A plea for clarity on prostate cancer

Dear Dr G,

I understand you are featuring prostate cancer for Movember, Men’s Health Month this November.

I could really use some advice as I have recently been diagnosed with prostate cancer.

I am a 51-year-old man who is generally fit and healthy.

Recently, my insurance agent approached me to upgrade my policy, and as part of the requirement, I underwent cancer marker screening.

To my horror, my PSA (Prostate-Specific Antigen) levels were double the normal rate.

The doctors advised an MRI scan, which showed abnormal results.

I started getting nervous and proceeded with a biopsy, feeling utterly devastated when the results confirmed cancer.

Truthfully, my mind went blank upon the diagnosis.

The situation was made more complicated by the medical jargon used by the doctors, which I did not understand.

I must admit I have been avoiding facing the diagnosis until now.

After reading your article last week, I am determined to fight this cancer.

Before starting any treatment, I would like to ask Dr G for some clarifications.

Firstly, how is the severity of my cancer determined?

The doctors mentioned numbers regarding the aggressiveness of the cancer; what do these numbers mean?

Also, how can I gauge how extensive my cancer is?

Lastly, the doctors talked about staging my cancer before treatment; what exactly does this mean?

Please help me.

Regards,

Cancer Calvin

Most men experience some degree of urinary symptoms due to benign prostatic enlargement as they age, with an increasing risk of prostate cancer. The assessment of prostate health usually begins with the International Prostate Symptoms Scores (IPSS) and a general examination, including the abdomen followed by a Digital Rectal Examination (DRE).

The prostate, a walnut-sized organ located between the base of the bladder and the penis, can be accessed quickly via the rectum using an index finger. The examination typically concludes with laboratory investigations, including the PSA cancer marker test.

Prostate-Specific Antigen (PSA) is a natural marker specifically produced by the prostate. PSA levels do not definitively indicate cancer, as they can also be elevated due to non-cancerous conditions such as infections and benign age-related enlargement. A detailed assessment of the prostate through MRI scans can identify certain cancer characteristics, reducing unnecessary biopsy risks in men with high PSA levels.

MRI can also pinpoint the exact location of abnormal tissue for more accurate targeting. The definitive method to detect cancer after PSA elevation is a TRUS (Transrectal Ultrasound) guided biopsy of the prostate. This involves inserting an ultrasound probe into the rectum to visualise the prostate and extract samples for analysis. Even after a biopsy confirms prostate cancer, further evaluation is necessary.

The cancer is assessed for aggressiveness using the Gleason Score system. The Gleason grade describes the tumour’s aggressiveness, with 1 being the least and 5 the most aggressive. The Gleason score is the sum of two grades—the most prevalent and the second most common score. Thus, the least aggressive score is 2, while the most aggressive is 10.

The second crucial assessment involves determining the cancer’s stage, usually via imaging like PET scans, CT scans, or bone scans. Cancer spread is divided into four stages:

Stage I represents confined disease, often with a high chance of cure.

Stage II indicates a larger tumour still within the prostate.

Stages III and IV involve metastasis to lymph nodes or distant organs, respectively, requiring palliative care.

The extent of cancer spread is crucial for clinicians to plan definitive or palliative treatment and is the most important determinant of survival post-treatment.

November is an important month to highlight prostate conditions affecting men. A prostate cancer diagnosis is often devastating, but early detection can enhance survival chances. Modern technology and imaging are vital in accurately staging malignancies and aiding clinicians in mapping the best treatment paths.

As American writer and activist Betty Friedan said: “Ageing is not lost youth but a new stage of opportunity and strength.” Men facing the trauma of prostate cancer should not lose hope; being cancer-aware is the first step towards staging for strength to become cancer-free.