The Diagnosis of Prostate Cancer
Prostate cancer is most commonly diagnosed in men in their 50s, 60s and 70s, following an abnormal PSA blood test and/or a nodule discovered during a digital rectal exam (DRE). One or both of these abnormal findings will lead your doctor to order a trans-rectal ultrasound guided biopsy of the prostate (TRUS biopsy). The biopsy is done in the office with an ultrasound probe inserted into the rectum. The procedure takes between 5 and 10 minutes and discomfort is minimized with the use of injected drugs to numb the nerves that supply the prostate. Twelve samples or “cores” are usually taken although occasionally a few more or less is appropriate.
Approximately 10 days to 2 weeks after the biopsy, a patient will meet with his urologist to discuss the results. If prostate cancer has been detected, your urologist will discuss with you your Gleason grade. This grade is the pathologist’s interpretation of how aggressive the cancer cells look under the microscope. The grading scale ranges from 1 (not at all aggressive looking) to 5 (very aggressive looking). There can often be more than one pattern and therefore two numbers are assigned, the first number representing the pattern with the highest amount seen, the second number representing the second most common pattern. For example a Gleason grade of 3+3 or “six” is commonly found, and is in most cases mild to moderate aggressiveness.
Urologists will base treatment options on the patient’s age, general health, Gleason grade, PSA, and other factors. Treatments available to patients at the Richard A. Henson Cancer Institute at Peninsula Regional Medical Center include radical prostatectomy (Da Vinci robotic and open), brachytherapy (radioactive seeds), external beam radiation and cryotherapy. Hormone therapy is occasionally used initially in conjunction with radiation therapy.