In the United States, the chances a man has of developing some type of cancer is around 45%. Prostate cancer is the most common cancer diagnosis for men. Research suggests that nearly 1 in 6 men will develop prostate cancer. Under heart disease, cancer is a leading cause of death.
The diagnostic process has been made easier with improvements in testing. Doctors are now able to diagnose prostate cancer much earlier, which has improved patient outcomes. Doctors test for what is called prostate specific antigen, or PSA, which is present in early forms of prostate cancer. When the PSA is very high, it can be a sign of prostate cancer.
What is Prostate Specific Antigen?
Known for short as PSA, it’s a glycoprotein enzyme and has the highest concentration of all the proteins in the prostate. When the body ejaculates semen, it coagulates. PSA is designed to break down that coagulant, and under specific conditions, the enzyme has been observed to leak into the blood.
It can leak into the blood for a few reasons:
- Benign prostate hyperplasia (BPH), or enlargement.
- Malignancy: PSA concentrations are higher in cancer because it has blind-ending ducts that don’t leave the enzyme anywhere else to go.
PSA concentration values
Common questions arising with this new information, of course, are what is a normal PSA value and does it change year to year? Unfortunately, researchers have discovered that no PSA measurement above 0.1 guarantees you are cancer-free or not living with an aggressive tumor.
Instead of using a single value or a range, doctors recommend monitoring PSA levels from year to year. If your PSA level was 4 or less, and if it went up by more than 0.4 annually, it could indicate a problem.
PSA’s impact on outcomes
Prostate cancer has no symptoms at the early curable stages; unfortunately, so this new information has been crucial in increasing positive patient outcomes. Prior to this discovery, men came to see their doctor because they had symptoms such as trouble urinating or bone pain. These symptoms usually presented after the cancer has metastasized, making cure rates significantly lower.
Over the past ten years, we’ve seen the rate of prostate cancer-related deaths drop 33%: more than with any other cancer for men or women. The discovery of PSA has largely contributed to that rate since doctors can now diagnose most patients much earlier when the prostate cancer is still curable.
One should note, however, even with PSA testing, men also need to have digital rectal examinations because around 25% of men will not experience an elevated PSA level when prostate cancer is present.
PSA levels are significantly elevated, now what?
After a doctor suspects a patient has prostate cancer, the diagnosis is confirmed by a biopsy. The specialist will remove small tissue samples in an outpatient procedure with localized anesthetics. A urologist will perform the biopsy because they specialize in diseases related to the urinary tract and sex organs: the organs that are involved with producing and discharging urine. Once the biopsy is performed, it is sent to a pathologist. Pathologists specialize in identifying diseases by studying tissue samples underneath a microscope. The pathologist will check the tissue sample for any signs of cancer.
What is a prostate cancer Gleason Score?
After the biopsy is completed to either confirm or deny the prostate cancer diagnosis, doctors then begin to discuss a grade called the “Gleason Score” with the patient. The Gleason Score indicates how quickly the cancer may spread, or metastasize, outside the gland and how aggressive the prostate cancer likely is. The score will serve the patient’s team as guidance to determine the right course of treatment after the presence of the cancer has been confirmed.
Key facts about the Gleason Score
After the biopsy and the pathologist reviews the tissue sample, the Gleason Score is assigned. Below is a list of what you need to know about this score.
- Determination: The pathologist determines the Gleason Score by looking for cell patterns. Cell patterns in the tissue form in certain ways that indicate how aggressive the cancer is. Cell patterns are assigned a grade between 1 and 5. Level 1 indicates that cells are most similar to healthy cells, whereas a 5 would indicate abnormal cells.
- Multiple patterns: sometimes more than one cell pattern may be found in a tissue sample. If this is the case, the second pattern is given a grade between 1 and 5 as well. The two scores of the patterns that are most common are then put together to give us the final Gleason Score. If only one pattern is present, the level is simply included twice.
- Range: The Gleason Scores can range anywhere from 2 up to 10 for prostate cancer. A 10 indicates a high-risk, high-grade tumor is present.
- Higher Gleason Scores mean higher-grade prostate cancer. High-grade tumors are more likely to grow rapidly and spread more quickly than low-grade tumors.
Gleason Score Breakdown
- 1: The cancerous tissues found look like the normal cells that are typically found in the prostate.
- 2-4: Patterns in these cells vary; some look like regular healthy cells normally found in the prostate, while other cells appear abnormal.
- 5: Most if not all of the cells in the sample are abnormal and are very likely to spread in the prostate haphazardly.
Gleason Scores are incredibly useful tools for pathologists to articulate their findings to doctors and patients clearly so the right treatment plan for the cancer can be developed. It is critical, especially with a higher score, to select the right treatment options to slow down or prevent the progression of the cancer.
A little over 39,000 men in the United States are projected to die annually from prostate cancer. As research on prostate cancer has advanced, it has become apparent that early diagnosis plays a crucial role in patient outcomes. Because prostate cancer is so prevalent in men in the U.S., developing new diagnostic tools like the PSA screening are important. With an increased national interest in advancing diagnostic tools and prostate cancer treatments, more medical developments are to be expected in the future, helping this number to drop. It is estimated that medical treatment for prostate cancer patients costs about $3 billion a year. A movement similar to breast cancer awareness has been developing over the past five or so years, which has had a great impact on the research and development of detection and treatments.