation). Radio waves are used to burn away excess prostate tissue. TUNA helps with urine flow, relieves symptoms, and may have fewer side effects than TURP. Most men need a catheter to drain urine for a period of time after the procedure.
• TUMT (transurethral microwave thermotherapy). Microwaves sent through a catheter are used to destroy excess prostate tissue. This can be an option for men who should not have major surgery because they have other medical problems.
• TUVP (transurethral electroevaporation of the prostate). An electrical current is used to vaporize prostate tissue.
• Laser surgery. The doctor passes a laser fiber through the urethra into the prostate, using a cystoscope, and then delivers several bursts of laser energy. The laser energy destroys prostate tissue and helps improve urine flow. Like TURP, laser surgery requires anesthesia. One advantage of laser surgery over TURP is that laser surgery causes little blood loss. The recovery period for laser surgery may be shorter too. However, laser surgery may not be effective on larger prostates.
• Open prostatectomy. This may be the only option in rare cases, such as when the obstruction is severe, the prostate is very large, or other procedures can't be done. General anesthesia or a spinal block is used, and a catheter remains for 3 to 7 days after the surgery. This surgery carries the highest risk of complications. Tissue is sent to the laboratory to check for prostate cancer.

Prostate Cancer

Prostate cancer means that cancer cells form in the tissues of the prostate. Prostate cancer tends to grow slowly compared with most other cancers. Cell changes may begin 10, 20, or even 30 years before a tumor gets big enough to cause symptoms. Eventually, cancer cells may spread (metastasize). By the time symptoms appear, the cancer may already be advanced.

By age 50, very few men have symptoms of prostate cancer, yet some precancerous or cancer cells may be present. More than half of all American men have some cancer in their prostate glands by the age of 80. Most of these cancers never pose a problem. They may never cause symptoms or become a serious threat to health.

Symptoms of Prostate Cancer

• Trouble passing urine
• Frequent urge to pass urine, especially at night
• Weak or interrupted urine stream
• Pain or burning when passing urine
• Blood in the urine or semen
• Painful ejaculation
• Nagging pain in the back, hips, or pelvis

Prostate cancer can spread to the lymph nodes of the pelvis. Or it may spread throughout the body. It tends to spread to the bones. So bone pain, especially in the back, can be a symptom of advanced prostate cancer.

Risk Factors For Prostate Cancer

Some risk factors have been linked to prostate cancer. A risk factor is something that can raise your chance of developing a disease. Having one or more risk factors doesn't mean that you will get prostate cancer. It just means that your risk of the disease is greater.

• Age. Men who are 50 or older have a higher risk of prostate cancer.
• Race. African-American men have the highest risk of prostate cancer—the disease tends to start at younger ages and grows faster than in men of other races. After African-American men, prostate cancer is most common among white men, followed by Hispanic and Native American men. Asian-American men have the lowest rates of prostate cancer.
• Family history. Men whose fathers or brothers have had prostate cancer have a 2 to 3 times higher risk of prostate cancer than men who do not have a family history of the disease. A man who has 3 immediate family members with prostate cancer has about 10 times the risk of a man who does not have a family history of prostate cancer. The younger a man's relatives are when they have prostate cancer, the greater his risk for developing the disease. Prostate cancer risk also appears to be slightly higher for men from families with a history of breast cancer.
• Diet. The risk of prostate cancer may be higher for men who eat high-fat diets.

Prostate Cancer Screening

Screening means testing for cancer before you have any symptoms. A screening test may help find cancer at an early stage, when it is less likely to have spread and may be easier to treat. By the time symptoms appear, the cancer may have started to spread.

The most useful screening tests are those that have been proven to lower a person's risk of dying from cancer. Doctors do not yet know whether prostate cancer screening lowers the risk of dying from prostate cancer. Therefore, large research studies, with thousands of men, are now going on to study prostate cancer screening. The National Cancer Institute is studying the combination of PSA testing and DRE as a way to get more accurate results.

Although some people feel it is best to treat any cancer that is found, including cancers found through screening, prostate cancer treatment can cause serious and sometimes permanent side effects. Some doctors are concerned that many men whose cancer is detected by screening are being treated—and experiencing side effects—unnecessarily. Talk with your doctor about your risk of prostate cancer and your need for screening tests.

Large research studies are looking at how prostate cancer can be prevented. Studies have shown that 5-alpha reductase inhibitors finasteride and dutasteride can lower the risk of developing prostate cancer, but whether they can decrease the risk of dying of prostate cancer is still unclear.

Talk with your doctor about your risk of prostate cancer and your need for screening tests.

Tests Used to Check the Prostate

This first step lets your doctor hear and understand the "story" of your prostate concerns. You'll be asked whether you have symptoms, how long you've had them, and how much they affect your lifestyle. Your personal medical history also includes any risk factors, pain, fever, or trouble passing urine. You may be asked to give a urine sample for testing.

Digital Rectal Exam (DRE)

DRE is a standard way to check the prostate. With a gloved and lubricated finger, your doctor feels the prostate from the rectum. The test lasts about 10-15 seconds.

This exam checks for:

• The size, firmness, and texture of the prostate
• Any hard areas, lumps, or growth spreading beyond the prostate, and
• Any pain caused by touching or pressing the prostate

The DRE allows the doctor to feel only one side of the prostate. A PSA test is another way to help your doctor check the health of your prostate.

