What men need to know after a diagnosis of prostate cancer


What men need to know after a diagnosis of prostate cancer

Like any person diagnosed with cancer, the ones who tend to manage it best are those who understand their disease in detail, who know what treatment options are available, the stage of their disease, and their prognosis.

Men diagnosed with prostate cancer should have this same exact mindset in order to achieve the best outcome possible.  When a man understands the grade, stage, prognosis and treatments, it prepares him in making informed decisions regarding how his prostate cancer will be handled.  Anyone with a cancer diagnosis needs reassurance that knowledge means power which can bring comfort and confidence to the situation.

Once a man receives a definitive diagnosis of prostate cancer, there are steps he can take to have a more active role in his condition.  Establishing good communication between himself and his urologist is an important first step in reaching the kind of care and respect during this time of stress and the unknown.

Here are four things all men with prostate cancer should know after their diagnosis:

1.  Know the grade of the prostate cancer

When a man has a biopsy of his prostate, samples of prostate tissue are removed by core needle biopsy.  During this procedure, a doctor inserts a thin, hollow needle into the prostate gland.  As the needle is pulled out, it removes a small cylinder of prostate tissue called a core.  To get as accurate of a reading as possible, several cores from different areas of the prostate will be sampled.

The tissue is studied under a microscope by a specialized doctor called a pathologist who will then send a report to the doctor giving a diagnosis of each core sample taken.  The pathologist determines the Gleason score which is made up of two numbers – a primary grade and a secondary grade.  The primary grade determines where the cancer is most prominent and the secondary grade determines where the second most prominent area the cancer is found. 

The primary grade and secondary grade will be a number ranging from 1-5.  This is based on how many cells in the cancerous tissue look like normal prostate tissue under a microscope which is called a Gleason system.

This is how the pathologist may grade the tissue:

·      If the cancerous tissue looks a lot like normal prostate tissue, a grade of 1 is assigned

·      If the cancer cells and their growth patterns look abnormal, a grade of 5 is assigned

·      Grades 2 through 4 have features in between those extremes.

It is not unusual for prostate cancer tumors to have areas with different grades.

Understanding the Gleason grading system can be challenging.  Any man who is uncertain what exactly his score means, needs to thoroughly discuss this with his doctor to have a clear comprehension on how this affects his cancer prognosis. 

2.  Know the stage of the prostate cancer

Staging of prostate cancer can be very complex.  It is imperative that any man diagnosed with this disease to ask his doctor and other members of his cancer care team to explain the staging to him in a way he can understand. 

Staging is important as it allows the doctor to see how advanced the cancer is at the time of diagnosis.  Prostate cancer is usually localized meaning that the cancer has not spread beyond the prostate.

·      Stage I cancer

This stage is known as localized cancer as the cancer has been found in only one part of the prostate.  Stage I cancers cannot be felt during a digital rectal exam or seen with imaging tests.  If the PSA is less than 10 and the Gleason score is 6 or less, stage I cancer is most likely a slow growing cancer.

·      Stage II cancer

This stage of cancer is still localized and has not spread beyond the prostate but is more advanced than stage I.  In stage II, the cells are less normal than stage I and may grow more rapidly.  There are two types of stage II prostate cancer:

·      Stage IIA – found only on one side of the prostate

·      Stage IIB – found in both sides of the prostate

·      Stage III cancer

This stage of cancer is called locally advanced prostate cancer and has spread outside the prostate into local tissue such as the seminal vesicles, the glands that make semen. 

·      Stage IV cancer

This stage of cancer has spread to distant parts of the body such as nearby lymph nodes or bones of the pelvis or spine.  It could have spread to other organs such as the bladder, liver, or lungs. 

Men diagnosed with stage I, II or III prostate cancer, the goal is to cure the cancer by treating it and keeping it from returning.  Men diagnosed with stage IV prostate cancer, the goal is to improve symptoms and to prolong life as in most cases, stage IV prostate cancer is not curable.

3.  Know the prognosis

Every man’s prostate cancer is unique with prognosis depending largely on their Gleason score, PSA and stage of the cancer.  Even though prostate cancer is the second most common cancer diagnosed in American men, fortunately the vast majority of cases are curable.  In fact, 99% of men with the most common types of prostate cancer will have an overall survival rate of more than five years.  For the more than 90% of men whose prostate cancer is localized to the prostate or nearby, the prognosis is even better.  Almost 100% of these men will live at least five years. 

4.  Know the treatment options

A thorough understanding of prostate cancer treatment options and their possible side effects associated with each is imperative for men to be knowledgeable on.  When their doctor is making recommendations on how to treat their prostate cancer, this is when men need to ask many questions to gain full understanding of why their doctor is recommending that option.

More than 90% of men diagnosed with prostate cancer have localized disease defined as cancer that has not spread beyond the prostate.  These patients are typically given the options of active surveillance, radical (complete removal) prostatectomy or radiation therapy but they may also be advised to consider high intensity focused ultrasound (HIFU) or cryotherapy. 

Each of these treatment options come with benefits but also possible risk and side effects each man will need to take into consideration.  Again, good dialogue between a man and his doctor can help each patient choose the right option for them for the best outcome.