Getting Prostate Gland Test results

Getting Prostate Gland Test results

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Getting Prostate Gland Test results

It usually takes around two weeks to get all the results.
These can give an indication of how far the cancer has spread and how quickly it might be growing.

If your PSA (Prostate Specific Antogen) test shows that you have a high PSA level for your age, this could be a sign of prostate cancer, but it can also be caused by other things.

If your DRE (Digital Rectal Examination) shows that your prostate is larger than expected this could be a sign of an enlarged prostate. A prostate with hard, bumpy areas may suggest prostate cancer.
If your biopsy shows there is cancer present, the results are used to work out your Gleason score.
This can give an idea of how likely the cancer is to spread.
The results of any scans you might have had will help to stage your cancer to show how far the cancer might have spread.
Contents:
Gleason score
Staging
Localised prostate cancer
Locally advanced prostate cancer
Advanced prostate cancer
What happens next?
Rare types of prostate cancer
Questions to ask your doctor or nurse
Gleason grade
If there are prostate cancer cells in your biopsy samples, they are given a Gleason grade. This tells you how aggressive the cancer is – which means how likely it is to grow and spread outside the prostate.

When cancer cells are looked at under the microscope, they have different patterns, depending on how quickly they are likely to grow. The pattern is given a grade from 1 to 5. This is called the Gleason grade. If a grade is given, it will usually be 3 or higher, as grade 1 and 2 are not cancer.

Gleason score
There may be more than one grade of cancer in the biopsy samples. An overall Gleason score is worked out by adding together two Gleason grades.

The first is the most common grade in all the samples. The second is the highest grade of what’s left. When the most common and the highest grade are added together, the total is called the Gleason score.

For example, if the biopsy samples show that:

most of the cancer seen is grade 3 and
the highest grade of any other cancer seen is grade 4, then
the Gleason score will be 7 (3+4).
Because grade 1 and 2 are not cancer, the combined Gleason score is normally 6 or higher. So your Gleason score can normally only be between 6 (3+3) and 10 (5+5).

Some men will only be told their total Gleason score and not given their Gleason grades.

What does the Gleason score mean?

The higher the Gleason score, the more aggressive the cancer and the more likely it is to spread.

3+3 – All of the cancer cells found in the biopsy look likely to grow slowly.
3+4 – Most of the cancer cells found in the biopsy look likely to grow slowly. There were some cancer cells that look more likely to grow at a more moderate rate.
4+3 – Most of the cancer cells found in the biopsy look likely to grow at a moderate rate. There were some cancer cells that look likely to grow slowly.
4+4 – All of the cancer cells found in the biopsy look likely to grow at a moderately quick rate.
4+5 – Most of the cancer cells found in the biopsy look likely to grow at a moderately quick rate. There were some cancer cells that are likely to grow more quickly.
5+4 – Most of the cancer cells found in the biopsy look likely to grow quickly.
5+5 – All of the cancer cells found in the biopsy look likely to grow quickly.
Your doctor or nurse will talk you through what your results mean.

Back to contents

Staging
Staging is a way of recording how far the cancer has spread. The most common method is the TNM (Tumour Nodes Metastases) system.

The T stage measures the tumour.
The N stage measures whether the cancer has spread to the lymph nodes.
The M stage measures whether the cancer has spread (metastasised) to other parts of the body.
T Stage

The T stage shows how far the cancer has spread in and around the prostate. This is measured by a DRE. You may also have an MRI scan to confirm your T stage.

T1 prostate cancer
The cancer can’t be felt or seen on scans, and can only be seen under a microscope – localised prostate cancer.

T1 prostate cancer
T1 prostate cancer

T2 prostate cancer
The cancer can be felt or seen on scans, but it is contained within the prostate – localised prostate cancer.

T2 Prostate Cancer
T2 Prostate Cancer

T3 prostate cancer
The cancer can be felt or seen breaking through the capsule of the prostate – locally advanced prostate cancer.

