A NEW DIAGNOSIS OF PROSTATE CANCER
A new diagnosis of prostate cancer can feel overwhelming. This page is dedicated to get you started in the process of learning about prostate cancer and beginning to apply that knowledge to your individual diagnosis and clinical situation.
Pllease do not hesitate to ask questions and provide feedback on the resources you find here.
Good luck on your journey.
Stage and Grade
Pictured here is a copy of the original drawing of the Gleason Scoring System as originally drawn by Donald Gleason. Gleason was a pathologist working at the University of Minnesota and the VA Medical Center in Minneapolis when he correlated patterns of cancer growth with patient outcomes. Gleason had formal training as an artist, and this picture that he sketched as a way to teach other pathologist his grading system has been reproduced many, many times and impacted millions. Years ago I recorded a podcast episode telling the story of the Gleason System you can listen to. The link is below.
All men at their initial diagnosis will need to determine if their prostate cancer is “localized” to the prostate or has “advanced” beyond the prostate. While all cancers lie on a spectrum of cancer volume, doctors break the cancer volume into four “stages” of cancer. Here are the clinical stages of prostate cancer. When a prostate has been removed and examined under a microscope then a pathologist determines its pathologic stage.
A stage 1 cancer is detected usually because of an elevated PSA value. The prostate otherwise feels normal to the physician on examination. A cancer is also considered stage 1 if detected because a man has surgery for enlarged prostate.
A stage 2 cancer is detected by an area of irregularity on the prostate.
A stage 3 cancer is detected when the area of irregularity is beyond the prostate capsule.
A stage 4 cancer is when there are findings the cancer has advanced to lymph nodes, nearby tissue, bones, and other distant organs.
Additionally, the speed of cancer growth determines appropriate treament. Aggressive cancers should be treated whereas slow growing and small volume cancer can be monitored over time. The speed of a cancer growth is determined initially by a cancer’s “grade.” The traditional way of quantifying the grade of a cancer is the Gleason scoring system. The Gleason system assigns a number to the two most common growth patterns within a cancer and those numbers are added together to create a Gleason score. The Gleason score is often represented as a simple math equation, eg. 3+4=7. Gleason score totals range from 6 (slow) to 10 (most aggressive). In 2014, the World Health Organization adopted the Grade Grouping system for assigning prostate cancer grade. The Grade Grouping System assigns a single number, 1 (slow) though 5 (most aggressive), to a cancer. Both grading systems are used today but the Grade Grouping System parallels the Gleason system but improves the grading accuracy for moderate risk Gleason 7/Grade Group 2 and 3 cancers.
For Patients With Localized Disease
Localized prostate cancer is still contained within the prostate gland and has not invaded nearby tissues nor has it spread to distant sites in the body like bones or lymph nodes.
Localized prostate cancer is often determined through a combination of prostate-specific antigen (PSA) blood tests, digital rectal exams (DRE), MRI testing of the prostate, prostate biopsy, and possibly other studies such as a PET scan, bone scan or CT scan.
Treatment options for localized prostate cancer vary depending on factors such as the aggressiveness of the cancer, the patient's overall health, and the patient’s personal preferences.
Common treatment approaches may include active surveillance (watchful waiting), surgery (prostatectomy), radiation therapy, focal ablative therapy, androgen deprivation, or a combination of these treatments.
This video is a short presentation (2 min) video with a brief overview of things to learn when first diagnosed with prostate cancer. The slides are downloadable in the link provided as well as a “worksheet” to prepare for a visit to discuss a new diagnosis of prostate cancer. This is intended for men with localized disease.
In the link below is a worksheet you can use to prepare for your visit.
For Patients With Advanced Disease
Advanced Prostate Cancer has spread beyond the prostate and may have invaded nearby tissues or metastasized to distant parts of the body. When prostate cancer progresses to an advanced stage, it poses greater challenges for treatment and management. For most men that means that treatments such as radiation or surgery are no longer an option. Good treatments exist in the form of androgen deprivation, chemotherapy, and immunotherapy.
Advanced prostate cancer often requires a multidisciplinary approach to treatment, involving medical oncologists, radiation oncologists, urologists, and other specialists. Treatment options may include hormone therapy, chemotherapy, targeted therapy, immunotherapy, radiation therapy, or a combination of these modalities.
While advanced prostate cancer is not curable in most cases, treatment aims to slow the progression of the disease, manage symptoms, and improve quality of life. Additionally, clinical trials and emerging therapies offer hope for new treatment options and improved outcomes for individuals living with advanced prostate cancer