The Grade Group And Psa Level Are Used To Stage Prostate Cancer
The stage of the cancer is based on the results of the staging and diagnostic tests, including the prostate-specific antigen test and the Grade Group. The tissue samples removed during the biopsy are used to find out the Gleason score. The Gleason score ranges from 2 to 10 and describes how different the cancer cells look from normal cells under a microscope and how likely it is that the tumor will spread. The lower the number, the more cancer cells look like normal cells and are likely to grow and spread slowly.
The Grade Group depends on the Gleason score. See the General Information section for more information about the Gleason score.
- Grade Group 1 is a Gleason score of 6 or less.
- Grade Group 2 or 3 is a Gleason score of 7.
- Grade Group 4 is a Gleason score 8.
- Grade Group 5 is a Gleason score of 9 or 10.
The PSA test measures the level of PSA in the blood. PSA is a substance made by the prostate that may be found in an increased amount in the blood of men who have prostate cancer.
What Will This Summary Tell Me
This summary will tell you about:
- What localized prostate cancer is
- Common treatment options for localized prostate cancer
- What researchers found about how the treatments compare
- Possible side effects of the treatments
- Things to talk about with your doctor
This summary does not cover:
- How to prevent prostate cancer
- Less common treatments for localized prostate cancer, such as high-intensity focused ultrasound , cryotherapy , proton-beam radiation therapy , and stereotactic body radiation therapy
- Herbal products or vitamins and minerals
- Treatments for cancer that has spread outside the prostate gland
*In this summary, the term doctor refers to your health care professional, including your primary care physician, urologist, oncologist, nurse practitioner, or physician assistant.
Are There New Techniques That Reduce The Chance Of Becoming Incontinent
When removingthe prostate, surgeons try to save as much of the area around the bladder and the sphincter muscles around the urethra as possible, thus limiting damage to the sphincter. Doctors have also fine-tuned the process of placing radioactive seed implants, using sophisticated computer projections that allow the seeds to destroy the prostate while limiting damage to the bladder.
Still, at this point, any man who is undergoing radiation or surgery to treat prostate cancer should expect to develop some problems with urinary control. With newer techniques, some men will have only temporary problems controlling their urine, and many will regain full control of their bladder in time.
Continued
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Cryotherapy For Prostate Cancer
During this procedure, your doctor will use a transrectal ultrasound to guide multiple needles directly into your prostate. Very cold gases are sent through the needles to create ice balls that freeze and destroy the prostate. A warming catheter is then inserted in the urethra to protect it. You will use a catheter for around 3 weeks to help drain your bladder while you heal.
Often Recommended for:
- Bladder issues and loss of control
- Bleeding or infection in treated area
Pros & Cons of Cryotherapy for Prostate Cancer
Pros:
- Less blood loss and pain
- Shorter hospital stay and recovery
- Concentrated treatment on cancer cells
Cons:
- Relatively new, and long-term outcomes are unknown
- Higher probability of erectile dysfunction
- Not recommended for those with larger tumors, normal sexual function or who previously had surgery for rectal or anal cancer
What Is The Prostate Gland
The prostate is a gland about the size of a walnut. It is part of the male reproductive system and wraps around the tube that carries urine out of the bladder. It grows larger as you get older. If your prostate gets too large, it can cause health issues. Having prostate problems does not always mean you have cancer.
Sometimes a doctor may find a problem during a routine checkup or by doing a rectal exam. If you think there is something wrong with your prostate, see your doctor right away.
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Staging Of Prostate Cancer
Doctors will use the results of your prostate examination, biopsy and scans to identify the “stage” of your prostate cancer .
The stage of the cancer will determine which types of treatments will be necessary.
If prostate cancer is diagnosed at an early stage, the chances of survival are generally good.
What Is Prostate Cancer
Prostate cancer is common among American men. Your chance of getting prostate cancer may be affected by your:
- Age. Men age 50 and older run a greater risk.
- Race. Prostate cancer is most common among African-American men.
