What Does Prostate Cancer Mean

What Does It Mean If You Have Metastatic Prostate Cancer

ANSWER

If your prostate cancer spreads to other parts of your body, your doctor may tell you that it’s “metastatic” or that your cancer has “metastasized.”

Most often, prostate cancer spreads to the bones or lymph nodes. It’s also common for it to spread to the liver or lungs. It’s rarer for it to move to other organs, such as the brain.

It’s still prostate cancer, even when it spreads.

CancerCare: “Living With Metastatic Prostate Cancer,” “Caring for Your Bones When You Have Prostate Cancer.”

National Cancer Institute: “Metastatic Cancer.”

American Cancer Society: “What is advanced cancer?” “What is metastatic cancer?” “Can advanced or metastatic cancer be prevented?” “What’s New on Prostate Cancer Research? Topics,” “Prostate cancer that remains or recurs after treatment.”

CancerCare: “Living With Metastatic Prostate Cancer,” “Caring for Your Bones When You Have Prostate Cancer.”

National Cancer Institute: “Metastatic Cancer.”

American Cancer Society: “What is advanced cancer?” “What is metastatic cancer?” “Can advanced or metastatic cancer be prevented?” “What’s New on Prostate Cancer Research? Topics,” “Prostate cancer that remains or recurs after treatment.”

• What is advanced prostate cancer?

This tool does not provide medical advice. See additional information.

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Understanding Your Pathology Report: Prostate Cancer

When your prostate was biopsied, the samples taken were studied under the microscope by a specialized doctor with many years of training called a pathologist. The pathologist sends your doctor a report that gives a diagnosis for each sample taken. Information in this report will be used to help manage your care. The questions and answers that follow are meant to help you understand medical language you might find in the pathology report from your prostate biopsy.

How Prostate Cancer Spreads And Progresses

Prostate cancer grows within the prostate gland, often for many years. Over time, the cancer spreads outside the prostate. This happens in one of three ways:

• It grows into nearby tissues
• It spreads through your system of lymph nodes and lymph vessels
• It travels to distant tissues through your blood

Prostate cancer stages describe how far the cancer has spread.

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What Is The Gleason Grade Or Gleason Score What Do The Numbers In The Gleason Score Mean For Example 3+4=7 Or 3+3=6

Pathologists grade prostate cancers using numbers from 1 to 5 based on how much the cells in the cancerous tissue look like normal prostate tissue under the microscope. This is called the Gleason system. Grades 1 and 2 are not often used for biopsies most biopsy samples are grade 3 or higher.

• If the cancerous tissue looks much like normal prostate tissue, a grade of 1 is assigned.
• If the cancer cells and their growth patterns look very abnormal, a grade of 5 is assigned.
• Grades 2 through 4 have features in between these extremes.

Since prostate cancers often have areas with different grades, a grade is assigned to the 2 areas that make up most of the cancer. These 2 grades are added to yield the Gleason score . The highest a Gleason score can be is 10.

The first number assigned is the grade that is most common in the tumor. For example, if the Gleason score is written as 3+4=7, it means most of the tumor is grade 3 and less is grade 4, and they are added for a Gleason score of 7. Other ways that this Gleason score may be listed in your report are Gleason 7/10, Gleason 7 , or combined Gleason grade of 7.

If a tumor is all the same grade , then the Gleason score is reported as 3+3=6.

The higher the Gleason score, the more likely it is that your cancer will grow and spread quickly.

How Common Is Prostate Cancer

About one in nine men will receive a prostate cancer diagnosis during his lifetime. Prostate cancer is second only to skin cancer as the most common cancer affecting males. Close to 200,000 American men receive a diagnosis of prostate cancer every year. There are many successful treatments and some men dont need treatment at all. Still, approximately 33,000 men die from the disease every year.

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The Gleason Score: What Does It Mean

• What is the new condensed grading system?

The Gleason score functions as a measurement of the aggressiveness of prostate cancer.

Aggressiveness is the medical term used to describe the likelihood of the tumor spreading outside the prostate gland.

You will get receive a Gleason score after having a prostate biopsy.

Your doctor may recommend a biopsy if your PSA level rises or there is cause for concern after your annual checkup or a digital rectal exam , such as an increase in prostate volume or nodules and legions.

Modern biopsies are typically performed using transrectal ultrasound guidance, whereas older methods were unassisted these are called random needle biopsies. By using ultrasound guidance, the doctor can take a more accurate and evenly distributed sample from the prostate gland.

Normally twelve separate cores are extracted. After which they are sent to a laboratory.

At the laboratory, a pathologist examines the tissue cores using a microscope to see if they contain cancerous cells.

If the pathologist finds evidence of prostate cancer cells in the sample, he will attempt to match your samples with Gleason guidelines. These guidelines are scored between one and five.

Your Gleason score is made up of two of these guidelines, and therefore, your score can range from two to ten.

It is then put into a pathology report sometimes called a biopsy report, that will be sent to your primary care physician.

For more information on prostate biopsies click here.

