A

Ablation – Removal or separation of something

Active surveillance – Regular testing and biopsies of a localised prostate cancer. (See Mr PHIP No. 1)

Acute prostatitis– inflammation of the prostate gland that comes on suddenly and is usually caused by bacteria. Symptoms are similar to a bladder infection and can be treated with antibiotic medication.

Adjuvant radiotherapy – Radiotherapy offered immediately after surgery if the cancer is aggressive or at high risk of recurrence.
(See Mr PHIP No. 4)

Adrenal glands – Small glands lying on top of the kidneys which produce a small amount of male hormone.

Anaesthetic – A medication used to relieve pain and reduce feeling during surgery. An anaesthetic can be:

Local – when you lose feeling to the part of your body where the medication is injected, but you remain awake. Eg. a needle prior to having dental work;
Spinal – anaesthetic medication is injected into the spinal canal and you lose all feeling from your waist down; or
General – administered for more major procedures where you lose consciousness and wake up when the procedure is over.

Androgens – Male hormones. The most active male hormone, testosterone, is produced by the testicles. Other male hormones are produced by the adrenal glands. (See Mr PHIP No. 5)

Anti-androgens – Drugs which block the effects of male hormones. (See Mr PHIP No. 5)

Asymptomatic – Not having symptoms, symptom-free.

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B

Benign – Non-cancerous (not cancer).

Benign prostate enlargement – Non-cancerous enlargement of the prostate (See Mr PHIP No. 1 and 2)

Benign prostatic hyperplasia (BPH) – A condition causing non-cancerous enlargement of the prostate. (See Mr PHIP No. 2)

Biopsy of the prostate – Removal of small pieces of tissue, in this case, from the prostate gland. Tissue samples are taken from different areas of the prostate, and then examined under the microscope to see if they are cancerous. (See Mr PHIP No. 3)

Bisphosphonates – Drugs that improve bone strength in men with prostate cancer that has spread to the bone. They may also be recommended for patients on hormone (androgen deprivation) treatment, which weakens the bones. A common one is zoledronic acid.

Bone Scan – A type of X-ray used to locate cancerous activity in bones. A low-dose radioactive chemical is injected into a vein and the X-rays trace its location in the body. The chemical becomes focused in parts of the bones that are abnormal, such as areas of cancer and the X-ray images identify these as ‘hot spots’.

BPH – Benign Prostatic Hyperplasia. A condition causing non-cancerous enlargement of the prostate.

Brachytherapy – A type of prostate radiotherapy – involves the insertion of radioactive seeds or rods directly into the prostate. (See Mr PHIP No. 3)

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C

Castration – Removal or destruction of the testicles (also called hormone or androgen deprivation therapy). Drugs may be used to stop the function of the testicles (medical castration) or surgery to remove the testicles (surgical castration or orchidectomy). (See Mr PHIP No. 5)

Catheter – A hollow, flexible tube through which fluids can be passed into or drained from the body. During and following some prostate disease treatments, a catheter is used that runs from your bladder, along the inside of your penis to the outside of your body where it joins to a bag.

Chemotherapy – Usually refers to the killing of cancer cells with cytotoxic chemicals (cytotoxic means toxic to cells.)

Chronic prostatitis – Inflammation of the prostate gland that is often caused by bacteria. Continuously recurs; if bacterial, symptoms can be treated with antibiotic medication.

Clinical Staging – Staging or rating of prostate cancer determined by a digital rectal examination (DRE).

Combined androgen blockade– Use of two different types of drugs to block the function of organs producing testosterone. These types of drugs are called ‘LHRH agonists’ and ‘anti-androgens’.

Complementary therapies – Non-traditional interventions used to alleviate symptoms of chronic and acute illness. Often used alongside mainstream treatments. Examples are meditation, acupuncture and aromatherapy.

Computerised axial tomography (CT or CAT) scan – A series of X-ray pictures taken in a circle around the body and processed by a computer.

Conformal radiotherapy – A form of radiotherapy that directs the radiation beam to follow the shape of the prostate in three dimensions and to target the prostate while limiting damage to surrounding tissues. (See Mr PHIP No. 3)

Continence – Ability to control the flow of urine.
(See Mr PHIP No. 1)

Cryosurgery – The destruction of tissue with freezing temperatures. A type of local therapy to treat prostate cancer that has recurred after radiotherapy. (See Mr PHIP No. 3)

Cystitis – Inflammation of the bladder, often caused by infection.