- Family history. If your father or brother has had prostate cancer, you are more likely to have it, too.
- Diet. Eating high-fat food with few fruits and vegetables may raise your risk.
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Herbal Remedies For Treating Prostate Problems
Saw palmetto
Saw palmetto is a small palm that grows up to 3 m high. It is so slow growing that some plants in Florida are expected to be 700 years old.
Traditionally it has been used to treat many conditions of the prostate and arguably is the most popular herbal treatment for prostate problems.
Saw palmetto has been found to be effective in treating benign prostate hyperplasia in a number of studies.
Nettle
Nettle derives its names for its ability to sting if touched to the extent that some species in Asia can cause very nasty reactions. It has been used to make clothes, and is also consumed as a food.
One study has found nettle extract to kill prostate cancer cells.
Another study showed nettle can also treat prostate enlargement.
African cherry
Pygeum africanum or African cherry is a shrub distantly related to cherries. African cherries are one of gorillas favourite foods. Its bark has been used to treat various diseases such as malaria, gonorrhea and fevers.
A phytosterol from Pygeum africanum was found to kill prostate cancer cells in lab studies.
Another study found that the African cherry can be useful in treating benign prostate hyperplasia as well.
Are There New Strategies In The Near Future That May Be Helpful In Improving Erection Recovery After Surgery
Recent strategies have included cavernous nerve interposition grafting and neuromodulatory therapy. The former, as a surgical innovation meant to reestablish continuity of the nerve tissue to the penis may be particularly applicable when nerve tissue has been excised during prostate removal. In the modern era of commonly early diagnosed prostate cancer, nerve-sparing technique remains indicated for the majority of surgically treated patients.
Neuromodulatory therapy, represents an exciting, rapidly developing approach to revitalize intact nerves and promote nerve growth. Therapeutic prospects include neurotrophins, neuroimmunophilin ligands, neuronal cell death inhibitors, nerve guides, tissue engineering/stem cell therapy, electrical stimulation, and even gene therapy.
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Management Of Urinary Dysfunction
Because the urinary symptoms following radiation therapy are irritative in nature, drugs that improve urinary flow and treat irritative bladder symptoms are commonly prescribed to all men following radiation therapy for at least a few weeks. They are gradually withdrawn as symptoms improve.In cases of persistent urinary incontinence, surgical procedures, including a sling that relieves pressure buildup in the abdomen or artificial sphincters provide long lasting results.
Diet & Exercise Tips For Prostate Health
“What can I eat to reduce my risk of developing prostate cancer?” This is one of the most common questions physicians hear from men concerned about prostate health. Undoubtedly, many hope that their doctor will rattle off a list of foods guaranteed to shield them from disease. Although some foods have been linked with reduced risk of prostate cancer, proof that they really work is lacking, at least for now.
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Transurethral Resection Of The Prostate For Prostate Cancer
During this operation, your surgeon will remove part of the prostate to make it easier for your urine to exit through the bladder. There are no incisions with this surgery. A slender instrument called a resectoscope will be passed through the tip of your penis and into the urethra. Once in place, electricity or a laser is used to cut or vaporize the tissue.
Often Recommended for:
- Advanced prostate cancer
Possible Side Effects of TURP:
- Bleeding
- Retrograde ejaculation
- Erectile dysfunction or sexual impotence
- Urethral strictures
- Urinary incontinence
Pros & Cons of TURP for Prostate Cancer
Pros:
- Can fix or improve your urinary issues
- Surgery does not involve incisions
Cons:
- Risk of urinary symptoms worsening or not improving
- Not a curative treatment for prostate cancer
Active Surveillance For Prostate Cancer
Also known as watchful waiting, active surveillance is a non-treatment option that involves continued monitoring of prostate cancer. More frequent checkups are often required to keep an eye on any changes through PSA blood tests, Digital Rectal Exams and ultrasounds. Biopsies may also be done to assess the aggressiveness of the cancer and its risk of growing and spreading. Studies have found that, after 15 years on active surveillance, less than 1% of men developed a metastatic disease. Additionally, over 30% of men have prostate cancers so slow-growing that non-treatment may be a better option.
