Prostate cancer is a significant health care issue in the U.S. and remains the second leading cause of cancer death in this country. In 2012, approximately 215,000 new cases were diagnosed and over 30,000 deaths occurred as a result of the disease. Prostate cancer is a curable disease when detected early but it typically causes no symptoms in the early stages. Thus, in order to detect disease when it is early and most treatable, patients must be actively screened, with a blood test (PSA) and digital rectal exam (DRE) of the prostate.
Many men use the argument that testing is unnecessary if they feel well and have no urologic symptoms. The rationale seems misguided since prostate cancer is typically advanced and less curable once symptoms do occur, i.e. difficulty voiding, blood in the urine, back/bone pain or weight loss. Several treatment options are available for patients with cancer confined to the prostate with high rates of cure but only when detected early. Once the cancer spreads beyond the prostate, treatment is less successful. Unfortunately, about 15% of men will have this late stage or metastatic disease at initial diagnosis.
It should be emphasized that not all prostate cancers behave in the same way. Some are slow-growing and non-aggressive, while others tend to grow fast and spread quickly. The Gleason Score is a measure of the prostate cancer’s aggressiveness and is obtained by microscopic examination of the cancer cells detected on prostate biopsy. A scale of 2-10 is used in grading the cancer, and can be used to predict how aggressive the tumor will be. Most clinicians feel that a Gleason’s score of 2-6 signifies a slow-growing cancer, a score of 7 indicates a moderately growing cancer and an 8-10 score usually means a rapidly growing, potentially fatal tumor.
Once detected, not all prostate cancers need to be treated and observation has become an accepted approach for many patients with a slow-growing prostate cancer. For those who have cancers that are not slow-growing, many forms of treatment are available, including surgery, radiation, radioactive seeds, and other therapies. Identifying the type of prostate cancer is thus extremely important. The only means of detecting the specific type of cancer is through a prostate biopsy, which is indicated if an abnormality is detected on either the PSA blood test or prostate exam.
Gleason’s score, PSA, clinical scenario and the patient’s age/medical status are important factors in determining the best course of treatment for a particular individual. Ultimately, the decision should be made by both the patient and his physician after a thorough discussion, including both risks and benefits of treatment.