Glossary of Terms

Adjuvant Therapy

Treatment used in addition to the main treatment. It usually refers to hormone therapy, chemotherapy, or radiation added after surgery to increase the chances of curing the disease or keeping it in check.

Alpha Blocker

Drugs that relax the smooth muscle of the prostate and bladder neck. These can help relieve symptoms of BPH.

Androgen

Any male sex hormone. The major androgen is testosterone.

Androgen Deprivation

The use of drugs to disrupt the actions of male hormones. See also hormone therapy.

Benign Prostatic Hyperplasia (BPH)

Enlargement of the prostate gland. Symptoms of urination problems. Noncancerous. Symptoms can mirror those of prostate cancer.

Biopsy

The removal of a sample of tissue to see whether cancer cells are present. There are several kinds of biopsies. See also fine needle aspiration and core needle biopsy.

Boost

A supplemental amount of radiation that is used in the event of extra capsular penetration by the cancer (meaning the cancer has spread outside the gland). Boost refers to the use of external beam radiation before the seed implant to maximize the patient’s cancer treatment.

Brachytherapy

The process of permanently implanting radioactive seeds directly into the prostate gland. Radiation is achieved by use of either Iodine I-125 or Palladium Pd-103; approximately 60-120 seeds are used depending on the patient’s particular cancerous area. A physicist develops a plan or map that marks the location for each seed. The intent is to deliver radiation to a confined volume while sparing much of the adjacent normal tissue (such as the bladder and rectum). Brachytherapy is for early-stage, organ-confined cancer.

Capsule

The rim of tissue surrounding the prostate or other organs.

Chemotherapy

Treatment with drugs to destroy cancer cells.

Clinical Stage

Describes the extent of cancer present based on results of diagnostic tests and the physical examination.

Computer Tomography (T or CAT Scan)

An imaging test in which many x-ray images are taken from different angles of a part of the body. These images are combined by a computer to produce cross-sectional pictures of internal organs.

Core Oncology Needle Biopsy

A procedure in which the doctor uses a narrow needle to remove a cylinder of tissue, usually about 1/2-inch long and 1/16-inch across, which is sent to the laboratory and examined under a microscope to see if cancer is present.

Decay

Radioactive sources lose their energy over time. With a half-life of 60 days, a radioactive source would have lost half its energy in 60 days. Physicists and physicians use a decay table for determining the activity level on a given day. The half-life for Iodine is approximately 60 days, making it “half active” in 60 days and virtually inactive in 9-12 months.

Digital rectal examination (DRE)

An exam in which the doctor inserts a gloved finger into the rectum to feel for anything not normal. Some tumors of the rectum and prostate gland can be felt during a DRE.

Dysuria

A pain or burning sensation during urination.

External Beam Radiation Therapy (EBRT)

Radiation treatment for prostate cancer, where a high dose of radiation is delivered from an outside source into the prostate to kill the cancer. The radiation must transverse through healthy tissue to reach the cancerous area. Treatments are generally 5 days a week for 7-8 weeks. Each treatment last only a few minutes. Newer forms of external beam radiation, called three-dimensional conformal radiation (3D-CRT) and intensity modulated radiotherapy (IMRT) more accurately target the prostate and are considered the preferred method when using external beam radiation for the initial treatment of prostate cancer. With these newer therapies the patient is immobilized and subjected to radiation beams aimed from several directions.

Fine Needle Aspiration (FNA)

In this procedure, a thin needle is used to draw up (aspirate) samples for examination under a microscope. FNA is sometimes used to determine if prostate cancer has spread to lymph nodes inside the pelvis.

Fluoroscopy

A “live” moving x-ray image that appears on a screen for the physician to view. This differs from x-rays that provide a film of the image. Fluoroscopy lights up extremely well for viewing radioactive seeds. It is used during implantation and postimplantation to view the placement and coverage of the seeds. Fluoroscopy views better than ultrasound.

Gleason Score

A method of classifying prostate cancer cells on a scale of 2 to 10. The higher the Gleason score (also called Gleason sum), the faster the cancer is likely to grow and the more likely it is to spread beyond the prostate.

Gleason System

The most often used prostate cancer grading system. This system assigns a Gleason grade ranging from 1 through 5 based on how much the arrangement of the cancer cells looks like the way normal prostate cells are arranged in the prostate gland. Since prostate cancers often have areas with different grades, a grade is assigned to the 2 areas that make up most of the cancer. These 2 grades are added together to give a Gleason score between 2 and 10.

High Dose Rate Prostate Brachytherapy (HDR)

This is a temporary radioactive seed procedure. The active element Iridium seeds are used for temporary implantation into the prostate. This radiation is then followed by external beam radiation. This treatment continues every day for five days while the patient remains in the hospital. The patient receives both internal radiation and external radiation to the cancerous area.

Hematuria

The condition of having blood in the urine.

Hemophilia

The reduced ability of the blood to clot.

Hormonal Therapy

Also known as “hormonal deprivation.” This is a treatment for prostate cancer that deprives the cancer cells of the hormone they need to grow (testosterone). This therapy can be done by removing the testicles or taking specified medication. Both of these steps will shut down the production of testosterone.

I-125

“Iodine-125.” The active element in Iodine sources.

Intensity modulated radiotherapy (IMRT)

Newer form of external beam radiation therapy that more accurately targets the prostate gland. See External Beam Radiation Therapy (EBRT).