Often Recommended for:
Possible Side Effects of Active Surveillance:
- No treatment-related side effects
Pros & Cons of Active Surveillance for Prostate Cancer
Pros:
- No surgery or hospital stays
- New technologies continue to improve imaging and testing
Cons:
- Frequent checkups for testing and biopsies
- May face a greater risk of prostate cancer growing and spreading
- Stage of your prostate cancer may advance
- May limit future treatment options and chances of curing the cancer
- Diagnosis can create stress and anxiety
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How To Reduce Prostate Size
This article was medically reviewed by . Dr. Litza is a board certified Family Medicine Physician in Wisconsin. She is a practicing Physician and taught as a Clinical Professor for 13 years, after receiving her MD from the University of Wisconsin-Madison School of Medicine and Public Health in 1998.There are 13 references cited in this article, which can be found at the bottom of the page. This article has been viewed 65,131 times.
The prostate gland is a part of the male reproductive system that can enlarge with age, putting uncomfortable pressure on the urethra. This can cause urinary difficulties, urinary tract infections , and even bladder stones. By making lifestyle changes and using medication, most men can reduce their urinary troubles. A few men, though, may need to consider minimally invasive or traditional surgery options to feel their best.
Open Radical Prostatectomy For Prostate Cancer
During a radicalretropubic prostatectomy, an incision is made in the lower abdomen to remove the entire prostate gland, some tissues and/or seminal vesicles. If there is a reasonable chance the cancer has spread outside of the prostate, your surgeon may perform a lymph node biopsy to test the area before continuing with the surgery as its unlikely it can be cured with surgery alone and the removal of the prostate could lead to other serious side effects. In a radical perineal prostatectomy operation, your surgeon will make an incision between the anus and scrotum to access the prostate. While this operation is shorter, may result in less pain and is an easier recovery, its more likely to lead to erection problems.
Often Recommended for:
- Stage 1 or stage 2 prostate cancer
Possible Side Effects of Open Radical Prostatectomy:
- Erectile dysfunction or sexual impotence
- Urinary incontinence
- Changes in orgasm
- Loss of fertility
- Lymphedema
- Changes in penis length
Pros & Cons of Open Radical Prostatectomy for Prostate Cancer
Pros:
- Can be a curative option
- Nerve-saving approach may help prevent impotence
- Removed tissue helps accurately stage cancer
Cons:
- Cancer in nearby lymph nodes most likely cant be removed
- Prostate gland may not be removed if cancer has spread
- Surgical risks
- Longer recovery times and activity restrictions
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Surgery To Remove The Prostate Gland
In this type of surgery, the surgeon removes the prostate gland and seminal vesicles . The prostate gland surrounds the upper part of the urethra . So, that part of the urethra must be removed as well. The remaining urethra is reattached to the bladder. The surgeon may also remove lymph nodes or other tissues around the prostate gland to check if the cancer has spread.
Before surgery to remove the prostate gland
After surgery to remove the prostate gland
What Tests Check For Prostate Cancer
Common tests to check for prostate cancer include:
- Digital rectal exam: Your doctor inserts a finger into your rectum and touches your prostate gland. The doctor feels the shape of the prostate gland and checks for any hard spots.
- PSA blood test: This blood test tells how much PSA is in your blood. Many men with prostate cancer have PSA levels that are higher than normal or that have gotten higher over time.
- A high PSA level does not always mean a man has prostate cancer. As men get older, their prostate gland may grow larger over time. This growth, and other health conditions, can cause a high PSA level in men who do not have prostate cancer.
If the test results are not normal, your doctor may recommend more tests, such as a biopsy. During a biopsy, the doctor uses a needle to take out a tiny piece or pieces of the prostate gland. An ultrasound probe may be used to guide the needle. Another doctor called a pathologist looks at the tissue under a microscope to check for cancer cells.
