Diagnosed with Prostate Cancer / Have an Elevated PSA - What Next?

If you have received the diagnosis of prostate cancer, you can be assured that USMD Prostate Cancer Center has an impeccable reputation for delivering an unprecedented level of care. You will be in highly experienced hands to stop the cancer and allow you to return to an active lifestyle - quickly, with few side effects and minimum disruptions.

If the results of your PSA blood test and digital rectal exam show an increased potential for prostate cancer, you have several treatment options. In most cases, abnormal test results are not cancerous– rather, they are related to benign conditions like benign prostatic hyperplasia.

However, depending on the age of the patient and other factors determined by the physician, a biopsy may be recommended.

In general, the American Urologic Association recommends that men with a PSA greater than 2.5 or a significant PSA increase over the previous 12 months, or with a suspicious digital rectal exam and perhaps a family history of prostate cancer, should undergo further evaluation for prostate cancer with a biopsy.

Biopsy and What to Expect During a Biopsy

A biopsy is a minimally invasive outpatient procedure in which a tissue sample is taken from the prostate gland. During the procedure, a local anesthetic will help minimize any discomfort you may have. The patient lies on his side on an exam table while a lubricated ultrasound probe is inserted into the rectum. Sound waves produced by the ultrasound create images of the prostate, helping the physician determine whether there are any abnormalities in the gland’s size or shape. Then the prostate is anesthetized with a long, slender needle inserted into the probe and using a spring-loaded device, the physician takes multiple tissue samples of the prostate. This entire procedure takes approximately half an hour.

Prostate Cancer Biopsy

The Gleason Grading Scale

Tissue samples from the biopsy are sent to the laboratory for evaluation by a pathologist. Lab results can show if cancer is present in the cells and if so, the progression of the cancer. While early stage or low-grade cancer cells may look only slightly different, high-grade cancer cells will have a dramatically altered appearance from normal, healthy cells. The Gleason grading system is used to determine the degree of change in the cells’ appearance.

The Gleason “score” helps the physician decide how aggressive the prostate cancer cells are and what the next steps should be in diagnosing the cancer. If there is a concern that the prostate cancer has spread to nearby tissue or organs, other imaging tests such as an MRI, CT Scan or bone scan may be scheduled.

Age is a Factor

Many prostate tumors grow very slowly over a long period of time. Because of that, many older patients are able to choose less aggressive treatment for their prostate cancer. Younger men with a longer life expectancy tend to choose more aggressive options because of the potential spread from the cancer over several years. Because of that, treatment options may vary in younger men versus men over age 70. In many cases, older patients who do not have obvious symptoms and whose cancer is not limited to the prostate may opt not to have immediate treatment. The physician will instead recommend Active Surveillance, which means that you will be evaluated at frequent intervals at USMDPCC.

USMD Prostate Cancer Center is at the leading edge of advances in prostate cancer treatment that improve survival rates and minimize side-effects. Decisions on treatment are made in a consultation with your physician based on a number of factors– including your age, Gleason grading score and your lifestyle needs.

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Tests Performed After Diagnosis

To plan your treatment, it is important to know the status of your cancer. Prostate cancer can metastasize before treatment has started or any time after. Your doctor will assess your changes of having metastases based on your symptoms, PSA tests, and biopsy.

After treatment tests can show if the cancer was cured or has retuned. For long term treatment, tests can show if the cancer is under control or if treatment is harming your body.

  • Blood Tests - may help tell if your prostate cancer has spread and if your organs are working properly. It can also be used to monitor the disease after diagnosis.
  • Imaging Tests - take picture of the inside of the body. These tests are often easy to undergo. Imaging machines are large and have a tunnel in the middle.
  • Bone Scan - this scan may show if you have bone metastases. For this test you will receive an injection of radioactive dye into your vein. The dye will travel to diseased bone cells throughout your skeleton within several hours. A special camera will then take pictures and the dye in the bones. Disease will show as a dark areas called "hot spots". Hot spots may be metastatic cancer, but many abnormal results aren't cancer. Arthritis, previous trauma and other non cancerous conditions may show up as suspicious and these are often confirmed with a regular x-ray or MRI to confirm the suspicion of cancer.
  • CT Scan - Computed tomography test is often called CT or CAT scan. It tells if the cancer has spread or if cancer has returned after treatment. A CT scan takes many picture of a body part from different angles using x-rays.
  • Lymph Node Biopsy - Lymph is a clear fluid that returns fluid and protein to the blood. It travels between tissues, blood and lymph nodes in long, tube-shaped vessles. Lymph vessels and nodes are everywhere in the body, which allows prostate cancer to spread to other organs. Prostate cancer often spreads to the lymph nodes in the pelvis. Cancer continues to grow inside lymph nodes causing them to increase in size. A CT scan can show if lymph nodes are enlarged, although this is not the most sensitive test to confirm lower volume disease. Lymph node biopsy is performed by fine needle aspiration. This biopsy uses a very thin needle to remove very small pieces of a lymph node. A CT scan is used to guide the needle into the lymph node. With a local anesthetic, this test causes little discomfort and doesn't leave a scar.

Understanding the Staging of Prostate Cancer

Once a diagnosis of prostate cancer is confirmed, the course of treatment will depend on the extent or “stage” of the disease. A slow-growing cancer that is detected early when it is still confined to the prostate gland will have different treatment options than a more advanced cancer that has spread to nearby tissues or even other organs in the body.

A combination of the Gleason score from the pathology report, along with laboratory tests, imaging exams such as ultrasound and possibly a bone scan, MRI or CT scan, will help the physician determine the stage of disease.Gleason Score

Gleason Score is the sum of two grades. Grades range from 3 for cancer cells that look almost normal to 5 for very abnormal cells that have spread throughout the prostate. Cells with a grade 1-or 2 are rarely seen any longer. Primary grade is the most common pattern, and the secondary grade is second most common. The Gleason Score for prostate cancer range from 6 to 10. Higher Gleason scores mean the cancer is more likely to grow and spread more quickly. A higher primary grade also means more aggressive cancer. For Example: a Gleason score of 7 summed from primary and secondary grades of 4+3 is worse than a grade of 3+4.

USMD Prostate Cancer Center follows the American Urological Association “T” staging system for prostate cancer:

T1 – the tumor is visible or can be seen with imaging.
T1a – the cancer was found during treatment for benign prostate enlargement but is present in less than five percent of the tissue and has a low-grade Gleason score.
T1b – the cancer was found during treatment for benign prostate enlargement but is present in more than five percent of the tissue and has a higher grade Gleason score.
T1c – the cancer was diagnosed from a biopsy due to an elevated PSA lab test.
T2– the tumor can be felt during a digital rectal exam but appears to be confined to the prostate.
T2a – the cancer is found in one half or less of the left or right side only of the prostate.
T2b – the cancer is found on both sides of the prostate.
T3 – the cancer has begun to spread outside the prostate and may include the seminal vesicles.
T3a – the cancer has spread outside the prostate but not to the seminal vesicles.
T3b – the cancer has spread to the seminal vesicles.
T4 – the cancer has spread to nearby organs.

No matter what stage your diagnosis may be, USMD Prostate Cancer Center is determined to guide you toward the best evidence-based course of treatment for your condition. Combining years of experience and the latest technologies available today, USMDPCC is dedicated to providing you the highest chance for success in your battle against this disease.

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