Cystoscope – A tiny tube with a lighted end which slides along the urethra and is used to examine the bladder.

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D

Dual Energy X-ray Absortiometry, or DEXA scanning, An examination of the prostate through the rectum. The doctor places a gloved finger in the rectum and feels the shape of the prostate. Irregularities may be caused by cancer. (See Mr PHIP No. 1)

Digital Rectal Examination (DRE) – An examination of the prostate through the rectum. The doctor places a gloved finger in the rectum and feels the shape of the prostate. Cancer may cause irregularities.

Dry ejaculation – Also called reverse or retrograde ejaculation. After surgery on the prostate, a man may achieve orgasm, but produce no ejaculate. This is because of either the removal of a muscular valve which prevents the ejaculate from going backwards into the bladder (in the case of surgery called a TURP), or because the glands which produce much of the fluid in the ejaculate are also removed (in the case of a radical prostatectomy).

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E

Ejaculate – Fluid produced at ejaculation which contains sperm and secretions from glands such as the prostate, seminal vesicles and testicles.

Epididymis – A long tube that lies on top of each testicle and functions as a reservoir for sperm produced by the testes.

Erectile dysfunction – Inability to achieve and maintain an erection firm enough for penetration. Also called impotence.

External Beam Radiotherapy (EBR) – A form of radiotherapy where the prostate is targeted with high-energy X-rays from therapy outside the body.

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F

Focal therapy – The removal or ‘ablation’ of small areas of cancer within the prostate gland. (See Mr PHIP No. 3)

Free to total PSA ratio – In both healthy men and those with prostate cancer, the prostate specific antigen (PSA) in the bloodstream ‘binds’ onto protein. In men with benign prostatic enlargement (BPE), there tends to be more ‘free’ or ‘unbound’ PSA. This test compares the ratio of unbound PSA to total PSA in the bloodstream. A low result is more likely to indicate cancer. (See Mr PHIP No. 2)

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G

Gleason score – A way of grading cancer cells. Low grade cancers (Gleason score 2,3,4) are slower growing than high grade (Gleason scores 8,9,10) cancers. (See Mr PHIP No. 3 and 4)

Grade – A way of describing how abnormal the cancer cells look, and consequently how aggressive or fast-growing the cancer is likely to be. The most commonly used grading system is the Gleason score, which ranges from 2-10. (See Mr PHIP No. 3 and 4)

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H

High intensity focused ultrasound (HIFU) – Heating of tissue using microwaves.
(See Mr PHIP No. 3)

Hormone resistance – Prostate cancer cells are dependent on testosterone or male hormone for growth. Withdrawal of male hormone by surgery or by means of drugs is therefore a means of controlling its growth. However cancer cells may develop which do not need testosterone for growth. The cancer is then said to be ‘resistant’ to hormone treatment. (See Mr PHIP No. 3)

Hormone treatment – In prostate cancer, treatment with drugs that blocks the production or effects of testosterone in the body in order to slow or stop the growth of prostate cancer. (See Mr PHIP No. 3 and 5)

Hot flush – A sudden rush of heat to the face, neck, sometimes chest and back. It can be associated with hormonal therapy for prostate cancer. (See Mr PHIP 5)

Hyperthermia – Higher than normal temperature. In the case of prostate cancer, a way of destroying tissue by heating.

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I

Image-guided radiotherapy – A common technique used to assist radiation targeting and involves placing three (non-radioactive) seeds into the prostate before treatment. This means the doctor can better monitor the position of the prostate during the course of radiation. (See Mr PHIP No. 3)

Impotence – Inability to achieve an erection.

Incontinence – Inability to hold urine or control urine loss.

Indolent – Means “lazy”, usually referring to the type of cancer cells which grow only slowly.

Intensity modulated radiotherapy (IMRT) – A type of radiotherapy that uses computer-generated images to show the size and shape of a tumour. The intensity of radiation is designed to follow the outline of the tumour. (See Mr PHIP No. 3)

Intermittent hormone therapy – Hormone treatment that is started and stopped in cycles. Typically, it is continued for several months until PSA has reached a low level, and then discontinued. Once the PSA level in blood rises to a particular level again (and this can take many months), hormone treatment is restarted. The main expected benefit in this approach is reduction in side effects. (See Mr PHIP No. 3 and 5)

Intermittent therapy – A non-continuous form of hormone treatment for prostate cancer, where treatment starts and stops repeatedly. Its aim is to minimise the effects of hormone therapy. (See Mr PHIP No. 3 and 5)

Investigations – tests or procedures which can assist with the diagnosis or staging of a cancer

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L

Laparoscopic surgery – Surgery performed using only small cuts (‘keyhole surgery’) and telescopic instruments.

