Prostate Cancer
Diagnosis of Prostate Cancer
Prostate cancer is diagnosed by needle biopsy of the prostate gland. Only by viewing tissue under a microscope can cancer of the prostate be identified. The most common indications for biopsy of the prostate are a high PSA blood test or an abnormal feel to the prostate by digital rectal exam.
After a histological diagnosis of prostate cancer is made from tissue taken from your prostate, a thorough evaluation is made to determine how extensive or aggressive your particular cancer is. It is important to determine as best we can whether or not the cancer appears to be confined within the prostate gland or is it likely to have already escaped. This determination will have a profound effect on the treatment options available to you. Determining the extent of disease (staging) relies on the needle biopsy pathology report, PSA levels, digital rectal exam and other optional tests including a bone scan, CT scan, etc. Other factors which influence these decisions are family history of prostate cancer and changes in the PSA over the past few years.
After determining the extent of your disease we will assess your general health and other medical conditions. These factors will play an important role in determining the best treatment option for you.
Treatment Options for Prostate Cancer
There is no one treatment for prostate cancer that is best for everyone. Only after a thorough cancer evaluation to determine the extent and severity of your disease, can we then relate that to your personal health history and help you decide on the best treatment for you. Options include watchful waiting, hormone therapy, radiation therapy and surgical removal of the prostate.
Watchful Waiting
Not all men with prostate cancer should have aggressive treatment. Not all prostate cancers behave the same. Some are fast growing and aggressive while others are slow growing and less threatening. One factor which helps us understand the aggressive potential of a particular prostate cancer is the Gleason score. The Gleason score is a number between 2 and 10 which is assigned by the pathologist who examines your biopsy tissue under the microscope. Historical data tells us that Gleason scores of 7-10 are more aggressive cancers with more potential for harm. On the other hand, Gleason scores of 2 or 3 are generally slow growing and not considered threatening for many years. Thus we may sometimes recommend watchful waiting to men older than 75 years with a low volume, low Gleason score, low PSA, and normal digital rectal exam because long term studies of men with prostate cancer suggest that these men are more likely to die of other causes than these tiny prostate cancers.
Watchful waiting does not mean ignoring the disease. You will be monitored at regular intervals with serum PSA values to test our assumption that your particular prostate cancer is indeed slow growing. If a rapidly rising PSA suggests that this may be a more aggressive prostate cancer, we could still begin one of the other appropriate treatment options.
Hormone Therapy
Hormone therapy for prostate cancer (aka androgen ablation) means the removal of the normal male hormone, testosterone. The strong effect male hormone has on prostate cancer was demonstrated in the 1950’s. Testosterone behaves as a stimulant for prostate cancer, promoting its growth. It was shown that by removing testosterone from the body of men with advanced prostate cancer, patients would improve. Most prostate cancers will initially regress some when testosterone is blocked and then grow very slowly. Unfortunately this effect is temporary. The prostate cancer cells will eventually begin to grow again in most patients. Fortunately the effect of androgen ablation on prostate cancer will usually last for several years. Thus, it is important to understand that androgen ablation is not a cure for prostate cancer but can be very effective at slowing the growth and progression of the disease. Androgen ablation can be accomplished by removing the testicles or by taking medication, usually in the form of an injection once every 3 months. Loss of testosterone for a male does have some side effects. It is similar to female menopause. Hot flashes are the most notable side effect. In addition men will notice a loss of libido, energy level and may gain some weight if they are not careful.