You or your loved one has just been diagnosed with prostate cancer. You may be experiencing a number of feelings: disbelief, fear, anger, anxiety, and depression. The good news is that there are many treatment options and support resources that can help you or your loved one lead a normal, healthy life. This section provides information on diagnosis of prostate cancer, staging of prostate cancer, what to expect after an initial diagnosis of prostate cancer, questions to ask the doctor as you or your loved one enter treatment and during recovery, and where to find support.
Two tests are used to help diagnose prostate cancer—the digital rectal exam and a blood test that measures a protein called prostate specific antigen or PSA. There is no normal PSA level but the higher it is the greater the odds that cancer is present. Prostate cancer may also be present when the PSA is increasing. If any abnormalities are detected in the prostate during the DRE, or if PSA levels are above a certain level, the doctor may recommend further testing.
Ultrasounds help in diagnosing, staging, and treatment plans by measuring prostate gland volume, recognizing varied patterns of cancer, and identifying appropriate sites for biopsy. Ultrasonography alone, however, cannot detect all cancers.
If these test results indicate the presence of prostate cancer, the next step is a prostate biopsy to collect small tissue samples from the prostate for analysis by a pathologist. Biopsy results are usually obtainable within 48 hours.
Two kinds of biopsies are generally performed – transrectal or transperineal. Transrectal is the most common. An enema and an oral antibiotic are often given prior to the biopsy. Injecting a local anesthetic can greatly reduce pain and discomfort and should be used on all patients. The biopsy begins by inserting an ultrasound probe into the rectum. The ultrasound images show the contour of the prostate and allow the doctor to direct the biopsy needle to specific locations in the prostate. From outside the rectum wall, a handheld device with a spring-loaded, slender needle is positioned and inserted into the abnormal areas to collect tissue samples. If no abnormal areas are detected, 10-12 random tissue samples are collected from different areas of the prostate.
The transperineal procedure is the same as the transrectal procedure, only the needle is inserted through the skin between the rectum and scrotum (perineum). This method is used when access through the rectum wall is not possible.
If the biopsy shows cancer, the doctor may decide to run further tests to determine if the cancer has spread to other tissues in the body.
*Lymph nodes are small glands located in many parts of the body that help defend against harmful foreign particles. Lymph nodes in the pelvic region are usually the first place to which cancer spreads outside the prostate.
Staging of prostate cancer is a necessary step to determine the extent of the disease and select the best treatment strategy. A pathologist will look at the tissue that was taken during the prostate biopsy and will determine
The pathologist will assign a Gleason score based on how the cancer looks under a microscope. Cancer cells are assigned a Gleason grade from 1 to 5. The score of the two most common types of cells are added together to give the Gleason score. In general, the lower the score, the better the prognosis. The most common score is 6. Gleason scores of 8-10 are the most dangerous.
Most of the information listed above will appear on the biopsy report. The report often will describe the length of cancer in each biopsy sample and the percentage of cancer on each core.
After all of the necessary tests are run and the results are available, your doctor will determine the stage of prostate cancer.
Stage III cancer is no longer confined to the prostate gland but has not yet spread (metastasized) to tissues outside the pelvic area. T3 tumors may have spread to the nearby seminal vesicles. T4 tumors are slightly more spread out and may have invaded other nearby tissues within the pelvic area including the bladder or pelvic wall.
Stage IV cancer is detected in tissues far from the prostate, including the lymph nodes (N+) or more distant tissues, such as bone (M+).
Once the doctor has determined the stage of the prostate cancer, the doctor will work with you to select the best treatment option.
After a prostate cancer diagnosis and staging, you should familiarize yourself with the available risk assessment tools to help understand your risk of disease recurrence and progression.
Prostate cancer can either present as a slow growing tumor causing minimal harm or a more aggressive type, which spreads quickly. Risk assessment is the critical step of determining the nature of each patient’s disease. Physicians look at clinical and pathology features (PSA, Gleason score, clinical stage, etc) to determine which patients may have aggressive forms of prostate cancer, and which patients do not.
Newly diagnosed men become very familiar with their individual PSA and biopsy Gleason scores. Over the last several decades, annual PSA screening has helped identify more men earlier in the disease process. As a result, many patients present with a narrow Gleason score range (Gleason 6 or 7) and low PSA values which compress the results of existing risk assessment and prognostic tools, making them less useful for individual patients. New personalized methods of risk assessment using molecular biomarker analysis are available to assess progression risk. However, their clinical utility is still evolving.
Patients should learn as much as possible about their disease prior to treatment selection. Risk assessment and disease prognosis tools assist in making informed treatment decisions.
Learning more about prostate cancer and the available treatments is the first step towards improving your or your loved one’s outlook and relieving some of the anxiety and stress caused by diagnosis.
Once you or your loved one are diagnosed, your doctor will want to run tests and may need to ask you to have one or two imaging tests such as a bone scan or a computed tomogram (CT) or magnetic resonance image (MRI) to determine the extent of the disease. Depending on the stage of the cancer, the doctor will discuss treatment options.
Certain treatments for prostate cancer are associated with side effects that can have a profound effect on one’s lifestyle. The important thing to remember as a patient is to keep a diagnosis of prostate cancer and the side effects of treatment from interfering with your life or your emotional health.
Join a support group for prostate cancer patients
The following is a list of questions to ask your doctor if you have been diagnosed with prostate cancer. It may be worthwhile to audio record your conversation with your doctor so that you can review his answers to each question and be able to make informed decisions about your treatment options.
You can also post questions for physicians and join discussions on specific topics about prostate cancer on the Physician-to-Patient (P2P) bulletin board located in the Online Communities: Prostate Pointers section of this Web site.
This section lists only some of the many support resources available that can help you learn more about prostate cancer and its treatment, and that can connect you to medical experts, other patients, caregivers, and families. For a more comprehensive list, please visit the Helpful Resources section.
While the Internet has become a valuable source of information and support for those dealing with prostate cancer, Us TOO recommends that you verify all information you obtain from the Internet with your doctor.