Early detection with PSA blood testing is changing the outlook for men who are diagnosed with prostate cancer. At this point the tumour is usually confined to the prostate gland, so it is highly curable with surgery or radiation therapies.
The diagnosis of prostate cancer may fill you with fear and the feeling that you have to do something immediately. Lukily, because most prostate cancers are slow-growing, time is on your side. When cancer is detected early, you can still learn about how aggressive it is, and then properly assess appropriate treatment strategies with your doctors (of urology, radiotherapy, oncology). By understanding the benefits of each doctor's approach, you will be better equipped to make an informed decision about your next steps.
The prostate, a walnut-sized gland near the neck of the bladder, produces part of the fluid for semen. Prostate cancer is the unchecked growth o abnormal cells within the gland. Researchers don't know why cells becomes cancerous, but a fat-rich diet and the male hormone testoterone are suspected. If the cancer goes undetected, it may spread through the capsule containing the gland and invade nearby nodes and the bladder. Or cells may be carried by the bloodstream to the bones or elsewhere. If this occurs, the cancer is no longer curable but can be controlled for some years with hormonal treatment, radiation, chemotherapy and newer therapies under investigation. Your treatment is based on the stage of the cancer at diagnosis. The classifications below focus on the extent of the tumour (T1 to 4), if it's in the nodes (N) or has metastasised (M).
STAGES OF PROSTATE CANCER
STAGE SPREAD OPTIONS
-----------------------------------------------------------------------------------------------------------------------------------------
T1 Within prostate and detectable only by a PSA Watchful waiting, radical prostatectomy,
blood test radiation.
-----------------------------------------------------------------------------------------------------------------------------------------
T2 Within gland and detectable by digital rectal Radical prostatectomy and/or radiation.
examination.
------------------------------------------------------------------------------------------------------------------------------------------
T3-4 Cancer has spread just beyond the prostate Radiation therapy and/or hormone therapy.
gland.
------------------------------------------------------------------------------------------------------------------------------------------
N Cancer has spread beyond the prostate into one Hormone therapy and/or experimental
(or more) lymph nodes. therapies.
----------------------------------------------------------------------------------------------------------------------------------------
M Cancer has spread to the bones or other locations Experimental therapies, radiation and
in the body. medication for pain.
------------------------------------------------------------------------------------------------------------------------------------------
LIKELY FIRST STEPS
If your cancer is confined to the prostate gland and has not gone beyond the thick envelope of tissue encasing it (called the prostate capsule), ask your doctor if watchful waiting is an option you should consider. Also called expectant management or the 'wait-and-watch approach', this type of therapy is best suited for men with small, low-grade, slow-growing tumours, with Gleason scores between 2 and 4 (see box at right). It may also be a good treatment strategy if you are elderly, too weak to tolerate surgery or radiation therapy or have an additional and more serious medical condition. During watchful waiting, you receive no immediate medical or surgical treatment. Instead, your doctor will carefully monitor your status with DRES and PSA tests every 6 to 12 months. If your PSA levels rise, you must then determine what you want to do next.
UNDERSTANDING YOUR GLEASON SCORE
Your pathologist will use your biopsy sample to determine a Gleason score, a figure from 2 to 10 that grades how cancerous your cells appear. A score of 2 to 4 indicates a low risk that your cancer will grow and spread; 5 to 6 shows an intermediate risk; and 7 to 10, a high risk. Your Gleason score, along with your PSA level, cancer stage and age, are used to determine the best treatment for you.
What is happening
The diagnosis of prostate cancer may fill you with fear and the feeling that you have to do something immediately. Lukily, because most prostate cancers are slow-growing, time is on your side. When cancer is detected early, you can still learn about how aggressive it is, and then properly assess appropriate treatment strategies with your doctors (of urology, radiotherapy, oncology). By understanding the benefits of each doctor's approach, you will be better equipped to make an informed decision about your next steps.
The prostate, a walnut-sized gland near the neck of the bladder, produces part of the fluid for semen. Prostate cancer is the unchecked growth o abnormal cells within the gland. Researchers don't know why cells becomes cancerous, but a fat-rich diet and the male hormone testoterone are suspected. If the cancer goes undetected, it may spread through the capsule containing the gland and invade nearby nodes and the bladder. Or cells may be carried by the bloodstream to the bones or elsewhere. If this occurs, the cancer is no longer curable but can be controlled for some years with hormonal treatment, radiation, chemotherapy and newer therapies under investigation. Your treatment is based on the stage of the cancer at diagnosis. The classifications below focus on the extent of the tumour (T1 to 4), if it's in the nodes (N) or has metastasised (M).
STAGES OF PROSTATE CANCER
STAGE SPREAD OPTIONS
-----------------------------------------------------------------------------------------------------------------------------------------
T1 Within prostate and detectable only by a PSA Watchful waiting, radical prostatectomy,
blood test radiation.
-----------------------------------------------------------------------------------------------------------------------------------------
T2 Within gland and detectable by digital rectal Radical prostatectomy and/or radiation.
examination.
------------------------------------------------------------------------------------------------------------------------------------------
T3-4 Cancer has spread just beyond the prostate Radiation therapy and/or hormone therapy.
gland.
------------------------------------------------------------------------------------------------------------------------------------------
N Cancer has spread beyond the prostate into one Hormone therapy and/or experimental
(or more) lymph nodes. therapies.
----------------------------------------------------------------------------------------------------------------------------------------
M Cancer has spread to the bones or other locations Experimental therapies, radiation and
in the body. medication for pain.
