Prostate cancer detection
PSA blood test – This blood test is designed to detect the level of prostate specific antigen (PSA) in the blood. This protein is produced by cells located in the prostate – whether they are normal, healthy cells, or cancerous cells. This protein is measured in nanograms of prostate specific antigen in the blood. Generally, a PSA level that is below 4 nanograms is ‘normal’. However men with seemingly normal readings may still have cancer, so other tests may be indicated.
DRE – A digital rectal exam is a standard exam that is performed for men to analyze the size and shape of their prostate. The physician performing this exam may also detect lumps that may be suspicious and warrant additional testing.
Prostate biopsy – This exam is indicated when men have an abnormal PSA and/or digital rectal exam. This tests involves removing prostate tissue, for further study, from approximately 12 quadrants of the prostate. State-of-the-art technology now allows physicians to perform targeted biopsies (rather than blind or random biopsies) in which they can see inside the prostate with MRI / Ultrasound fused 3D imaging.
MRI – Multiparametric MRIs are now being indicated to help Radiologists pinpoint areas of suspicion within the prostate. The MRI imaging is fused with Ultrasound imaging that is used by the Urologist while performing a targeted prostate biopsy.
Prostrate cancer grading and staging
When prostate cancer is detected, it is graded and staged by a Pathologist.
Gleason Grade or Gleason Score – This system was developed by Dr. Donald Gleason, an American Pathologist in the 1960s. In simple terms, it is a way of grading prostate cancer cells to determine how likely they are to spread. The smaller the ‘score’ the least likely the cancer cells will spread. Likewise, the higher the score, the more likely the cancer will spread. Grading involves assigning grades based on the pattern of tumor that is observed by a Pathologist. A tumor grade will include a primary, secondary and tertiary grades which will result in an overall grade. Gleason scores that range between 2 and 4 are generally found with small tumors. Scores between 5 and 7 are ordinarily treatable. Scores between 8 and 10 are more advanced and harder to treat or cure.
Cancer Staging – As with other cancers, prostate cancer is ‘staged’ to indicate how far the cancer has spread. When staging prostate cancer, the staging will be based on whether the cancer is still contained within the prostate gland, or if it has moved outside the capsule to surrounding tissue, the bone, lymph nodes, or other organs. For the prostate, staging may include “T”, “N” and/or “M” categories.
T staging – This category indicates ranges from 1 to 4. T1 is a small tumor that is contained within the prostate that can’t be seen or felt by the physician. It is usually found by a needle biopsy when the PSA level is abnormal, or other incidental findings. T4 indicates that the cancer has moved outside of the capsule into areas that closely surround the prostate gland.
N staging – Prostate cancer is either assigned a “N0′ designation which means it has not moved into surrounding lymph nodes, or a ‘N1’ designation which means it has moved into surrounding lymph nodes.
M staging – Prostate cancer is assigned a ‘M0’ designation which means it has spread to nearby lymph nodes, but not beyond these nodes. A ‘M1’ designation means the cancer has spread beyond the surrounding lymph nodes. This designation is further refined based on whether it has spread to distant lymph nodes, bone, or other organs such as the lungs. Essentially, how far it has metastasized.
ADVANCED PROSTATE CANCER
When prostate cancer spreads outside the prostate gland (also known as the capsule), it is then characterized as Advanced Prostate Cancer. Once outside the capsule, it is identified based on where it is spreading. This also helps determine treatment options.
Locally advanced prostate cancer is cancer that moves outside the prostate into adjoining tissue. It has not moved into the bone or other organs.
Metastatic prostate cancer is cancer that moves outside the prostate and spreads to lymph nodes, bones, and/or organs. Metastatic prostate cancer is incurable, so treatment is focused on pain control, symptom relief and quality of life issues.
PROSTATE CANCER TREATMENT OPTIONS
Watchful waiting – This is an option for men who have a small tumor that is localized within the prostate and isn’t causing any symptoms. During watchful waiting, the patient will continue to meet with their physician so that the cancer can be closely monitored.
Open Prostatectomy – An open prostatectomy is a major surgery in which the prostate gland and seminal vesicle are completely removed. While the primary goal is to remove the prostate cancer, it is also important to preserve urinary and erectile function by avoiding contact with nerves that surround the prostate.
Robotic Prostatectomy – Robotic removal of the prostate is a minimally-invasive, robot-assisted surgery. The object is to remove the prostate and maintain urinary and erectile function. Because this surgery is minimally-invasive, it customarily has fewer side effects compared to major surgery.
Cryoblation – Cryoblation or Cryotherapy is a minimally-invasive treatment option in which cancer cells are destroyed through a freezing process.
HIFU – High Intensity Focused Ultrasound is a minimally-invasive treatment option in which a focused ultrasound energy heats and destroys cancer cells within the prostate capsule.
Radiation – This treatment option directs high doses of radiation into the prostate to destroy cancer cells. Radiation therapy is delivered in small doses over several days/weeks to complete treatment.