 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 4.0 or a significant PSA increase over the previous 12 months, combined with a suspicious digital rectal exam and perhaps a family history of prostate cancer, should undergo further evaluation for prostate cancer with a biopsy.
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 can 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.
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 it is, 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, treatment options may vary in younger men versus men over age 70. In many cases, older patients who do not have obvious symptoms and who's 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.
However, there is always the concern that the prostate cancer cells can spread to other parts of the body and become life-threatening. The spread of cancer to other tissues or organs is called metastasis. Regular screening and follow-ups with your physician hopefully will prevent the prostate cancer from reaching this stage.
Treatment for younger men may be more aggressive. 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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