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January 22, 2013
Prostate cancer treatment

Over the last few weeks, I have been discussing the various aspects of prostate cancer. Today we discuss the treatment, which as you would expect, would depend on many factors. In other words, there is no one-size fit all treatment. The main factors, which determine the treatment, are the age of the man, how the prostate feels on rectal examination, the stage and grade of the cancer, the man’s wishes and his resources.{{more}} In older men, the wishes of the family may sometimes be a factor, as these men may sometimes be dependent on their family for support. Let’s explore some of these factors.

We will deal with the age issue after I have dealt with the stage and grade issues. The stage of a cancer tells us how far it has spread at the time of diagnosis. Early stage means it has not begun to spread, intermediate stage means it has just started to spread but it is confined to the area around where the cancer started, in other words roots are just about to form or the cancer has just broken out of the shell. Late stage or advanced cancer means the cancer has spread far or as the older folks say “it already gone far” or “it already form root or prongs”. This means you can detect cancer far away from where it started. These far-away pieces of cancer are called deposits or metastases. To metastasize means to spread, not just cancer, but anything else including seeds in a field or dust or garbage in a clean area. There are different types of stages, there is the clinical stage i.e. what we doctors detect from examining you, the radiological stage i.e. what we doctors find using X-rays, CT scans and MRIs to name a few and there is pathological staging i.e. when we sample the prostate or take the prostate gland out, how does it look under the microscope?

The best indicator of the stage of the disease is the level of PSA. We have already discussed the PSA in an earlier article. This is the blood test used to tell us whether you have cancer or not. The higher the PSA at the time of diagnosis, the higher the risk of cancer spread outside the prostate. We know this from experience removing thousands of prostates with cancer and comparing them to their PSAs. The grade of the cancer tells of the aggressiveness of the cancer. Basically, the higher the grade, the more aggressive the cancer and the more grave the prognosis. Additionally, the more aggressive cancers tend to spread quicker in the same period of time, hence they tend to be more advanced (higher stage) at the time of diagnosis. In summary, high-grade (aggressive) cancers tend to be high-stage (spread) at the time of diagnosis. This is so true for prostate cancer that we now have tables called nomograms that can accurately predict a patient’s risk of actual spread given how the prostate feels on rectal examination, the PSA at the time of diagnosis and the aggressiveness of the cancer based on how it looks under the microscope. The risk of actual spread is what we use to decide the best way for treating you. Next week, I will look at the various types of stages and how they affect treatment.

For comments or question contact:

Dr. Rohan Deshong

Tel: (784) 456-2785

email: deshong@vincysurf.com