Stages Of Prostate Cancer

Doctors combine the T, N, and M results with the Gleason score and PSA level in a process called stage grouping. The system uses Roman numerals from I to IV . The stage helps your doctor choose the best course of treatment for you.

Stage I

• The cancer is growing in your prostate but hasnât spread beyond it.
• In most cases, the doctor canât feel the tumor during a DRE or see it in imaging tests.
• The Gleason score is 6 or less, and the PSA level is less than 10.
• The tumor is in half or less of one side of the prostate.

Stage IIA

• The cancer is growing in your prostate but hasnât spread beyond it.
• The doctor may or may not be able to feel the tumor during a DRE or see it on an imaging test.
• The tumor can touch more than half of one lobe of the prostate but doesnât involve both lobes.
• The Gleason score is 7 or less, and the PSA level is less than 20.

Stage IIB

• The cancer is growing in your prostate but hasnât spread beyond it.
• The doctor may or may not be able to feel the tumor during a DRE or see it on an imaging test.
• The tumor can be in one or both lobes of the prostate.
• The Gleason score is 7, and the PSA level is less than 20.

Stage IIC

• The cancer hasn’t spread beyond the prostate.
• The doctor may or may not be able to feel the tumor during a DRE or see it on an imaging test.
• The tumor can be in one or both lobes of the prostate.
• The Gleason score is 7 or 8, and the PSA level is less than 20.
• The cancer cells appear more abnormal than in stage IIB.

Stage IIIA

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Can Too Much Sex Cause Prostate Cancer

There are many myths about why prostate cancer develops. However, there is no evidence that “too much sex,” masturbation, benign prostatic hyperplasia , or a vasectomy increases the risk or causes prostate cancer. Current research is investigating if STDs, prostatitis, or alcohol use increase the risk of developing prostate cancer.

Hope For Advanced Cancer

Your doctor will continue to monitor your PSA levels and may perform other tests after treatment for prostate cancer. If it recurs or spreads to other parts of the body, additional treatment may be recommended. Lifestyle choices may matter, too. One study found that prostate cancer survivors who exercised regularly had a lower risk of dying, for example.

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What Is The Psa Test

Prostate-specific antigen, or PSA, is a protein produced by normal, as well as malignant, cells of the prostate gland. The PSA test measures the level of PSA in a mans blood. For this test, a blood sample is sent to a laboratory for analysis. The results are usually reported as nanograms of PSA per milliliter of blood.

The blood level of PSA is often elevated in men with prostate cancer, and the PSA test was originally approved by the US Food and Drug Administration in 1986 to monitor the progression of prostate cancer in men who had already been diagnosed with the disease. In 1994, FDA approved the use of the PSA test in conjunction with a digital rectal exam to test asymptomatic men for prostate cancer. Men who report prostate symptoms often undergo PSA testing to help doctors determine the nature of the problem.

In addition to prostate cancer, a number of benign conditions can cause a mans PSA level to rise. The most frequent benign prostate conditions that cause an elevation in PSA level are prostatitis and benign prostatic hyperplasia . There is no evidence that prostatitis or BPH leads to prostate cancer, but it is possible for a man to have one or both of these conditions and to develop prostate cancer as well.

What Is Localized Prostate Cancer

Localized prostate cancer is cancer that is only inside your prostate gland and has not spread to other parts of your body. The prostate is a gland in men about the size of a walnut. It makes and stores the liquid that carries sperm.

The prostate is near the bladder and rectum . It is just below the bladder and surrounds the upper part of the urethra .

Most men with localized prostate cancer have few or no symptoms. Possible symptoms can include:

• Problems when you urinate
• Pain in your lower back
• Pain when you ejaculate
• Blood in your urine

Note

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Functional Outcomes And Quality Of Life After Treatment For Localized Prostate Cancer

At 15 years after treatment of localized prostate cancer diagnosed in 1994â1995, declines in urinary, sexual, and bowel function were common. These functional declines in quality of life occur to a significantly greater extent among those that undergo treatment for prostate cancer as compared to a normative aging population without a diagnosis of prostate cancer, and symptom distress is more common among men with prostate cancer that are treated compared to those not treated. In a contemporary study of quality of life after treatment for localized prostate cancer, the authors reported that a substantial proportion of men did not return to baseline function in the domains of bowel, sexual, and urinary function that changes in quality of life domains were treatment specific and that patient and partner outcome satisfaction were closely associated with changes in quality of life after treatment. Thus, treatment for prostate cancer commonly results in quality of life changes that affect both the patient and his partner.

What Does It Mean If My Biopsy Mentions That There Is Perineural Invasion

Perineural invasion means that cancer cells were seen surrounding or tracking along a nerve fiber within the prostate. When this is found on a biopsy, it means that there is a higher chance that the cancer has spread outside the prostate. Still, perineural invasion doesnt mean that the cancer has spread, and other factors, such as the Gleason score and amount of cancer in the cores, are more important. In some cases, finding perineural invasion may affect treatment, so if your report mentions perineural invasion, you should discuss it with your doctor.