PSA (Prostate-Specific Antigen) Test

The U.S. Food and Drug Administration (FDA) has approved the use of the PSA test along with a DRE to help detect prostate cancer in men age 50 and older. PSA is a protein made by prostate cells. It is normally secreted into ducts in the prostate, where it helps make semen, but sometimes it leaks into the blood. When PSA is in the blood, it can be measured with a blood test called the PSA test. In prostate cancer, more PSA gets into the blood than is normal. However, a high PSA blood level is not proof of cancer, and many other things can cause a false-positive test result. For example, blood PSA levels are often increased in men with prostatitis or BPH. Even things that disturb the prostate gland--such as riding a bicycle or motorcycle, or having a DRE, an orgasm within the past 24 hours, a prostate biopsy, or prostate surgery--may increase PSA levels.

Also, some prostate glands naturally produce more PSA than others. PSA levels go up with age. African-American men tend to have higher PSA levels in general than men of other races. And some drugs, such as finasteride and dutasteride, can cause a man's PSA level to go down. PSA tests are often used to follow men after prostate cancer treatment to check for signs of cancer recurrence. It is not yet known for certain whether PSA testing to screen for prostate cancer can reduce a man's risk of dying from the disease.

Researchers are working to learn more about the PSA test's ability to help doctors tell the difference between prostate cancer and benign prostate problems, and the best thing to do if a man has a high PSA level. For now, men and their doctors use PSA readings over time as a guide to see if more follow-up is needed.

PSA test results

PSA levels are measured in terms of the amount of PSA per volume of fluid tested. Doctors often use a value of 4 nanograms (ng) or higher per milliliter of blood as a sign that further tests, such as a prostate biopsy, are needed. Your doctor may monitor your PSA velocity, which means the rate of change in your PSA level over time. Rapid increases in PSA readings may suggest cancer. If you have a mildly elevated PSA level, you and your doctor may choose to do PSA tests on a scheduled basis and watch for any change in the PSA velocity.

Free PSA test

This test is used for men who have higher PSA levels. The standard PSA test measures total PSA, which includes both PSA that is attached, or bound, to other proteins and PSA that is free, or not bound. The free PSA test measures free PSA only. Free PSA is linked to benign prostate conditions, such as BPH, whereas bound PSA is linked to cancer. The percentage of free PSA can help tell what kind of prostate problem you have.

• If both total PSA and free PSA are higher than normal (high percentage of free PSA), this suggests BPH rather than cancer.
• If total PSA is high but free PSA is not (low percentage of free PSA), cancer is more likely. More testing, such as a biopsy, should be done.

You and your doctor should talk about your personal risk and free PSA results. Then you can decide together whether to have follow-up biopsies and, if so, how often.

There is no magic PSA level below which a man can be assured of having no risk of prostate cancer nor above which a biopsy should automatically be performed. A man's decision to have a prostate biopsy requires a thoughtful discussion with his physician, considering not only the PSA level, but also his other risk factors, his overall health status, and how he perceives the risks and benefits of early detection.

Dr. Howard Parnes, Chief of the Prostate and Urologic Cancer Research Group, Division of Cancer Prevention, National Cancer Institute

Prostate Biopsy

If your symptoms or test results suggest prostate cancer, your doctor will refer you to a specialist (a urologist) for a prostate biopsy. For a biopsy, small tissue samples are taken directly from the prostate. Your doctor will take samples from several areas of the prostate gland. This can help lower the chance of missing any areas of the gland that may have cancer cells. Like other cancers, prostate cancer can be diagnosed only by looking at tissue under a microscope. Most men who have biopsies after prostate cancer screening exams do not have cancer.

A positive test result after a biopsy means prostate cancer is present. A pathologist will check your biopsy sample for cancer cells and will give it a Gleason score. The Gleason score ranges from 2 to 10 and describes how likely it is that a tumor will spread. The lower the number, the less aggressive the tumor is and the less likely it will spread. Treatment options depend on the stage (or extent) of the cancer (stages range from 1 to 4), Gleason score, PSA level, and your age and general health. This information will be available from your doctor and is listed on your pathology report.

Reaching a decision about treatment of your prostate cancer is a complex process. Many men find it helpful to talk with their doctors, family, friends, and other men who have faced similar decisions.

Talking With Your Doctor

Different kinds of doctors and other health care professionals manage prostate health. They can help you find the best care, answer your questions, and address your concerns. These health care professionals include:

• Family doctors and internists
• Physician assistants (PAs) and nurse practitioners (NPs)
• Urologists, who are experts in diseases of the urinary tract system and the male reproductive system
• Urologic oncologists, who are experts in treating cancers of the urinary system and the male reproductive system
• Radiation oncologists, who use radiation therapy to treat cancer
• Medical oncologists, who treat cancer with medications such as hormone treatments and chemotherapy
• Pathologists, who identify diseases by studying cells and tissues under a microscope

View these professionals as your partners—expert advisors and helpers in your health care. Talking openly with your doctors can help you learn more about your prostate changes and the tests to expect.

Questions you may want to consider asking your doctor include:

• What type of prostate problem do I have?
• Is more testing needed and what will it tell me?
• If I decide on watchful waiting, what changes in my symptoms should I look for and how often should I be tested?
• What type of treatment do you recommend for my prostate problem?
• For men like me, has this treatment worked?
• How soon would I need to start treatment and how long would it last?
• Do I need medicine and how long would I need to take it before seeing improvement in my symptoms?
• What are the side effects of the medicine?
• Are there other medicines that could interfere with this medication?
• If I need surgery, what are the benefits and risks?
• Would I have any side effects from surgery that could affect my quality of life?
• Are these side effects temporary or permanent?
• How long is recovery time after surgery?
• Will I be able to fully return to normal?
• How will this affect my sex life?
• How often should I visit the doctor to monitor my condition?

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Source: https://www.cancer.gov/types/prostate/understanding-prostate-changes