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Diagnosis of Prostate Cancer

Estimates report that prostate cancer is very common and up to 1 out of 6 men will develop prostate cancer. Why is that the case? It seems to be more common as for all cancers. As long as heart disease doesn’t take us in our 60s, we frequently go on to develop all the tumors that occur with aging. The chance that a man living in the United States will develop cancer at some point is now 45% and prostate cancer is the #1 cancer in men.

Improved testing is playing a role. The prostate specific antigen is a tumor marker which enables us to diagnosis prostate cancer at a much earlier and more curable stage. What exactly is PSA? PSA is an enzyme, in this case a glycoprotein, and is made is highest concentration of any protein in the prostate. When semen is ejaculated it coagulates. Prostate specific antigen, or PSA, breaks down the coagulant. Under certain conditions, the PSA enzyme can leak into the blood. One reason is enlargement called benign prostate hyperplasia or BPH. The second reason could be an infection, or it could be malignancy. PSA increases in cancer because the ducts that form PSA are blind ending and it has nowhere else to go.

Doctors are frequently asked what a normal value of PSA is. Is the actual PSA amount important or is it the year to year change? We originally said that a PSA of more than 4 is abnormal. Then we said more than 2.5. We now know that there is no single PSA measurement above 0.1 that says you are free of cancer and free from an aggressive tumor. One way to judge what you should do is to see how your PSA changes from year to year. If a man’s PSA is less than 4 it should not go up more than 0.4 per year. At an early curable stage, prostate cancer produces no symptoms. But men also need a digital rectal examination because the PSA will not be elevated in 25% of men with prostate cancer. Twenty-five years ago before we had PSA, virtually everyone came in because they either had symptoms, problems with urination, or bone pain because the prostate cancer had metastasized to their bones.

Over the past decade, deaths from prostate cancer have fallen 33% which is more than any other cancer in men or women. The reason is that very few men who were diagnosed thirty years ago were curable and those that were curable weren’t offered intervention with techniques such as we have today. Once PSA came along, we could diagnose men when they were curable.

How is prostate cancer diagnosed?

The diagnosis of prostate cancer can be confirmed only by a biopsy. A biopsy is the surgical removal of tissue samples, while under local anesthesia, drugs or substances that cause a loss of feeling or awareness, in a doctor’s office. The biopsy is done by a urologist, a doctor who specializes in diseases of the sex organs and urinary tract, the organs of the body that produce and discharge urine. Then a pathologist, a doctor who identifies diseases by studying tissues under a microscope, checks the patient’s tissue for signs of cancer.

What a Prostate Cancer Gleason Score Means

When prostate cancer is suspected and a biopsy is performed to confirm or deny the diagnosis, men will find their doctors discussing something called a “Gleason Score” with them. This score or grade indicates how aggressive prostate cancer is likely to be and just how quickly it may spread outside the gland. Essentially, a prostate cancer Gleason Score serves as a guideline for helping doctors and their patients determine how to proceed with treatments once the disease has been confirmed.

A Gleason Score is only assigned to a prostate tissue sample following a biopsy and review of tissue by a qualified pathologist. Patients need to know these things about Gleason Scores, what they mean, and how they are determined:

• The range – Gleason Scores for prostate cancer range from 2 to 10 with 10 representing a high-grade, high-risk tumor.

• How they are determined – Gleason Scores are determined by a pathologist after a tissue sample is examined under a microscope. The pathologist will look for cell patterns that are indicative of different levels of aggressiveness. The most common cell patterns found are given a grade of 1 to 5 with 1 being most like healthy cells and 5 representing abnormal cells. Should there be a second most common pattern seen in cells, it will also be given a grade of 1 to 5. The two most common grades are put together to create the resulting score. Should only one pattern be found, the singular score will count twice.

• A high Gleason Score indicates a high-grade prostate cancer. This scoring means that the tumor found is more likely than a low-grade tumor to spread quickly and grow rapidly.

Prostate cancer Gleason Scores are graded based on these observations:

• Gleason Score of 1 – Cancerous tissues look like normal cells found within the prostate.
• Gleason Score of 2-4 – While some cells appear like normal, healthy prostate cells, others do not. The patterns found in cells of these grades may vary.
• Gleason Score of 5 – Cells appear abnormal and not at all like normal, healthy prostate cells. Abnormal cells are likely to be spread throughout the prostate in a haphazard fashion.

Gleason Scores enable pathologists to relay their findings to doctors so that appropriate prostate cancer treatment recommendations can be made. The higher the score, the more aggressive the prostate cancer is likely to be.

With prostate cancer becoming the most prevalent form of cancer in men in the United States, more emphasis has been placed on early diagnosis. An estimated 39,200 American men will die annually of prostate cancer. With increased attention focused on the growing prevalence and monetary cost of prostate cancer, advancements in diagnosis and treatments are evolving and should continue to do so over the coming years. The cost of medical treatment for prostate cancer patients is estimated to be $3 billion annually. Much like the breast cancer awareness movement, a similar effort has been mounted against prostate cancer over the last five years. This has influenced research, development, detection and treatment.