What is Prostate Cancer?
The prostate is a small gland in men that is located below the bladder and above the rectum. Its function is to produce fluid that helps carry sperm during ejaculation. It is wrapped around the urethra, which is the tube that carries urine form the bladder out through an opening at the tip of the penis. This is why an enlarged prostate sometimes makes it difficult to urinate with a strong, steady stream. However, these symptoms are most often caused by benign overgrowth of the prostate, which is a common occurrence in men as they age. Prostate cancer, by contrast, often presents with no symptoms in the early stages.
There are a number of risks associated with prostate cancer. It rarely occurs in men younger than 50 years of age, but becomes more common the older a man is. It is also more common among black men, especially of Caribbean descent, and the form of cancer most common in this group of men is generally more aggressive. Family history is also a significant risk, not only with male relatives who have had prostate cancer, but also with female relatives who have had breast cancer associated with the BRCA gene. It is also believed that a diet high in animal fat and low in vegetables adds to the risk of prostate cancer.
The Pros and Cons of Screening
In the past, regular screening for prostate cancer by a blood test measuring PSA was recommended for all men over 50 years of age. PSA is a protein produced by the prostate. It is elevated in a man who has prostate cancer, however it is also elevated when you have benign enlargement, or prostatitis (inflamed prostate). This is one of the reasons why it is not recommended to have routine screening anymore. There has been some conflicting evidence regarding the benefits of routine PSA screening. While detecting the most aggressive forms of prostate cancer improves the chances of survival, most prostate cancers are not aggressive. Some studies have even shown that the majority of men with an elevated PSA do not have prostate cancer, and being diagnosed by PSA screening did not have an effect on survival rates. However, routine screening did result in many unneeded biopsies. For this reason, it is recommended that all men have a meaningful discussion with their doctor regarding the necessity of PSA screening. Of course, men who have the risks mentioned above should probably have screening.
How is Prostate Cancer Graded?
When you are diagnosed with prostate cancer, your disease will be categorized based on staging and grading. The tumor will be staged, as in other cancers, with regards to the extent and size of the tumor, any lymph node involvement and if the tumor has spread to other areas of the body. A greater description of prognosis is gained when incorporating your PSA level, and the grade of tumor they find. This grade, called the Gleason grade, describes the aggressiveness of the type of cancer and has a great deal to do with the type of treatment recommended and your chances for survival. When describing prognosis and choosing treatment, your doctor will also take into consideration your age, your general state of health and any other chronic illnesses you might have, the presence of any symptoms and any preferences you might have.
Based on your Gleason grade, which is calculated based on the 2 most prevalent types of cancer cells that are found in the biopsy, your doctor will determine your Gleason group. This group number is a description of the aggressiveness of the cancer found, and will have a determination on what type of treatment you might expect. The groups range from group 1 to group 5, with increasing severity and mortality associated with the higher numbered groups.
While prostate cancer is very prevalent, most men do not die from it. In fact, most forms of this cancer grow so slowly that the majority of men die from another cause before even developing any symptoms. That said, the more advanced the disease when discovered, the poorer the survival rate is. Additionally, some forms of this cancer are much more aggressive and are associated with a higher death rate.
What Should I Expect After the Biopsy?
After your biopsy results are obtained, your physician will review them with you and discuss your options for treatment. Again, the grading system will partially determine your options. If you have grade 1 disease, no symptoms, a PSA less than 10 and a very small tumor, the recommendations could include monitoring for progression of the disease, radiation therapy, or removal of the prostate. This grade is associated with a high survival rate. If you have a somewhat larger tumor, which is only in the prostate, a grade of 2 to 3, and a PSA of 10 to 20, it may be recommended that you have radiation therapy, possibly medications that suppress male hormones, and/or removal of the prostate. In this case, only monitoring of the disease would not be recommended unless your general health is otherwise poor. If your tumor is larger but still only in the prostate, or you have a Gleason grade of 4 or 5, or a PSA greater than 20, radiation therapy in conjunction with male hormone suppression therapy, and removal of the prostate will most likely be recommended. Men who are in Gleason group 5 and who have extensive disease, with cancer in areas outside of the prostate, have a poorer prognosis. These men will also have recommendations of radiation and removal of not only the prostate, but also surrounding structures and lymph nodes. Continued close monitoring, including PSA levels, rectal exams, and possibly CT and MRI scans will be recommended to watch for recurrence. In those patients with lymph node involvement, chemotherapy may be added to the other treatments offered.
In conclusion, prostate cancer is one of the most prevalent cancers found in men, however the range in type and severity of this disease is extensive, and less aggressive forms are the most common. It is very important that every man have a discussion with their physician by the time they are 50 years old regarding the need for prostate cancer screening. Any man in a high-risk group, including black men, those with family history of prostate or breast cancer, and those with a diet high in animal fats should have this discussion before the age of 40.
If you have any more questions regarding prostate cancer, screening recommendations, treatment options, or any other concerning urological symptoms, please call Ironwood Urology at (480) 961-2323 to learn more, or request an appointment online.