Note
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Cancer May Spread From Where It Began To Other Parts Of The Body
When cancer spreads to another part of the body, it is called metastasis. Cancer cells break away from where they began and travel through the lymph system or blood.
- Lymph system. The cancer gets into the lymph system, travels through the lymph vessels, and forms a tumor in another part of the body.
- Blood. The cancer gets into the blood, travels through the blood vessels, and forms a tumor in another part of the body.
The metastatic tumor is the same type of cancer as the primary tumor. For example, if prostate cancer spreads to the bone, the cancer cells in the bone are actually prostate cancer cells. The disease is metastatic prostate cancer, not bone cancer.
Denosumab, a monoclonal antibody, may be used to preventbone metastases.
What Is The Most Effective Treatment For Prostate Cancer
The choice of treatment for prostate cancer depends on many factors such as the patients prostate cancer risk as calculated from prostate-specific antigen levels, Gleason score, and tumor staging. Patients can discuss the significance of these factors in the choice of treatment with their doctor.
The standard effective treatment choices for men with early-stage prostate cancer are as follows
- Active surveillance: Monitoring the progression/status of the low-risk or early-stage cancer with regular testing and not treating it right away.
- Prostatectomy: Surgical removal of the prostate.
- Radiation therapy: Use of high-energy waves to destroy cancer cells.
Radiation therapy is one of the most effective treatments for many men with early-stage prostate cancer. It is also the best prostate cancer therapy for older men or those with other co-existing diseases. It can be delivered to the patient in any of the two ways
- External beam radiation: Sending/focusing high-energy waves from an external machine into the tumor.
- Brachytherapy: Placing a radioactive dye in the tumor through an implant or hollow tubes.
For metastatic prostate cancer, androgen deprivation therapy is usually the choice of treatment. ADT is also the only option in patients with prostate cancer who are unfit or unwilling to undergo surgery or/and radiation therapy.
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Proton Therapy For Prostate Cancer
Proton therapy is a highly accurate and much less invasive form of radiation treatment. Protons are subatomic particles with a positive charge that can be manipulated and controlled to deliver the maximum dose directly at a tumor. Radiation stops precisely at the tumor wall to spare healthy tissues and surrounding organs. Proton therapy also uses intensity modulated radiation therapy , a computer-driven machine that moves around you to shape the beam and adjust the dose at different angles. Similar to standard X-ray radiation, your team of doctors will map out a detailed radiation plan and possibly create a plastic mold to keep you in the optimal position during your treatment session.
Often Recommended for:
- Lower risk of treatment-related side effects, impotence and incontinence
- Up to 97% chance of avoiding a recurrence
- Up to 60% less radiation to surrounding organs
- Shortened treatment time
- Hypofractionation treatment option
- Lower chances of secondary cancers
- May allow retreatment for those with secondary or recurrent cancer
Cons:
- Requires frequent treatments
- Higher chance of developing long-term side effects
- May not cure the cancer
Brachytherapy For Prostate Cancer
This is also known as implantation or interstitial radiation therapy because small radioactive seeds are placed directly in your prostate. Seldom do the seeds cause discomfort. Most doctors use Permanent Brachytherapy, but some opt for Temporary Brachytherapy. If Permanent Brachytherapy is recommended, your doctor will use a needle to insert around 100 seeds in your prostate. Seeds will release low doses of radiation for weeks or months until the radioactive material is completely dissolved. Temporary Brachytherapy delivers high doses of radiation through a catheter. Seeds are removable and kept in for only 5 to 15 minutes. Generally, there are 3 treatments given over the course of 2 days. The catheter is removed after your final treatment.
Often Recommended for:
- No surgical risks or hospital stays
- Radiation concentrated in the prostate
- Little damage to surrounding tissues, nerves, bladder and rectum
Cons:
- Internal radiation may demand you to stay away from children and pregnant women, limit children and pets sitting on your lap for prolonged time periods, refrain airport travel and require a condom during sex
- Seeds may require you strain urine
- Might not work as well in men with large prostate glands, urinary problems or post-TURP surgery
- May not cure the cancer
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