A Biopsy Is Done To Diagnose Prostate Cancer And Find Out The Grade Of The Cancer
A transrectal biopsy is used to diagnose prostate cancer. A transrectal biopsy is the removal of tissue from the prostate by inserting a thin needle through the rectum and into the prostate. This procedure may be done using transrectal ultrasound or transrectal MRI to help guide where samples of tissue are taken from. A pathologist views the tissue under a microscope to look for cancer cells.
Sometimes a biopsy is done using a sample of tissue that was removed during a transurethral resection of the prostate to treat benign prostatic hyperplasia.
If cancer is found, the pathologist will give the cancer a grade. The grade of the cancer describes how abnormal the cancer cells look under a microscope and how quickly the cancer is likely to grow and spread. The grade of the cancer is called the Gleason score.
To give the cancer a grade, the pathologist checks the prostate tissue samples to see how much the tumor tissue is like the normal prostate tissue and to find the two main cell patterns. The primary pattern describes the most common tissue pattern, and the secondary pattern describes the next most common pattern. Each pattern is given a grade from 3 to 5, with grade 3 looking the most like normal prostate tissue and grade 5 looking the most abnormal. The two grades are then added to get a Gleason score.
Drugs To Treat Cancer Spread To Bone
If prostate cancer spreads to other parts of the body, it almost always goes to the bones first. These areas of cancer spread can cause pain and weak bones that might break. Medicines that can help strengthen the bones and lower the chance of fracture are bisphosphonates and denosumab. Sometimes, radiation, radiopharmaceuticals, or pain medicines are given for pain control.
Side effects of bone medicines
A serious side effect of bisphosphonates and denosumab is damage to the jaw, also called osteonecrosis of the jaw . Most people will need to get approval from their dentist before starting one of these drugs.
Prostate Cancer Treatment: Chemotherapy
Chemotherapy is designed to kill fast-growing cancer cells anywhere in the body so it is often used when aggressive prostate cancer cells metastasize to other body sites. Usually, chemotherapy is given through a special intravenous line in a series of treatments over several months. There have been new advances in both the hormonal and chemotherapy treatment of prostate cancer. Unfortunately, chemotherapy often kills other fast-growing body cells like hair cells, mucosal cells, and cells that line the gastrointestinal tract. This can result in several unwanted side effects.
Prostate Cancer Chemotherapy Side Effects
- Hair loss
- Other body ailments
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Prostate Cancer Screening Guidelines
Although screening tests are not routinely done for prostatic cancers, the American Cancer Society guidelines suggest some men should be screened.
Screening Guidelines Based on Age and Risk
- Men aged 40 with more than one close relative diagnosed with prostate cancer at an early age
- Men aged 45 that are African American or have a father, brother, or son diagnosed with prostate cancer before age 65
- Men aged 50 or older who have average risk and expect to live at least 10 more years
However, not everyone agrees with these guidelines clinicians should explain that treatments can have severe side effects, may have little or no effects on the cancer, and that some cancers are so slow-growing.
Questions To Ask The Doctor
- What treatment do you think is best for me?
- Whats the goal of this treatment? Do you think it could cure the cancer?
- Will treatment include surgery? If so, who will do the surgery?
- What will the surgery be like?
- Will I need other types of treatment, too?
- Whats the goal of these treatments?
- What side effects could I have from these treatments?
- What can I do about side effects that I might have?
- Is there a clinical trial that might be right for me?
- What about special vitamins or diets that friends tell me about? How will I know if they are safe?
- How soon do I need to start treatment?
- What should I do to be ready for treatment?
- Is there anything I can do to help the treatment work better?
- Whats the next step?
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What You Can Do
Its important that you learn all you can about advanced prostate cancer so you can make informed decisions. Be open with your doctors and others on your healthcare team. Express your concerns and feel free to advocate for yourself and your quality of life. Get another medical opinion if you feel its necessary.
Some complementary therapies may prove helpful in coping with advanced cancer. For example:
- tai chi, yoga, or other movement therapy
- music therapy
- meditation, breathing exercises, or other relaxation techniques
A variety of services can help you with everything from lodging while youre getting treatment to getting some help around the house. Communicating with online or in-person groups are a good way to share information and lend mutual support.
Testing For Prostate Cancer Metastasis
After your biopsy, additional tests or imaging may be performed to check for cancer spread, though these are not required in all men with newly diagnosed prostate cancer.
You may need additional tests if you have:
- High PSA levels
- Extensive prostate involvement on biopsy
- High Gleason scores
- Computed tomography scans of your abdomen and pelvis
- Bone scans
- Magnetic resonance imaging of your pelvis
Many centers, including SCCA, are testing other means of finding cancer spread using new types of positron emission tomography scans. Sometimes lymph nodes around the prostate may be checked for metastasis in order to design treatment appropriately.