Luteinising Hormone (LH) – A hormone produced by the pituitary gland in the brain and acts on the testes to produce the principle male hormone, testosterone.

LHRH – Luteinising Hormone Releasing Hormone. It is produced by the hypothalamus in the brain and stimulates the pituitary (another part of the brain) to produce LH (Luteinising Hormone). This, in turn causes cells in the testicles to produce testosterone, the male hormone.

LHRH agonists – A substance that resembles LHRH, which controls the production of sex hormones. The LHRH agonists keep the testicles from producing hormone (testosterone). See Mr. PHIP no 5.

Libido – Sex drive.

Localised cancer – Cancer that has not spread beyond the place where it began.

Locally advanced prostate cancer – Prostate cancer that has spread to organs and tissues near the prostate but not to more distant sites.

Lower Urinary Tract Symptoms (LUTS) – Symptoms related to the flow or passing of urine, such as poor stream, frequent urination, needing to get up at night two or more times to urinate, incontinence and incomplete emptying of the bladder. They are often caused by benign enlargement of the prostate.

Lymph nodes – Small glands which filter tissue fluid before it returns to the blood stream. This means that they often capture cancer cells which have escaped from the main tumour and have started to spread to other parts of the body.

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M

Magnetic resonance imaging (MRI) – A way of imaging the inside of the body without using X-rays.

Malignant – Cancerous.

Margin-positive – See surgical margins. (See Mr PHIP No. 4)

Medical oncologist – A specialist in the treatment of cancer using chemotherapy.

Medicare Benefits Schedule (MBS) – A book that lists the professional services rendered by medical professionals that have been approved for Australian Government Funding.

Metastasis – A piece of cancer which has broken off from the main cancer and become established in a different part of the body. Prostate cancer metastases often occur in lymph glands, bone or in the lungs.

MRI – Magnetic Resonance Imaging. A way of imaging the inside of the body without using X-rays.

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N

Nadir – The lowest PSA reading before it starts to rise, occurring some months after radiotherapy to cure prostate cancer. (See Mr PHIP No. 4)

Nerve-sparing operation – A specialised technique for prostate cancer surgery that aims to preserve the nerves needed for erections. (See Mr PHIP No. 3)

Nodules – Small lumps.

Nomogram –  mathematical device that calculates risk based on several factors, for example risk that the cancer will recur after surgery, based on PSA level, stage of the cancer and Gleason score.

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O

Oncologist – A doctor who specialises in treating cancer.

Orchidectomy – (Also Orchiectomy) A type of operation which removes the testicles, but usually leaves the scrotal sac or scrotum.

Osteoporosis – Thinning of the bones making them weaker and more likely to break.

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P

Pelvis/pelvic – The area of the body below the waist and surrounded by the hip and pubic bones.

Perineal (perineum) – Area of body between the anus and the scrotum.

Pituitary – Part of the brain which produces hormones which stimulate the testicles to produce testosterone (male hormone) and other hormones.

Placebo –  a medicine or preparation which looks like a drug or other treatment, but has no useful ingredient. The old term for placebo was a ‘sugar pill’

Positive lymph node – A lymph node with cancer present. This is determined by removing the lymph nodes surgically and examining them under a microscope.

Positive surgical margin – After a radical prostatectomy, a pathologist examines the tissue removed to see whether the cancer extends to the cut edge of the prostate (the surgical margin)

Potency – The capacity to have erections.

Priapism – A painful, prolonged erection lasting 3 hours or more.

Prognosis – The course and likely outcome of a disease.

Prostate capsule – The thin layer of connective tissue surrounding the prostate.

Prostate Gland – Part of the male reproductive organs; lies under the bladder and surrounds the urethra. The prostate gland secretes a milky fluid that is added to semen during ejaculation.

Prostatectomy – Removal of all or part of the prostate gland. There are two main types:

– Transurethral prostatectomy (see TURP): removal of part of the tissue surrounding the urethra which may be blocking the flow of urine.

