What You Should Know

What You Should Know About

Prostate Cancer Information

  • prostate cancer is the second leading cause of male cancer deaths after lung cancer
  • prostate cancer has a variable biological potential from cancers that maybe followed untreated with active surveillance to cancers that require treatment
  • most men with prostate cancer have few, if any, symptoms
  • the risk for prostate cancer is increased with age
    family history of prostate cancer
    race
    precancerous findings on previous prostate biopsies
  • most cancers are now stage T1c and picked up on screening with
    a) a blood test called prostatic specific antigen (PSA). This is more accurate when combined with the free PSA and
    % free PSA. It is also important to realize that several medicines like the cholesterol medicines can give you a
    false sense of security by lowering your PSA without lowering your risk for cancer.

    b) an examination, the digital rectal exam (DRE) may detect abnormalities with the prostate but not very accurate

  • about 20% of men with a PSA UNDER 4ng/ml will have clinically significant prostate cancer. Unless you have the %free PSA component measured these prostate cancers with a PSA under 4 may go undetected.
  • if you were to be diagnosed with prostate cancer and would definitely be looking towards a treatment option you have to assume that you have a reasonable life span ahead of you and with no significant co-morbidities
  • you would consider a needle biopsy of your prostate if your repeat PSA and or your repeat %free PSA were abnormal
  • men and there spouses can only be counseled on the man’s particular prostate cancer after a needle biopsy of his prostate
  • prostate needle biopsies may be performed in the office or as an outpatient under sedation
  • needle biopsies of the prostate DO NOT spread cancer through metastases or damage the prostate
  • ONLY a prostate biopsy can diagnose a prostate cancer and estimate the tumor volume and Gleason score. No ultrasound or MRI study can do this definitively
  • have your prostate needle biopsy slides sent out to an independent prostate reference laboratory for validation of the reading. Due to a large degree of subjectivity involved in the reading of prostate biopsy slides it is very important to seek validation
  • always get a copy of your biopsy results and of the validation and try to understand their meaning
  • if your validated report indicates only precancerous changes such as atypical small acinar proliferation (ASAP) or high grade prostatic intraepithelial neoplasia (HGPIN) you should be closely followed and considered for a repeat biopsy at some time
  • if your validated report indicates only less than a 5% Gleason 6 tumor volume on one biopsy needle core (a microfocus of prostate cancer) you should undertake active surveillance with a further biopsy in 3 or 4 months, for two reasons. You want to make sure nothing was missed but you also should not be having treatment for something that may not be there. If a subsequent biopsy fails to confirm additional cancer or the microfocus, a further biopsy can be undertaken about 12 months later
  • if your validated report indicates significant prostate cancer BUT low volume and low to intermediate risk disease, your prostate cancer is likely to be localized to the prostate and suitable for a minimally invasive treatment option such as HIFU
  • if your validated report indicates significant prostate cancer BUT high volume and or high risk disease, you may want to consider having the margins of your prostate biopsied and or a high resolution MRI of the prostate so that disease at the margins and or capsule may be assessed through targeted biopsies of suspicious areas so that you can be assured that the prostate cancer is localized and not outside the prostate
  • for staging purposes, CT scans and bone scans have little value in determining local or distant spread of prostate cancer when the PSA is less than 15ng/ml
  • checking data bases and “cure” rates are unhelpful for two reasons:
    a) most, if not all prostate cancer diagnoses in these studies were never verified and validated by an independent prostate pathology reference laboratory so true Gleason and tumor volume of the included patients is unknown
    b) technology is rapidly advancing so there is little sense in comparing data within, as well as between studies several years back as the equipment becomes refined
  • if your prostate cancer seems localized, you and your spouse should research your prostate cancer treatment options and get informed. You will realize that all the treatment options have very similar SURVIVAL BENEFITS but quite different amounts of COMPLICATIONS. Not all cancers require cutting for cure. The only time men have told me after any operation that they “made the worst decision of their life” was after prostate cancer surgery/robotic prostatectomy. Do your homework and empower yourself. Cure does not have to come at the expense of quality of life (QoL).
  • Follow up is lifelong with PSA monitoring to detect a possible recurrence