Let's Talk Sex
February 5, 2013
Rectal examinations in treating prostate cancer

Men generally do not like to have a rectal examination and most do not like going to the doctor;, but it is very important when treating prostate cancer to have a rectal examination done, as it helps us doctors to give your prostate lump a name.{{more}}

This name actually tells us the clinical stage of the cancer. If you look at your notes as a patient (and you should be allowed to look at or even copy your notes if you so desire) who has prostate cancer, you may see letters such as cT2a. This is the clinical stage found from rectal examination being described. The “c” is for clinical, the “T” is for tumour or lump, “2” tells me I can feel a lump and “a” tells me it is a small lump on one side of the prostate. So a cT2a stage tells me when I examine the prostate I feel a small lump on one side of the prostate. And a cT3b tells me that the tumour appears to be on both sides of the prostate, but not confined to the prostate only. In other words it feels like it is beginning to spread out of the prostate.

Apart from how the prostate feels on examination, the aggressiveness of the prostate cancer is important in planning treatment. Last episode we discussed the grade or aggressiveness. As we said before, aggressive cancers tend to spread quickly and the patients tend to do badly. We number aggressiveness from 2 to 10, with 2 being the least aggressive and rarely found (only in the books) and 10 being bad news. Generally, numbers 6 and 7 are the most common and have the most varied treatment. Numbers 4, 5 and 6 are considered non-aggressive, 7 moderately aggressive and 8, 9, and 10 very aggressive. Aggressive tumours tend to get aggressive treatment like surgery and radiation and non-aggressive tumours tend to have minimal treatment, especially if these men are elderly (more than 75 years old).

I have just introduced the idea of age in the treatment of prostate cancer. Age is very important, because prostate cancer generally grows very slowly. If the man is young (40-60) when the prostate cancer is discovered, then it has “all the time to grow” before the man gets elderly or before he dies from other causes. In other words, the cancer might grow and affect him before he dies. We, therefore, advise aggressive treatment in younger men. At the other end of the spectrum, men over 70 years are not advised to have aggressive treatment unless their tumour is aggressive and they are in good health or have a life expectancy of at least 10 years. So, what about the men between 60 and 70? Well it depends on all the above factors, like how aggressive the tumour is, the PSA level and how the tumour feels on examination.

The other factor is the level of the PSA. We talked about the PSA briefly in the last article. As a general rule of thumb, we have evidence that patients with PSAs less than 10 generally have cancers which have not spread, those with PSAs 10 – 20 have a significant risk of spread, but only locally, whilst those with PSAs more than 20 tend to have cancers which have a significant risk of spread to the local lymph glands or further. Therefore, patients with PSAs less than 20 tend to have curative treatment, but those over 10 tend to have combination treatment. By now you are beginning to get the idea that there is no one treatment that fits all. Every patient is an individual and therefore treatment has to be planned individually. Hence, next episode, we will look at the individual and his wishes, his family and his resources.

For comments or question contact:

Dr Rohan Deshong

Tel:(784) 456-2785