------------------------------------------------------------------------------------------------------------------------------------------
- Develop a thorough understanding of all available therapies, including surgery and radiation.
- If a procedure is needed, seek out the most experienced doctor for your treatment, whether a urologist or a radiation oncologist.
- Continue to work with your doctor as a team to map out your strategies for a cure.
- Mobile support with family, friends, a counsellor or a support group.
QUESTIONS TO ASK
- What is my PSA? What is my Gleason score?
- What is your best estimate as to the aggressiveness of my cancer? What is its stage?
- Am I a good candidate for watchful waiting? Or do I need prompt treatment?
- How many surgical/radiation procedures do you perform weekly? What are your cure rates?
- What are the side effects of each treatment?
- Am I good candidate for 'seed' therapy?
LIFESTYLE CHANGES
------------------------------------------------------------------------------------------------------------------------------------------
Watchful waiting Regular examinations, blood tests, for early stage.
------------------------------------------------------------------------------------------------------------------------------------------
Find support Helps deal with emotional and practical issues.
-------------------------------------------------------------------------------------------------------------------------------------------
Rethink your habits Try a vegan diet, no alcohol, meditation.
PROCEDURES
------------------------------------------------------------------------------------------------------------------------------------------
Surgery Radical prostatectomy removes gland/nodes
---------------------------------------------------------------------------------------------------------------------------------------------
Radiation Various forms; used with and without surgery.
---------------------------------------------------------------------------------------------------------------------------------------------
Brachytherapy Radioactive 'seeds' implanted in gland.
MEDICATIONS
---------------------------------------------------------------------------------------------------------------------------------------------
Hormone therapy Blocks androgens to inhibit tumour growth.
In Australia and New Zealand, prostate cancer is the most common cancer in men and the third most common cause of death from cancer. The likelihood of developing prostate cancer increases with age: the average age of diagnosis is 72 years. Thanks to the recently developed prostate-specific antigen (PSA) blood test, doctors are now commonly finding prostate cancer at the earliest stage and their ability to cure it at this time is much better than in later stages.
TAKING CONTROL
------------------------------------------------------------------------------------------------------------------------------------------
Watchful waiting Regular examinations, blood tests, for early stage.
------------------------------------------------------------------------------------------------------------------------------------------
Find support Helps deal with emotional and practical issues.
-------------------------------------------------------------------------------------------------------------------------------------------
Rethink your habits Try a vegan diet, no alcohol, meditation.
PROCEDURES
------------------------------------------------------------------------------------------------------------------------------------------
Surgery Radical prostatectomy removes gland/nodes
---------------------------------------------------------------------------------------------------------------------------------------------
Radiation Various forms; used with and without surgery.
---------------------------------------------------------------------------------------------------------------------------------------------
Brachytherapy Radioactive 'seeds' implanted in gland.
MEDICATIONS
---------------------------------------------------------------------------------------------------------------------------------------------
Hormone therapy Blocks androgens to inhibit tumour growth.
In Australia and New Zealand, prostate cancer is the most common cancer in men and the third most common cause of death from cancer. The likelihood of developing prostate cancer increases with age: the average age of diagnosis is 72 years. Thanks to the recently developed prostate-specific antigen (PSA) blood test, doctors are now commonly finding prostate cancer at the earliest stage and their ability to cure it at this time is much better than in later stages.
TAKING CONTROL
- Talk over your options. Don't be embarrassed. The best treatment evolves when you involve family members and various medical practitioners in the discussion.
- Take your time to decide. In most cases, prostate cancer is slow-growing, leaving you time to plan a counterattack.
- Seek different opinions. Get advice from various specialists including a urologist and an oncologist. Be as informed as possible.
Treatments
Prostate cancer rarely produces symptoms, so the first indication of the disease is often found when you have a routine digital rectal examination or DRE (see on later), or a PSA screening test (see on later). A positive prostate biopsy is certainly disturbing. When detected early, however, prostate cancer is usually curable with either surgery or one of a variety or radiation therapies.
Lifestyle changesProstate cancer rarely produces symptoms, so the first indication of the disease is often found when you have a routine digital rectal examination or DRE (see on later), or a PSA screening test (see on later). A positive prostate biopsy is certainly disturbing. When detected early, however, prostate cancer is usually curable with either surgery or one of a variety or radiation therapies.
If your cancer is confined to the prostate gland and has not gone beyond the thick envelope of tissue encasing it (called the prostate capsule), ask your doctor if watchful waiting is an option you should consider. Also called expectant management or the 'wait-and-watch approach', this type of therapy is best suited for men with small, low-grade, slow-growing tumours, with Gleason scores between 2 and 4 (see box at right). It may also be a good treatment strategy if you are elderly, too weak to tolerate surgery or radiation therapy or have an additional and more serious medical condition. During watchful waiting, you receive no immediate medical or surgical treatment. Instead, your doctor will carefully monitor your status with DRES and PSA tests every 6 to 12 months. If your PSA levels rise, you must then determine what you want to do next.
UNDERSTANDING YOUR GLEASON SCORE
Your pathologist will use your biopsy sample to determine a Gleason score, a figure from 2 to 10 that grades how cancerous your cells appear. A score of 2 to 4 indicates a low risk that your cancer will grow and spread; 5 to 6 shows an intermediate risk; and 7 to 10, a high risk. Your Gleason score, along with your PSA level, cancer stage and age, are used to determine the best treatment for you.
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