– Radical prostatectomy: removal of all of the prostate and the seminal vesicles. (See Mr PHIP No. 3)

Prostatitis – Inflammation of the prostate gland. The condition can cause urinary symptoms, lower abdominal pain and be acute or chronic.. The cause can be infection but is not always clear. (See Mr PHIP No. 2)

PSA – Prostate Specific Antigen A protein produced by normal and cancerous prostate cells. Its level in the blood increases when cancer is present. It can be used as a test for prostate cancer or to monitor its recurrence. (See Mr PHIP No. 1, 2, 3, 4 and 5)

PSA Bounce – A temporary rise in PSA reading during the first 18 months after brachytherapy to cure prostate cancer. The cause is not well understood. (See Mr PHIP No. 3 and 4)

PSA density – The PSA level divided by the volume of the prostate (determined from ultrasound). PSA may be raised because of benign prostate growth, which is common in older men. The PSA density helps distinguish an elevation that is due to cancer (higher PSA density).

PSA doubling time – The time taken for the PSA to double, for example from 4 to 8 ng/mL. This is a measure of how fast a cancer is growing and can also be used to predict cancer recurrence after treatment. (See Mr PHIP No. 4)

PSA Velocity – change in PSA  over a period of time. It can be used to estimate cancer risk. For example a change in PSA of greater than 2 ng/ml/year is thought to indicate a high risk cancer

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R

Radiation oncologist – A specialist doctor who uses X-rays and radioactive substances to diagnose and treat cancer.

Radical prostatectomy – An operation that removes the prostate and seminal vesicles through a cut in the abdomen or the perineum. (See Mr PHIP No. 3)

Randomised – used to describe a study or trial in which patients are allocated randomly to the treatment being tested. Example: in a randomised controlled trial, patients are randomly allocated to a treatment or a control group.

Recurrence – When cancer comes back after treatment. (See Mr PHIP No. 4)

Rectum – The last part of the bowel, leading to the anus, and through which stool passes.

Retrograde ejaculation – Also called reverse ejaculation. See ‘dry ejaculation’.

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S

Salvage radiotherapy – Radiotherapy used to treat a recurrence of prostate cancer after surgery or another treatment. (See Mr PHIP No. 4)

Screening – Regular testing for a disease when there are no symptoms present.

Scrotum – A pouch of skin which contains the testicles and some other parts of the male reproductive system. It hangs outside the body and below the penis.

Semen – A fluid, discharged at ejaculation, that contains sperm, (see ejaculate).

Seminal vesicles – Glands which lie very close to the prostate and produce secretions which form part of the ejaculate.

Sphincter – A circular band of muscle that can relax and contract to open and close like a tap.

Staging – A way of describing how far the cancer has spread. (See Mr PHIP No. 3)

Stricture – Scar tissue which obstructs fluid flow; in the case of a urethral stricture, urine flow is obstructed.

Surgical margins – After a radical prostatectomy, the edges of the tissue which has been removed are examined to see if cancer cells are present. If they are not (negative surgical margins) the chance is higher that all of the cancer has been removed. (See Mr PHIP No. 4)

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T

Testicles – Glands which produce sperm and the male hormone, testosterone. They are found in the scrotum.

Testosterone – The major male hormone. It is produced by the testicles. (See Mr PHIP No. 5)

TNM system – A system for staging cancer, depending on the size and invasiveness of the tumour, whether lymph nodes are affected and whether there is metastasis. (See Mr PHIP No. 3)

Transrectal ultrasound (TRUS) – A means of imaging the prostate in order to locate cancer. The ultrasound probe is placed in the rectum. (See Mr PHIP No. 3)

TRUS – Trans-Rectal Ultra-Sound. A means of imaging the prostate in order to locate cancer. The ultrasound probe is placed in the rectum.

TURP – Trans-Urethral Resection of the Prostate. An operation to remove blockage of the urethra (urine outlet tube) by prostate overgrowth. This growth is usually benign, but can be cancerous. An instrument is inserted, under anaesthetic, along the urethra (urine tube) and removes prostate tissue which may be blocking the flow of urine. It is a common operation for benign enlargement of the prostate, and is occasionally used to treat prostate cancer. (See Mr PHIP No. 1 and 2)

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U

Urethra – Tube which carries urine and ejaculate along the length of the penis and to the outside.

Urologist – A specialist surgeon, who diagnoses, manages and treats diseases of the urinary tract in men and women.

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V

Vas (ductus) deferens – Ducts (tubes) that take sperm to the urethra on ejaculation.