Prostate Cancer

How is Prostate Cancer Diagnosed?

There are various tests and procedures that can us used to diagnose prostate cancer including the following:

1. Physical Exam and Health History: An exam that involves checking the body for general health and checking for diseases and lumps. Knowing a patient’s health history can also determine what illnesses they have had in the past.
2. Digital Rectal Exam (DRE): A rectal exam where the doctor or nurse inserts a gloved finger into the rectum and feels the prostate through the rectal walls to check for any abnormalities.?
3. Prostate-specific antigen (PSA) test: This test measures PSA levels in the blood. PSA is made by the prostate and may be in high amounts in the blood of men who have prostate cancer.
4. PSMA PET scan: Imaging procedure used to identify prostate cancer cells that have spread outside of the prostate and into bone, lymph nodes, and other organs.
5. Transrectal Ultrasound: A probe the size of a finger is inserted into the rectum to check the prostate.
6. Transrectal Magnetic Resonance Imaging (MRI): Uses strong magnet, radio waves, and a computer to make detailed pictures of the inside of the body. A probe is inserted into the rectum and is used to determine if the cancer has spread to nearby tissues.

If a patient is suspected of having prostate cancer, a transrectal biopsy is performed where a thin needle is inserted through the rectum and into the prostate to remove a small amount of tissue. If cancer is found, the pathologist examining the tissue will give the cancer a grade by using the Gleason score. This is done by checking the tissue samples and seeing how much the tumor tissue is similar to the normal prostate tissue by finding the two most abundant cell patterns, primary and secondary. The two are then added to give the Gleason score.

How Can The Stage of Prostate Cancer Be Determined?

Prostate cancer stage determination is known as staging. These tests may not be done unless the patient has signs that the cancer is spreading such as bone pain, high PSA levels, or a high Gleason score.

The following procedures can be used to determine prostate cancer stage:

1. Bone scan: This procedure is used to determine if there are cancer cells in the bone.
2. MRI
3. CT Scan
4. Pelvic Lymphadenectomy: Surgical procedure that removes lymph nodes in the pelvis
5. Seminal Vesicle Biopsy: Removal of fluid from the seminal vesicles, where semen is made, to look for cancer cells
6. ProstaScint Scan: A procedure to determine if the cancer has spread from the prostate to other parts of the body, like the lymph nodes.

What Are the Various Stages of Prostate Cancer?

1. Stage I: This stage is found in the prostate only. There are 2 ways that stage I prostate cancer can be determined:The first way is not via a rectal exam but through a needle biopsy. For this, the PSA level is typically lower than 10 and the Gleason score grade group is 1.The second technique is through a rectal exam and is found in ? or less of 1 side of the prostate. The PSA levels and Gleason score grade group is the same as the previous technique.

1. Stage II: This stage is more advanced than stage I but is still localized in the prostate. This stage is divided into 3 sub-stages:Stage IIA: This is found in ? or less of one side of the prostate and the PSA level is between 10 and 20 with a Gleason score grade group of 1. Or, it is found in more than ? of one side of the prostate or in both sides of the prostate with PSA and grade group the same as the previous.Stage IIB: This is found in one or both sides of the prostate and the PSA level is less than 20 with a grade group score of 2.Stage IIC: This is found in one or both sides of the prostate and the PSA level is less than 20 with a grade group of 3 or 4.

1. Stage III: Like stage II, this stage is also divided into 3 sub-stages:Stage IIIA: This is found in one or both sides of the prostate with a PSA level of at least 20 and grade group of 1, 2, 3, or 4.Stage IIIB: This stage has spread from the prostate to the seminal vesicles or to nearby tissue or organs like the rectum, bladder, or pelvic wall. The PSA level for this stage is not specified and the grade group is typically 1, 2, 3, or 4.Stage IIIC: This stage of cancer is found in one or both sides of the prostate and can have spread to the seminal vesicles or nearby tissues or organs. The PSA level is unspecified with a grade group of 5.

1. Stage IV: This stage is divided into 2 sub-stages and is the most advanced stage.Stage IVA: This stage is found in one or both sides of the prostate and has spread to the seminal vesicles or nearby tissues or organs. It has spread to nearby lymph nodes thereby entering the circulation. The PSA can be any level with a grade group of 1-5.Stage IVB: This stage has spread to other parts of the body such as bones and distant lymph nodes.

What Treatment Options Are Available For Prostate Cancer?

There are eight key treatment options available for prostate cancer:

1. Watchful waiting or active surveillance: This technique is used for older men who have not shown signs or symptoms and have other medical conditions and for men who found prostate cancer via a screening test. For this treatment, the attending physician is closely monitoring the patient’s condition without giving any treatment to the patient unless he develops signs and symptoms.
2. Surgery: There are various surgeries that can be used to treat prostate cancer. First is radical prostatectomy which is the removal of the prostate, surrounding tissue, and seminal vesicles. The second is a pelvic lymphadenectomy, which is the removal of the lymph nodes in the pelvis. The final technique is called transurethral resection of the prostate, or TURP, which is the removal of tissue from the prostate utilizing a resectoscope.
3. Radiation therapy
4. Hormone therapy: this removes hormones and/or blocks their action and stops the growth of cancer cells. There are various types available including abiraterone acetate, orchiectomy, estrogens, luteinizing hormone-releasing hormone agonists, and antiandrogens.
5. Chemotherapy
6. Targeted therapy: This uses drugs or other substances to identify and attack specific cancer cells. This is typically safer than chemotherapy and radiation therapy.
7. Immunotherapy: This treatment option uses the patient’s own immune system to combat the cancer cells. Substances already made in the body are brought to a lab and given a boost to help the body attack these cells.
8. Bisphosphonate therapy: This is used to reduce bone disease if the cancer has spread to the bone. This is also taken in conjunction with antiandrogen therapy or orchiectomy as these two hormones increase the risk of bone loss