Last time we discussed PSA screening – that is, checking to see if you may have prostate cancer. The PSA and digital rectal examination alone does not confirm a diagnosis of cancer – it merely says to us that your case is suspicious and should be investigated further.
What if the PSA or rectal exam is abnormal?
If either test is abnormal, the urologist will request a prostate biopsy. During a prostate biopsy the urologist uses an ultrasound probe to visualize the prostate. This probe is inserted in the rectum. He then uses a special needle to take 12 bites of the prostate and these are then examined under a microscope by the pathologist who will determine if there is cancer present. During the procedure an anaesthetic liquid is injected close to the prostate and this should reduce pain significantly. You will also be required to use antibiotics prior to the procedure in order to reduce your risk of infection – this is taken by mouth on the morning of your biopsy. Biopsies are not without risk – there is a small risk of infection and it is not uncommon to have some bleeding in the urine, stool and even the semen. Bleeding usually resolves on its own. Rarely, a complication will require readmission to hospital. Prior to the procedure, you should let your doctor know of any medical condition you have as well as the medication which you are currently using especially blood thinners such as aspirin.
What if my biopsy shows
prostate cancer?
It is important to realize that a diagnosis of prostate cancer is NOT a death sentence. Prostate cancer is a curable cancer and even in its advanced stages, still very treatable. The next steps are:
To determine whether or not you have an aggressive cancer and into which risk category you fall
To determine what stage of cancer you have, i.e. whether it has spread outside the prostate
To select a treatment that is right for you
How can the doctor tell how
aggressive my tumour is?
The pathologist looks at the cancer under a microscope and assigns the tumour a Gleason score. In contemporary times, the tumours are graded on a scale of 6-10. Tumours with a Gleason score of 6 are considered less aggressive than those with a score of 7 – these are considered intermediate. Tumours which score 8-10 are the most aggressive. There are also other more technical details found on the biopsy which will be taken into consideration by the pathologist and urologist.
The urologist will also determine your risk category – low, intermediate or high risk. He will assign you to these categories based on your PSA level, prostate examination and Gleason score. These categories will guide important decisions in your management.
How is prostate cancer staged and why is this done?
It is important to determine if your cancer is localized to the prostate. In order to do this the urologist may request further imaging tests. He may request a magnetic resonance imaging (MRI) test and a special scan of the bones.
This is important because cancers which are localized to the prostate are curable. However, even for cancers which have spread beyond the prostate, there are still very effective options for treatment.
If my cancer is localized, what are my options?
Several treatment options are available to the man with localized prostate cancer. While we will have an in-depth discussion about these various options in a later article, briefly, the options are:
Active surveillance – the cancer is observed closely and treated with curative intent only if necessary.
Radical prostatectomy – the prostate is surgically removed,
External beam radiotherapy – a powerful machine is used to deliver radiation beams to the prostate, usually utilizing a CAT scanner to ensure the beam is aimed only at the prostate.
Brachytherapy – this uses radiation as well but the radiation is delivered in the form of tiny seeds which are surgically implanted in the prostate.
As usual I am happy to answer any questions via email – satyendrapersaud@yahoo.com