At SCCA and University of Washington Medical Center, a long-term effort has identified cells in the bone marrow that originated from prostate cancer, even in the absence of other evidence of spread. With these and other studies being offered to men with advanced prostate cancer, we hope to find ways to identify men at the highest risk of relapse so this knowledge can inform our treatment recommendations.
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Does It Matter Where Treatment Is Performed
A large body of evidence shows that in the case of surgery for prostate cancer, surgical experience matters greatly. Medical centers and surgeons performing a high number of prostatectomies per year demonstrate better outcomes in terms of both cancer control and quality of life than those performing relatively low numbers. We don’t have similar data regarding radiation outcomes, but performing brachytherapy well certainly requires expertise and experience, particularly in prostate ultrasound. Planning and administering EBRT effectively has many subtleties, which likely translate to better outcomes with more experienced doctors. No matter what the practice volume of specific surgeons or radiation oncologists, they should be able to discuss their own demonstrated outcomes both in terms of cancer control and quality of life.
Eight Types Of Standard Treatment Are Used:
Watchful waiting or active surveillance
Watchful waiting and active surveillance are treatments used for older men who do not have signs or symptoms or have other medical conditions and for men whose prostate cancer is found during a screening test.
Active surveillance is closely following a patient’s condition without giving any treatment unless there are changes in test results. It is used to find early signs that the condition is getting worse. In active surveillance, patients are given certain exams and tests, including digital rectal exam, PSA test, transrectal ultrasound, and transrectal needle biopsy, to check if the cancer is growing. When the cancer begins to grow, treatment is given to cure the cancer.
Other terms that are used to describe not giving treatment to cure prostate cancer right after diagnosis are observation, watch and wait, and expectant management.
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How Prostate Cancer Staging Is Done
Initial staging is based on the results of PSA blood tests, biopsies, and imaging tests. This is also called clinical staging.
PSA refers to a protein made by the prostate measured by a lab test.
- A higher level of PSA can indicate a more advanced cancer.
- The doctors will also look at how fast the PSA levels have been increasing from test to test. A faster increase could show a more aggressive tumor.
A prostate biopsy is done in your doctor’s office. The results can indicate:
- How much of the prostate is involved.
- The Gleason score. A number from 2 to 10 that shows how closely the cancer cells look like normal cells when viewed under a microscope. Scores 6 or less suggest the cancer is slow growing and not aggressive. Higher numbers indicate a faster growing cancer that is more likely to spread.
What Is The Treatment For Advanced Prostate Cancer
No matter where prostate cancer spreads, its still treated as prostate cancer. Its harder to treat when it reaches an advanced stage.
Treatment for advanced prostate cancer involves targeted and systemic therapies. Most men need a combination of treatments and they may have to be adjusted from time to time.
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Joining A Clinical Trial
Clinical trials are medically supervised, carefully controlled patient studies that attempt to determine whether a proposed new treatment is both safe and effective. Clinical trials also look at whether a new treatment can lead to better outcomes than existing treatments. These studies may involve researchers from a variety of disciplines, such as general medicine, medical specialties, genetics, biology, chemistry, engineering and psychology. Clinical trials are conducted at medical centers around the country, and participants are often actively recruited.
New treatments are continually being developed for prostate cancer. Many prostate cancer trials are designated for patients with a rising PSA after local treatment or for those with advanced, metastatic cancers. However, there are also many trials for men with less aggressive cancer, such as the active surveillance trials at UCSF. We also conduct trials of neoadjuvant treatment, which are medications given before surgery for higher-risk prostate cancer. Several new treatments and approaches show promise some as simple as lifestyle changes in diet and exercise.
Funding sources for clinical trials include the National Cancer Institute, Department of Defense, universities and medical centers, private research foundations, pharmaceutical and biotechnology companies, and various combinations of these groups.
Clinical trials usually occur in phases:
Is Active Surveillance Right For You
There are some risks associated with active surveillance. They include a low risk of infection with every biopsy and a very low risk of cancer progressing in any one interval of surveillance. Sometimes men choose active surveillance for a period of time and then decide to undergo treatment.
Thousands of UCSF patients have chosen active surveillance to initially manage their prostate cancer. This is one of the largest groups of patients on active surveillance in the world. About one-third of these men receive treatment by five years and 50% by 10 years. The window of opportunity to cure prostate cancer is usually measurable in years or even decades. In fact, treatment results for these men appear to be similar to what would have been expected had they chosen treatment right after their original diagnosis. Based on our experience and those reported from other centers, the risk of significant cancer progression in the short to intermediate term, while not zero, appears to be very low.