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Gleason Score For Grading Prostate Cancer

Prostate cancer is also given a grade called a Gleason score. This score is based on how much the cancer looks like healthy tissue when viewed under a microscope. Less aggressive tumors generally look more like healthy tissue. Tumors that are more aggressive are likely to grow and spread to other parts of the body. They look less like healthy tissue.

The Gleason scoring system is the most common prostate cancer grading system used. The pathologist looks at how the cancer cells are arranged in the prostate and assigns a score on a scale of 3 to 5 from 2 different locations. Cancer cells that look similar to healthy cells receive a low score. Cancer cells that look less like healthy cells or look more aggressive receive a higher score. To assign the numbers, the pathologist determines the main pattern of cell growth, which is the area where the cancer is most obvious, and then looks for another area of growth. The doctor then gives each area a score from 3 to 5. The scores are added together to come up with an overall score between 6 and 10.

Gleason scores of 5 or lower are not used. The lowest Gleason score is 6, which is a low-grade cancer. A Gleason score of 7 is a medium-grade cancer, and a score of 8, 9, or 10 is a high-grade cancer. A lower-grade cancer grows more slowly and is less likely to spread than a high-grade cancer.

Prostate Cancer Treatment: Watch And Wait

“Watch and wait,” is a phrase that is being used more frequently to describe a program of active surveillance without other cancer treatment for some patients with prostate cancer. It means that if your cancer is not aggressive , treatments may be deferred and your condition periodically checked. This approach is used because the risks of urinary and sexual problems inherent in most prostate cancer treatments are serious and may be put off or avoided if the cancer is not aggressive. However, aggressive prostatic cancer is usually treated even if secondary complications of treatments are serious.

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Living With Prostate Cancer

• Connect with members of the Inspire Prostate Cancer Community.

• Join an online or in-person support group, and seek mental health counseling.

• See a dietitian to improve your diet and address treatment side effects like loss of appetite and nausea.

• See a palliative care specialist if you have pain or lingering treatment side effects.

From the community: I was diagnosed with stage four with a spot on the spine and was put on Lupron. A little later I had radiation to the prostate and spine. Some time later I had chemotherapy. More recently I had radiation to a new pelvic lymph node. My PSA is now undetectable and I have a good quality of life. Inspire member

From the community: My story. After being diagnosed with prostate cancer I elected radiation… Numbers went down and held … Had a pet scan , bone scan, body scan … The pet scan showed hot only in my prostate. The Lungs came back with spots and enlarged lymph nodes. Had a 6 month chest scan and it showed changes from 6 months ago. Had a Lung biopsy and unfortunately it came back positive for prostate. So its in my blood. Stage 4. My uncologist is scheming me for my first Lupron on the 19th. With a secondary drug called Apalutamide. Would appreciate any responses from folks with similar journeys. Comments on alternatives, side effects,, longevity , etc. Inspire member

Screening For Prostate Cancer

There are no tests available with sufficient accuracy to screen populations of men for early signs of prostate cancer. However, early detection and treatment can significantly improve prostate cancer survival.

The test most commonly used to aid early detection of prostate cancer is the prostate specific antigen blood test. This is not a diagnostic test as it can only indicate changes in the prostate. If you are concerned about prostate cancer you should talk to your doctor and make an informed choice about whether to have one of the tests designed to find early signs of prostate cancer, in view of the potential risks and benefits.

There are no proven measures to prevent prostate cancer.

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Should I Try A Clinical Trial

Researchers are actively conducting clinical trials to find better ways to treat metastatic prostate cancer and stop cancer spread. Many prostate cancer clinical trials focus on new therapies that target gene changes, as well as immunotherapies and chemotherapies.

Your doctor can help you determine if you might benefit from a clinical trial.

What Does It Mean If In Addition To Cancer My Biopsy Report Also Mentions Acute Inflammation Or Chronic Inflammation

Inflammation of the prostate is called prostatitis. Most cases of prostatitis reported on biopsy are not caused by infection and do not need to be treated. In some cases, inflammation may increase your PSA level, but it is not linked to prostate cancer. The finding of prostatitis on a biopsy of someone with prostate cancer does not affect their prognosis or the way the cancer is treated.

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Active Surveillance Of Prostate Cancer

Active surveillance is a management option for localized that can be offered to appropriate patients who would also be candidates for aggressive local therapies , with the intent to intervene if the disease progresses. Active surveillance should not be confused with , another observational strategy for men that would not be candidates for curative therapy because of a limited life expectancy. Active surveillance offers men with a prostate cancer that is thought to have a low risk of causing harm in the absence of treatment, a chance to delay or avoid aggressive treatment and its associated side effects.While prostate cancer is the most common non cutaneous cancer and second leading cause of cancer-related death in American men, it is conservatively estimated that approximately 100,000 men per year in the United States who would be eligible for conservative treatment through active surveillance, undergo unnecessary treatments. The management of localized prostate cancer is controversial and men with localized disease diagnosed today often undergo treatments with significant side effects that will not improve overall health outcomes. The 2011 NIH State-of-the-Science Conference Statement on the “Role of active surveillance in the management of men with localized prostate cancer” pointed out the many unanswered questions about observational strategies for prostate cancer that require further research and clarification. These included: