What Are The Types Of Prostate Cancer
Believe it or not, theres more than one kind of prostate cancer. They differ in how quickly and aggressively they grow. Heres the breakdown:
Nearly all prostate cancers are known as adenocarcinomas. This type of cancer develops in gland cells. And, more than nine out of 10 prostate cancers are acinar adenocarcinomas. They affect a type of cell called acini.
Other types of prostate cancer are rare. They include:
Small cell carcinoma, a very aggressive cancer which accounts for about 1% of prostate cancers
Urothelial carcinoma of the prostate, a deadly, difficult-to-diagnose cancer that accounts for 1% to 4% of prostate cancers
Ductal adenocarcinoma, which on its own accounts for less than 1% of prostate cancers, but it can occur with acinar adenocarcinoma
Active Surveillance For Gleason 6 Cancer
Per the Cancer Care Ontario guideline,1 active surveillance for patients with Gleason 6 disease should include:
- PSA testing every 3 to 6 months
- Annual digital rectal exam
- 12- to 14-core confirmatory transrectal ultrasound biopsy, including anterior-directed cores, within 6 to 12 months of starting surveillance, and then a serial biopsy every 3 to 5 years thereafter
1. Chen RC, Rumble RB, Loblaw DA, et al: Active surveillance for the management of localized prostate cancer : American Society of Clinical Oncology Clinical Practice Guideline Endorsement. J Clin Oncol 32:2182-2190, 2016.
2. Cooperberg MR, Broering JM, Carroll PR: Time trends and local variation in primary treatment of localized prostate cancer. J Clin Oncol 28:1117-1123, 2010.
3. Loeb S, Folkvaljon Y, Curnyn C, et al: Uptake of active surveillance for very low-risk prostate cancer in Sweden. JAMA Oncol 3:1393-1398, 2016.
4. American Cancer Society: Key statistics for prostate cancer. Available at www.cancer.org/cancer/prostate-cancer/about/key-statistics.html. Accessed June 26, 2018.
5. Morash C, Tey R, Agbassi C, et al: Active surveillance for the management of localized prostate cancer. Available at www.cancercareontario.ca/en/guidelines-advice/types-of-cancer/2286. Accessed June 26, 2018.
6. Hamdy FC, Donovan JL, Lane JA, et al: 10-Year outcomes after monitoring, surgery, or radiotherapy for localized prostate cancer. N Engl J Med 375:1415-1424, 2016.
Cancer Lethality Set Early
The study looked for changes in cancer aggressiveness in men diagnosed with prostate cancer from 1982 to 2004. All of the men had their prostates removed after diagnosis, and biopsy samples were taken from the glands. The Harvard team reexamined the samples and graded them using a tool called the Gleason score, which assigns a number from 2 to 10 based on how abnormal the cells look under a microscope. High-scoring or high-grade cancers tend to be the most lethal.
Over the study period, fewer and fewer men were diagnosed with advanced, late-stage prostate cancers that had spread beyond the prostate gland. This reflected the growing use of prostate-specific antigen testing to diagnose prostate cancers earlier and earlier. In contrast, the proportion of high-grade cancers, as measured by the Gleason score, remained relatively stable rather than gradually becoming more aggressive. Previous studies have seen a similar pattern.
Its a very interesting study that confirms what previous studies have found, says Dr. Marc B. Garnick, a prostate cancer specialist at Harvard-affiliated Beth Israel Deaconess Medical Center who was not involved in the study. There may be rare exceptions, but in the vast majority the cancer is born with a particular Gleason score.
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Your Cancer Care Team
People with cancer should be cared for by a multidisciplinary team . This is a team of specialists who work together to provide the best care and treatment.
The team often consists of specialist cancer surgeons, oncologists , radiologists, pathologists, radiographers and specialist nurses.
Other members may include physiotherapists, dietitians and occupational therapists. You may also have access to clinical psychology support.
When deciding what treatment is best for you, your doctors will consider:
- the type and size of the cancer
- what grade it is
- whether the cancer has spread to other parts of your body
Use The Menu To See Other Pagesdoctors Use Many Tests To Find Or Diagnose Cancer
Here are 10 more facts about prostate cancer. They also do tests to le. Its important to understand what is a. Nearly 2 million american adults each year are diagnosed with cancer. But hearing the words can still be scary. What is prostate cancer grading, and what does your gleason score mean? Grading is an important part of the evaluation of your prostate cancer. If you receive a diagnosis, your schedule can quickly start to fill up with doctors appointments, medical procedures and pharmacy visits. Use the menu to see other pages.doctors use many tests to find, or diagnose, cancer. Prostate cancer occurs when cells in the tissue of the prostate gland become abnormal and grow out of control. The earlier the detection of prostate cancer, the better the patients chance of survival is. However, as with other types of cancer,. It may grow slowly and its typically treatable.
Creating a checklist of things. Prostate cancer is a common type of cancer in men, according to the mayo clinic. They also do tests to le. It may grow slowly and its typically treatable. If you or someone you love recently had a biopsy of the prostate, youll notice numbers on the pathology report.
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When A Gleason Score Increases
If your Gleason score changes while youre on active surveillance, its time for a discussion with your urologist to better understand the situation.
You may find it helpful to ask these questions:
- In what way did my Gleason score increase? Remember that the numbers that comprise your Gleason score represent the two most common grades of tissue in your biopsy. Finding out which number increased is important to understanding how your tumor has changed. A change in your first number means that most of your tissue samples are now grade 4 . A new Gleason score of 3+4 means that grade 3 is still the most prominent type of tissue in your biopsy.
- How does this impact my risk level? Your risk level is based on the distribution of grade 3 and grade 4 samples. A Gleason 7 has a more favorable risk level than a Gleason 7 .
- Is it time to consider active treatment? It can be unsettling to find out that your prostate cancer has changed or may be getting worse. However, even if your urologist recommends staying on active surveillance, it may bring you peace of mind to better understand at what point youll need to consider other options.
What Are The Symptoms Of Prostate Cancer
Nearly all men diagnosed with prostate cancer learn they have the disease while its still in its early stages, before symptoms occur. Screening for prostate cancer, which well get into next, picks up as many as nine out of 10 cases.
So, what happens when the cancer is not caught in early stages? More advanced prostate cancer can cause the following symptoms:
Frequent urination, especially at night
Weak stream when urinating, along with dribbling or interrupted flow
Blood in your urine or semen
Pain in your bones, where prostate cancer often first spreads
See your doctor if you have any of these symptoms. While they could signal cancer, some symptoms may arise from other conditions. For example, benign prostatic hyperplasia causes your prostate to grow. It is a common and non-cancerous culprit of urinary difficulties in men over 50.
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Weighing Up Treatment Options
A higher Gleason score generally means that prostate cancer will grow more quickly. However, remember that the score alone does not predict your prognosis . The Gleason score is only one consideration in establishing your risk of advancing cancer, and in weighing up your treatment options.
As a general guide, treatment options for men with Gleason score 6 prostate cancers include Active Surveillance , surgery, and radiation therapy. For Gleason score 7 , treatment options are often individualised because of the different severity levels . Gleason 8 and above will need treatment and treatment options might include surgery, radiotherapy, cryosurgery, hormone therapy, chemotherapy and immunotherapy.
There are pros and cons to consider in terms of your personal experience, potential side-effects and if additional treatment is needed. Ultimately, treatment decision-making depends on your own preferences and values, in consultation with expert advice from your treating doctor.
If you are reading this article before 31st April 2021 and have recently been diagnosed with early-stage, low-risk prostate cancer, please consider joining our research trial www.navigateprostate.com.au to help navigate your treatment options. Wed love to hear from you! | 8559 7453Need questions answered now?
Do Cancers Really Disappear Spontaneously Or Are They Just Eluding Us
Cancer specialists are comfortable with the terms partial remission and complete remission when patients undergo some sort of aggressive therapy such as radiation or chemo.
But the concept of spontaneous remission is more problematic, especially with low-risk prostate cancers in patients like me on active surveillance who have had no treatment at all.
Back in May, Michael Scott, a patient advocate and layman with loads of expertise with prostate cancer, went out on a limb to suggest in his blog that spontaneous remission was real and worthy of the attention of serious researchers.
Scott, founder of Prostate Cancer International and its Active Surveillance Virtual Support Group, mentioned my case and that of a man whose name he couldn’t recall.
I asked other men in two virtual support groups for men on AS if they had experienced spontaneous remission. James Simms, 72, a retired banker from Tampa, was the only one to reply. As it happens, he had described his case at Scott’s group.
Simms and Scott gave me a new perspective on what might have happened with my “lame” cancer, as my urologist calls it.
So my cancer potentially disappeared sometime in 2011, though that was not acknowledged at that time.
My urologist, Brian Helfand, MD, PhD, of NorthShore University HealthSystem in Glenview, Illinois, joked last year that if my PHI were any lower, I wouldn’t have cancer at all. Was he inadvertently on to something?
Pathologists weigh in
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What Is My Prognosis
It is not possible to predict the exact outcome of your prostate cancer as there are many factors that can influence how cancer cells grow and spread. Additional tests are used to determine the cancer stage and risk level including PSA blood tests, Digital Rectal Examinations , bone scans, MRI scans, CT scans etc. Your doctor will also take into consideration your age, overall health, medical and family history.
In general, the prognosis is better when prostate cancer is diagnosed as low-risk and confined to the prostate. According to the Cancer Council, prostate cancer has one of the highest five-year survival rates compared with other cancers.
Localized Prostate Cancer: Low
Low-risk prostate cancer often grows very slowly, or doesn’t grow at all. Because of this, a treatment approach known as “active surveillance” can be considered as an alternative to radiotherapy or surgery. In this approach, the tumor is monitored regularly and only treated with radiotherapy or surgery if it grows.
Prostate cancer is described as low-risk if it is only found in the prostate and it is highly likely to grow only very slowly, or not at all . The medical criteria for low-risk prostate cancer are:
- The cancer is found in only one of the two sides of the prostate.
- The cancer takes up less than half of the affected prostate lobe.
- The cancer cells havent mutated much and arent very aggressive.
- The cancer hasnt spread to any lymph nodes or led to the growth of tumors in other parts of the body.
Even if the can be worrying: Low-risk prostate cancer grows only very slowly, or sometimes doesn’t grow at all. So the chances of recovery are very good. Over a time period of 10 years, only 1 out of 100 men who have low-risk prostate cancer will die of this disease. In other words: 99 out of 100 men will not die of prostate cancer in the 10 years after it is diagnosed.
There are various ways to deal with low-risk prostate cancer. All of the options have their pros and cons. So it’s a good idea to get enough information and discuss the options with your doctors before making a decision.
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Initial Treatment Of Prostate Cancer By Stage
The stage of your cancer is one of the most important factors in choosing the best way to treat it. Prostate cancer is staged based on the extent of the cancer and the PSA level and Gleason score when it is first diagnosed.
For prostate cancers that haven’t spread , doctors also use risk groups to help determine treatment options. Risk groups range from very low risk to very high risk, with lower risk group cancers having a smaller chance of growing and spreading compared to those in higher risk groups.
Other factors, such as your age, overall health, life expectancy, and personal preferences are also taken into account when looking at treatment options. In fact, many doctors determine a mans possible treatment options based not just on the stage, but on the risk of cancer coming back after the initial treatment and on the mans life expectancy.
You might want to ask your doctor what factors he or she is considering when discussing your treatment options. Some doctors might recommend options that are different from those listed here.
Enhancing Healthcare Team Outcomes
Prostate cancer diagnosis and treatment can be complex and is often controversial. an interprofessional team of specialty-trained nurses, nurse practitioners, physician assistants, primary care providers, and urologists must work to manage:
These and many more issues continue to challenge clinicians who deal with prostate cancer patients and men at risk for this common, potentially lethal male malignancy.
The interprofessional team can optimize the treatment of these patients through communication and coordination of care. Primary care providers, urologists, oncologists, radiation oncologists, and nurse practitioners provide diagnoses and care plans. Specialty care urologic nurses should work with the team for coordination of care and are involved in patient education and monitor compliance. The interprofessional team can thus improve outcomes for patients with prostate cancer.
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What Does Gleason Score 6 Mean
Gleason score 6 suggests the prostate cancer is low-grade or low-risk as it is slow-growing and localised to the prostate .
Gleason score 6 is reported as:
Gleason Score: 3 + 3 = 6
Gleason Score 3+3=6 is considered low-risk because the 1st number and 2nd number is Grade 3. Grade 3 is considered only slightly cancerous and this is the most common cell pattern found in the tissue samples.
How Do Doctors Screen For Prostate Cancer
The answer is complicated. While nearly all cases of prostate cancer are discovered during screening for the disease, you and your doctor first must decide if screening is right for you. Lets start there.
First, what is prostate cancer screening? Screening tells your doctor whether or not youre likely to have this disease. Its not a diagnosis but rather helps guide the decision to undergo further testing, such as a biopsy, which will help determine whether you actually do have prostate cancer, how aggressive it is, and If treatment is recommended. The tricky part, as well soon unpack in more detail, is that sometimes you can test positive for prostate cancerand immediate treatment is not recommended.
Lets first go over the initial tests youll likely have if screening is right for you:
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How Does Tumor Grade Affect A Patients Treatment Options
Doctors use tumor grade and other factors, such as cancer stage and a patients age and general health, to develop a treatment plan and to determine a patients prognosis . Generally, a lower grade indicates a better prognosis. A higher-grade cancer may grow and spread more quickly and may require immediate or more aggressive treatment.
The importance of tumor grade in planning treatment and determining a patients prognosis is greater for certain types of cancer, such as soft tissue sarcoma, primary brain tumors, and breast and prostate cancer.
Patients should talk with their doctor for more information about tumor grade and how it relates to their treatment and prognosis.
American Joint Committee on Cancer. AJCC Cancer Staging Manual. 7th ed. New York, NY: Springer 2010.
Whats Lifeand Sexlike With Prostate Cancer
If youve completed treatment for prostate cancer, youll continue to be monitored to make sure your cancer doesnt return. Regular PSA tests are necessary.
That said, youre probably wondering about the elephant in the roomwhat about sex? Its true that treatment for this disease can radically change your sex life, but the good news is it does not have to end it. Different treatment options can trigger different side effects, and your age and health history all come into play, too. However, sexual side effects often go away, though perhaps not as soon as you would like. The Prostate Cancer Foundation says that most men see improvements within a year of surgery, for example, while the lack of sex drive that can accompany hormone therapy often resolves right after treatment ends. So remember: The road back to a healthy, active sex life is very frequently achievable.
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The Gleason Grading System
Screening for prostate cancer involves the prostate-specific antigen test and a digital rectal exam. If results are suspect, your doctor may recommend a prostate biopsythe only way to confirm the diagnosis.
During a prostate biopsy, a urologist uses a small needle to remove tissue samples from different parts of the prostate. These samplesalso called coresare then sent to a pathologist so they can review each one under a microscope.
The pathologist uses a pattern scale, developed by Donald Gleason, MD, PhD in 1966, to give each sample a grade from 1 to 5. Grade 1 cells are well-differentiated and look like normal tissue. Grade 5 cells, on the other hand, are “poorly differentiated” or even unrecognizable from normal tissue.
Your Gleason score is the sum of the two numbers that represent the most common types of tissue found in your biopsy. The first number in the equation is the most common grade present, the second number is the second most common grade. For example, if seven of your cores are grade 5 and five are grade 4, your Gleason score would be 5+4, or a Gleason 9.
Today, pathologists typically only flag tissue samples that are grade 3 or higher, making 6 the lowest Gleason score.
In 2014, a revised grading system for prostate cancercalled Grade Groupswas established. This system builds on the Gleason scoring system and breaks prostate cancer into five groups based on risk. This can help make it easier to understand the Gleason score scale.