Some men with risk factors such as family history, genetic mutations and being African American may still be candidates for active surveillance but need a more careful or intense surveillance regimen to make sure any early signs of progression are identified.
The most common reason for seeking treatment is a biopsy that shows the cancer is growing or becoming more aggressive in appearance . Changes in PSA or cancer stage based on imaging results may also lead to treatment.
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Biopsy And Gleason Score
A pathologist looks for cell abnormalities and “grades” the tissue sample from 1 to 5. The sum of two Gleason grades is the Gleason score. These scores help determine the chances of the cancer spreading. Gleason grades of 1 and 2 are not usually given in biopsies, so 6 is typically the lowest score for a prostate cancer. Cancer with Gleason scores of 8 to 10 is called high-grade, and can grow and spread more quickly. Gleason scores help guide the type of treatment your doctor will recommend.
There Are Different Types Of Treatment For Patients With Prostate Cancer
Different types of treatment are available for patients withprostate cancer. Some treatments are standard , and some are being tested in clinical trials. A treatment clinical trial is a research study meant to help improve current treatments or obtain information on new treatments for patients with cancer. When clinical trials show that a new treatment is better than the standard treatment, the new treatment may become the standard treatment. Patients may want to think about taking part in a clinical trial. Some clinical trials are open only to patients who have not started treatment.
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The Grade Group And Psa Level Are Used To Stage Prostate Cancer
The stage of the cancer is based on the results of the staging and diagnostic tests, including the prostate-specific antigen test and the Grade Group. The tissue samples removed during the biopsy are used to find out the Gleason score. The Gleason score ranges from 2 to 10 and describes how different the cancer cells look from normal cells under a microscope and how likely it is that the tumor will spread. The lower the number, the more cancer cells look like normal cells and are likely to grow and spread slowly.
The Grade Group depends on the Gleason score. See the General Information section for more information about the Gleason score.
- Grade Group 1 is a Gleason score of 6 or less.
- Grade Group 2 or 3 is a Gleason score of 7.
- Grade Group 4 is a Gleason score 8.
- Grade Group 5 is a Gleason score of 9 or 10.
The PSA test measures the level of PSA in the blood. PSA is a substance made by the prostate that may be found in an increased amount in the blood of men who have prostate cancer.
What Are Prostate Cancer Treatment Side Effects
Some prostate cancer treatments can affect the bladder, erectile nerves and sphincter muscle, which controls urination. Potential problems include:
- Incontinence: Some men experience urinary incontinence. You may leak urine when you cough or laugh, or you may feel an urgent need to use the bathroom even when your bladder isnt full. This problem can improve over the first six to 12 months without treatment.
- Erectile dysfunction : Surgery, radiation and other treatments can damage the erectile nerves and affect your ability to get or maintain an erection. Some men regain erectile function within a year or two . In the meantime, medications like sildenafil or tadalafil can help by increasing blood flow to the penis.
- Infertility: Treatments can affect your ability to produce or ejaculate sperm, resulting in male infertility. If you think you might want children in the future, you can preserve sperm in a sperm bank before you start treatments. After treatments, you may undergo sperm extraction. This procedure involves removing sperm directly from testicular tissue and implanting it into a womans uterus.
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Can Prostate Cancer Be Found Early
Screening tests are available to find prostate cancer early, but government guidelines don’t call for routine testing in men at any age. The tests may find cancers that are so slow-growing that medical treatments would offer no benefit. And the treatments themselves can have serious side effects. The American Cancer Society advises men to talk with a doctor about screening tests, beginning at:
- Age 50 for average-risk men who expect to live at least 10 more years
- Age 45 for men at high risk this includes African-Americans and those with a father, brother, or son diagnosed before age 65
- Age 40 for men with more than one first-degree relative diagnosed at an early age
The U.S.Preventive Services Task Force says that testing may be appropriate for some men age 55 â 69. They recommend that men talk to their doctor to discuss the potential risks and benefits of being tested.
Prostate Cancer Treatment Decisions
Once your doctor has all the results from diagnostic testing, you can plan a course of action. For some men, this may be no action. This optionwatchful waitingmeans delaying treatment until the tumor causes symptoms. Certain men with slow-growing and low-grade tumors that are not causing bothersome symptoms may choose this approach with the doctors consent. The goal is to avoid treatments you dont need. Another option is active surveillance, which involves more closely monitoring the disease to see if it is progressing. You would have regular blood tests and a biopsy within a year of diagnosis.
Both watchful waiting and active surveillance can be stressful for some men. Also, there is no strict definition or consensus among doctors as to what the terms mean. For some doctors, watchful waiting and active surveillance mean the same thing and you are continually monitored for any changeseither that you notice through your symptoms or that the doctor can determine with PSA tests and biopsies. If your preference is to treat the cancer, talk with your doctor about your treatment options.
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