Prostate Cancer Part II - Diagnosis and Treatment

We are continuing our discussion of prostate cancer today, focusing on diagnosis and treatment.  Over the next few weeks, we will continue to spotlight men’s health issues, including testicular cancer and mental health.

Is there routine screening for prostate cancer?

Screening for prostate cancer is controversial.  Part of the reason for this is that prostate cancer screening finds both the slow growing kind that might never cause any problems along with the aggressive kinds.  That makes the research harder to sort out and determine if the benefits of testing outweigh the potential risks involved.  

Most medical organizations encourage men in their 50s to discuss the risks and potential benefits of prostate cancer screening with their doctors.  This will include your own specific circumstances including race, family history, personal preferences, etc.  

Black men or men with a family history of prostate cancer may want to have this discussion earlier.

What are the screening tests?

• Digital rectal exam - The prostate can be felt by your doctor on a rectal exam because the prostate is directly adjacent to the rectum.  Your doctor feels for any abnormalities in the size or shape of the prostate, as well as feeling for any lumps or change in texture.
• Prostate-specific antigen test (PSA) - This is a blood test that checks the level of a substance produced by the prostate.  If the level is higher than expected, this may indicate prostate cancer.  The level can also be high due to noncancerous conditions such as an enlarged prostate or inflammation, so the PSA test cannot diagnose prostate cancer.  Sometimes the test is repeated later to see if the elevation was just temporary.
  

What if the screening test is abnormal?  How is the diagnosis made?

There are several tests that can be done to make a definitive diagnosis.

• Ultrasound - An ultrasound uses sound waves to create a picture of the prostate.
• MRI - This can create a more detailed picture of the prostate, as well as the surrounding tissues such as lymph nodes.
• Biopsy - Collecting a tissue sample that can be analyzed to look for cancer cells.

How can you tell if the cancer is aggressive or not?

• Cancer Grading - Once the cancer cells are seen on the biopsy, the pathologist will determine the “grade” of the cancer, which is a level of the aggressiveness determined by how different the cells are from normal cells.  The scale used to evaluate the grade is called the Gleason score.  Most scores range from 6-10.  A score of 6 is low-grade, 7 is medium-grade, and 8 through 10 are considered high-grade cancers.
• Cancer Staging - There are several imaging tests that can be done to determine if prostate cancer has spread and the extent of the spread.  Your doctor will help determine which test is right for you.  These results are used to assign a “stage”, using Roman numerals I through IV.  Stage I is confined to the prostate.  Stage IV is the widest spread to other areas of the body.

How is prostate cancer treated?

Treatment depends on many things, including the grade and stage of your cancer, your underlying health status, and the potential benefits and risks or side effects of treatment.

• Active Surveillance - If your cancer appears to be slow growing and confined to a small area of the prostate, you may not require any treatment.  Your doctor may instead recommend what is called “active surveillance”.  This involves regular follow-up tests to monitor your cancer.  If the tests show progression of cancer, your doctor may recommend treatment.  This option may also be considered for a man of advanced age, or one who has serious medical conditions that may make treatment more difficult or who might have more risk than benefit from treatment.
• Surgery - Prostate cancer surgery involves removing the entire prostate gland, some of the surrounding tissue, and a few lymph nodes.  Surgery may be used for cancer confined to the prostate or in combination with other treatments in more advanced cancer.
• Radiation Therapy - Radiation treatments can be used instead of surgery in some cases, or after surgery to kill any potential remaining cancer cells.  It can also be used to treat cancer spread to other areas, such as the bones.  
• Hormone Therapy - Because prostate cancer cells rely on testosterone to grow, cutting off the supply of testosterone can cause cancer cells to die or to grow more slowly.  There are several hormone therapy options available.  
• Chemotherapy - This is sometimes used for prostate cancer that has spread to other areas of the body or if the cancer does not respond to hormone therapy.
• Immunotherapy - One of the most recent treatment options for prostate cancer is immunotherapy.  This type of therapy helps your immune system to see the cancer as foreign and start attacking those cancer cells.

We will continue to focus on the men’s health issues spotlighted by The Movember Foundation over the next couple of weeks. 

If you have any questions about prostate cancer, please log into your account and send us your question. We are here to help.

Dr. Anita Bennett MD - Health Tip Content Editor