Understanding Your Prostate Cancer Diagnosis
By Wyatt Myers | Medically reviewed by Pat F. Bass III, MD, MPH
There's no question that a prostate cancer diagnosis can be overwhelming and confusing. Gain a greater understanding of your condition to get a clearer picture of your health.
With more than 200,000 new cases a year, prostate cancer is one of the most common cancers among men. Despite its common occurrence, nothing can truly prepare you for the emotional toll that a prostate cancer diagnosis takes on you. "The issues that a patient has to deal with are, of course, first and foremost the anxiety created by having been given the diagnosis of cancer," says Brian Miles, MD, a urologist at the Methodist Cancer Center in Houston. "This is something nobody wants to hear. I spend a lot of time reassuring the patient and educating them about the disease and how to manage it."
Adding to the anxiety about a prostate cancer diagnosis is the fact that often the diagnosis itself can be a bit confusing. Prostate cancer terminology, for example, can be hard to follow, and the different prostate cancer stages can be hard to understand.
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The best approach is to spend the necessary time with your doctor to become educated and informed about everything you need to know about the disease and the stage you're in. "I make myself very available to get patients to (a) understand the disease and treatment options, (b) be very comfortable with the potential complications that could occur, and (c) how we would manage those complications so that there are no surprises down the road for the patient," says Dr. Miles. "After a lengthy consultation, most patients become very comfortable with the whole process."
The following will give you a better understanding of your prostate cancer diagnosis and how treatment works.
Prostate Cancer Diagnosis and Terminology
The first tool that doctors use in a prostate cancer diagnosis is the PSA test, or prostate specific antigen screening. This is a blood test that doctors often perform, along with a rectal exam, usually starting at about age 50. "An antigen is a protein marker produced by cells in the body, and prostate specific antigen is one that is only produced by prostate cells," says Miles. "Elevated levels of PSA raise concerns about the possibility of prostate cancer in patients. The higher the PSA, the greater the chance of cancer. For instance, with a PSA between 4 and 10, the risk of having cancer is about 1 in 3; between 10 and 20, 1 in 2; and so on. When a patient has an elevated PSA, we recommend a prostate biopsy."
If your doctor determines that a biopsy is needed, then your attention will often turn to two new measurements: a Gleason score from your biopsy and the results of an imaging or CT scan. "The Gleason score gives an idea of how aggressive the prostate cancer cells are," says Veda N. Giri, MD, a medical oncologist with the Fox Chase Cancer Center in Philadelphia. "Once prostate cancer is diagnosed, then patients may undergo imaging (typically CT scan and bone scan) to get an idea of how far the cancer may have spread. This will determine the stage of prostate cancer, which gives doctors an idea of how advanced (or spread) the cancer is at the time of diagnosis. The PSA level at diagnosis, Gleason score, stage and patient's health condition all are used to determine the best mode of treatment for prostate cancer."
Prostate Cancer Stages
Part of a prostate cancer diagnosis is what's called "staging" the prostate cancer, and this is often where confusion arises. Essentially, your overall prostate cancer stage is determined by looking at a few different factors that make up the "TNM" system - T stands for tumor; N stands for lymph nodes; and M stands for metastasis, or how far the cancer has spread. Each of these factors receives a number score, and the doctor evaluates these scores, along with your PSA level and Gleason score, to determine the extent of your cancer and what the correct treatment should be.
"The grade and stage are used together to help the patient decide what treatment may be best for them," says Miles. "For a Gleason 3+3 with a negative metastatic workup, for example, the patient can often go on active surveillance. If the patient has higher-grade disease such as 8, 9, and 10, then surgery is generally recommended as a primary treatment and radiation as a secondary treatment if needed."
There are a variety of treatments for prostate cancer, and the correct option for you will be based on your unique situation. However, in the most general terms, Miles says that patients with the lowest prostate cancer stages are often put on active surveillance without treatment - you'll be closely monitored to check for any progression. Prostate cancer in the low to middle range is often be treated with radiation therapy, and higher prostate cancer stages and scores typically require some form of surgery to remove the cancer.