Isotope

The active element characterized by energy and half-life. Iodine I-125 energy is approximately 27 keV with a 60-day half-life. Palladium Pd-103 energy is approximately 21 keV with a 17-day half-life.

LHRH Analogs

Drugs that decrease the amount of testosterone produced by a man’s body. See “Hormonal Therapy” above.

Lymph Nodes

Bean-shaped pockets of lymphocytes held together by fibrous tissue. They are the part of the immune system that help fight disease.

Lythotomy Position

The position the patient is in during the seeding procedure—lying on his back with feet in stirrups.

Magnetic Resonance Imaging

A method of taking pictures of the inside of the body. Instead of using x-rays, MRI uses a powerful magnet and transmits radio waves through the body; the images appear on a computer screen as well as on film.

Malignant Cells

Abnormal cells that have the capacity to overcome a person’s immunological defense mechanisms and spread out of control. Tumors that are cancerous are malignant.

Metastasis

A migration of the disease-causing cells from one organ or area of the body to another unconnected area. If cancer spreads, it is said to have metastasized.

Needle Biopsy

Extraction of cells for microscopic examination by use of needle insertion.

Nerve-Sparing Prostatectomy

An operation that may treat the cancer while lowering the likelihood of impotence.

Orchiectomy

Surgery to remove the testicles; castration.

Partin Tables

With regard to prostate cancer, these are tables, based on a large group of previous cases, used to predict the likelihood that cancer has spread to the lymph nodes or other organs. It takes into account the clinical stage and Gleason score of a man’s cancer, as well as the PSA level.

Pathologic Stage

Describes the extent of cancer present based on surgical removal and examination of tissue.

Pd-103

“Palladium-103.” The active element in Palladium sources.

Perineum

The area between the scrotum and the anus.

Prostate

A gland found only in men that produces a slightly alkaline fluid that forms a portion of the semen. It is about the size of a walnut and it surrounds the neck of the bladder and a section of the urethra. The prostate is located behind the base of the penis, in front of the rectum, and under the bladder.

Prostate Cancer

A disease in which malignant cells have developed within the prostate gland.

Prostate Specific Antigen (PSA) Blood Test

A test of the blood for prostate specific antigens. It is given to a patient by a doctor during early exams and can indicate a tumor or show reason for further testing.

Radiation Sources

Sealed titanium capsule containing either radioactive Iodine I-125 or Palladium Pd-103. Commonly referred to as “seeds.”

Radical Prostatectomy

Surgical removal of the entire prostate gland and some surrounding tissue through an incision in the perineum or an incision in the lower abdomen.

Rectal Examination

Insertion by a physician of a gloved finger into the rectum to feel for lumps in the prostate.

Recurrent Stage

Cancer within this stage has regenerated after initial treatment. It may appear within the prostate or other tissues or organs of the body.

Seeds

See “Radiation Sources.”

Stage

Describes how much cancer is present. Determining the stage is essential for choosing the best treatment. The stage is often described using the TNM classification system, where T stands for tumor (size and how far it has spread to nearby organs), N stands for spread to lymph nodes, and M is for metastasis. Letters or numbers after the T, N, and M provide more details about each of these factors. see also clinical stage and pathologic stage.

Stage T1 (A)

Cancer cells may be confined to one area of the prostate. At this stage, the cancer causes no symptoms and is diagnosed through accidental discovery during surgery or by needle biopsy.

Stage T2 (B)

Cancer cells may be confined to the prostate.

Stage T3 (C)

Cancer cells have spread outside the prostate capsule to the surrounding tissues and/or areas.

Stage T4 (D)

Cancer cells have spread to the lymph nodes and/or to other areas and tissues of the body that are not within the vicinity of the prostate (liver, lungs, bone, etc.).

Staging Descriptors

T–tumor size; N–extent of the spread of cells to the lymph nodes; M–extent to which the cancer has spread to other organs/tissues of the body.

Three-dimensional conformal radiation (3D-CRT)

Newer form of external beam radiation therapy that more accurately targets the prostate gland. See External Beam Radiation Therapy (EBRT).

Transrectal Ultrasound (TRUS)

An ultrasound guidance tool utilizing sound waves for viewing the prostate for scans (pictures) and for viewing the placement of the seeds during the seeding procedure.

Transurethral Resection of the Prostate (TURP)

A treatment for BPH in which fragments of the enlarged prostate are removed to help improve urine flow. It is also used to remove a cancerous portion of the prostate gland. A tool with a wire loop at the end is placed into the urethra while electricity is passed through the tool to heat the wire and cut the tissue.

Ultrasound Imaging

Sound waves are used to create an outline of tissues and organs for diagnostic and therapeutic purposes. Ultrasound images taken by the doctor are used for designing a treatment plan that calculates the exact number of seeds for complete coverage and accurate placement within the prostate for optimum results from the radiation. The physicist plays an important role in developing the seed treatment plan.

Urgency

Frequent urination; a possible side effect from a prostate cancer treatment.

Watchful Waiting

Instead of active treatment for prostate cancer, the doctor may suggest close monitoring. This may be a reasonable choice for older men with small tumors that might grow very slowly. If the situation changes, active treatment can be started. Also called expectant management, watchful expectancy, observation, or surveillance.