Approximately 240,000 men will be diagnosed with prostate cancer each year, making it the most
common cancer in the United States. Fortunately, with improvements in early detection and recent advances in non-surgical
treatment, men can be cured of this disease and still maintain an excellent quality of life.
DIAGNOSIS & STAGING What do you do if your PSA blood test or physical exam is abnormal?
Prostate Anatomy
The prostate gland is a walnut-sized structure located in the pelvis.
It is sandwiched between the bladder, which is above the gland, and the rectum, which is below. This is why one side of the
prostate can be felt during a rectal exam. The prostate surrounds the upper part of the urethra, the tube that runs from the
bladder to the tip of the penis for urination. Its primary function is to secrete a fluid that helps to transport sperm.
Prostate Cancer - What are the causes?
The exact causes of prostate cancer are unknown. The risk
of developing prostate cancer increases as men age. Ultimately, more than one in six men will develop prostate cancer during
their lifetime. Men with a family history of prostate cancer and African-American men may also be at an increased risk. As
men continue to live longer and healthier lives, prostate cancer will likely become a more common problem in the 21st century.
What exactly is PSA?
PSA stands for Prostate Specific Antigen. It is a chemical produced only
by prostate cells, both normal and cancerous. It can be measured easily in the blood. Your physician must carefully review
your PSA results. Traditionally, it had been thought in the past that a PSA of 4 was normal. We now know that a “normal”
PSA depends on your age and the size of your prostate, amongst other factors. What is a normal PSA for one man, may, in fact,
be very abnormal for another.
Generally speaking, as men age and their prostates enlarge, the “normal”
level for PSA increases. Likewise, for men with prostate cancer, as the amount of prostate cancer increases, the PSA level
typically increases. Your physician will typically be alerted when your PSA is above what is expected for your age or if it
shows a significant rise from the previous year. Because not all cancers can be found by an elevated PSA, it is critical that
you also have regular physical exams to feel for abnormal growths of the prostate.
Prostate Cancer Screening - Don't Delay!
Early detection is the hallmark of successful
treatment of prostate cancer. Usually there are no warning signs for prostate cancer. As the cancer progresses, symptoms can
be very non-specific and might include a change in your urinary or bowel habits or a new onset of bone pain. Regular physical
exams and PSA tests will aid in the earlier diagnosis of prostate cancer. PSA is a simple blood test that can be done in most
doctors’ offices or laboratories. The American Cancer Society recommends that beginning at age 50, all men should have
yearly PSA blood tests and physical exams.Men with a close relative who has had prostate cancer and African-American men should
have yearly exams starting at age 40.
Because of regular screening, the majority of men are now diagnosed
with prostate cancer at an early, curable stage. In contrast, 20 years ago, most men were not diagnosed until the cancer had
already grown and spread to other parts of the body.
Diagnosis & Staging
What do you do if your PSA blood test or physical exam is abnormal?
If
your primary care physician detects an abnormal PSA or a lump in your prostate during a physical exam, you will be referred
to a Urologist for evaluation and consideration for a biopsy. This is a simple procedure that can be done in a few minutes
in the Urologist’s office. With an ultrasound in the rectum, thin needles can be inserted into the prostate to remove
tiny fragments for evaluation. Typically at least eight biopsies are performed, four from each side of the prostate.
These biopsies are sent to a lab where a physician will determine if cancer is present. If so, they will
then determine how aggressive the cancer is. A scoring system, called the Gleason score, assigns the cancer a number from
2 – 10, with 2 being a less aggressive cancer, and 10 being a more aggressive cancer.
What is early-stage or low-risk prostate cancer?
For truly early-stage disease, you must
have a very low risk of cancer being outside of your prostate. This risk can be estimated following a review of your records.
Generally speaking, several important criteria must all be met. These include:
PSA < 10
At
most, a small nodule felt in the prostate (stage T1-T2A)
Biopsy showing a Gleason score < 7
The Journal of the American Medical Association recently published a study looking at close to 2,000 men.
It showed that for men with low-risk prostate cancer, a prostate seed implant, external radiation, and surgery offered equivalent
cure rates. These results typically exceed those found with older technologies such as proton beam radiation.
What is intermediate to high-risk prostate cancer?
Although surgery (radical
prostatectomy) is an effective treatment option for early stage prostate cancer, it becomes less effective as the risk of
cancer having spread beyond the prostate increases. It is difficult for surgeons to completely remove the cancer once it has
grown beyond the confines of the prostate gland. Several factors can potentially identify patients who are at a higher risk
for having cancer outside the prostate.
These can include any of the following:
PSA > 10
A nodule felt to occupy half of the prostate gland or more on physical exam
A biopsy showing a more aggressive tumor, with a Gleason score > 6
A biopsy showing cancer invading
around the small nerves in the prostate (perineural invasion)
Multiple positive prostate biopsies
What do you do once diagnosed with prostate cancer?
If the biopsy shows the presence
of prostate cancer, the next step is to determine how much cancer is present and to make sure that it has not spread. Our
prostate cancer experts will expertly review your PSA blood tests, physical exam findings, and biopsy results. Some simple
and painless tests such as a CT scan, bone scan, MRI,and possibly a PET scan can help make sure there is no cancer that has
spread outside the prostate.
Using the above information, we can then calculate the likelihood
of the cancer being completely confined to the prostate, having spread beyond the confines of the prostate, or having spread
some distance to the lymph glands in the pelvis.
This information, as well as
an evaluation of your overall medical condition and well-being, is critical in determining which treatment options will offer
you the best chance for a cure.