T3a The cancer has broken through the capsule of the prostate but has not spread to the seminal vesicles (which produce some of the fluid in semen).
T3b The cancer has spread to the seminal vesicles.
T3 Prostate Cancer
T3 Prostate Cancer

T4 prostate cancer
The tumour has spread to nearby organs, such as the neck of the bladder, back passage, pelvic wall or lymph nodes – locally advanced prostate cancer.

T4 Prostate CancerN Stage

T4 Prostate Cancer

The N stage shows whether the cancer has spread to the nearby lymph nodes. The lymph nodes in the groin are a common place for prostate cancer to spread to. They are looked at with an MRI or CT scan.

You may be offered one of these scans if you’re thinking about having a treatment such as radiotherapy or surgery and there is a risk that your cancer might have spread to your lymph nodes.

NX The lymph nodes were not measured.
N0 No cancer cells can be seen in the lymph nodes.
N1 The lymph nodes contain cancer cells.
If your scans suggest that your cancer has spread to the lymph nodes (N1), it may either be treated as locally advanced or advanced prostate cancer. This may depend on several things, such as how far it has spread (M stage).

M Stage

The M stage shows whether the cancer has spread (metastasised) to other parts of the body, such as the bones. This is measured using a bone scan.

Your doctor may offer you a bone scan if they think your cancer may have spread.

MX The spread of the cancer was not measured.
M0 The cancer has not spread to other parts of the body.
M1 The cancer has spread to other parts of the body.
If you have a bone scan and the results show that your cancer has spread to other parts of the body (M1), you will be diagnosed with advanced prostate cancer.

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Localised prostate cancer
Localised prostate cancer is cancer that is contained within the prostate gland. It is also called early or organ-confined prostate cancer.

Prostate cancer can behave in different ways. Many localised cancers are not aggressive and will not cause any problems in your lifetime. However, some cancers may grow more quickly and spread to other parts of the body.

The tests you have had can give your doctor and idea of how the cancer will behave and what treatments may be suitable for you.

What is the chance my cancer will spread?

Doctors often divide localised prostate cancers into risk groups. This is the risk of the cancer coming back after treatment. This is used to help decide which treatment options are suitable for you.

Low risk

your PSA level is 10ng/ml or less, and
your Gleason score is 6 or less, and
the stage of your cancer is T1 to T2a
Medium risk

your PSA level is between 10 and 20ng/ml, or
your Gleason score is 7, or
the stage of your cancer is T2b or T2c
High risk

your PSA level is 20 ng/ml or higher, or
your Gleason score is 8 or higher, or
the stage of your cancer is T3 or T4.
Back to contents

Locally advanced prostate cancer
Locally advanced prostate cancer is cancer that is breaking through the capsule of the prostate, or has spread to the area just outside the prostate. This can include the seminal vesicles, lymph nodes, neck of the bladder or back passage.

Different doctors sometimes use the term “locally advanced prostate cancer” in slightly different ways, so ask your doctor or nurse what it means in your case.

Back to contents

Advanced prostate cancer
Advanced prostate cancer is cancer that has spread from the prostate gland to other parts of the body. It is also called ‘metastatic’ prostate cancer. It develops when tiny prostate cancer cells move from the prostate to other parts of the body through the blood stream or lymphatic system.

Prostate cancer can spread to any part of the body but it most commonly spreads to the bones and the lymph nodes.

Advanced prostate cancer can cause symptoms, which may be the first sign that something is wrong for some men. Symptoms will depend on where the cancer has spread to, but can include bone pain or problems passing urine. Not all men diagnosed with advanced prostate cancer will have symptoms.

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What happens next?
The results will give your multi-disciplinary team (MDT) an idea of how your cancer is behaving and the most suitable treatment options for you.

If you are not sure whether your prostate cancer is localised, locally advanced or advanced, speak to your doctor or nurse. They can explain your test results and talk to you about your treatment options. Or you can call our Specialist Nurses. You can also request a second opinion from another specialist by talking to your GP.

It can be hard to take everything in, especially when you’ve just been diagnosed with prostate cancer. You might find it useful to have someone with you at the consultation, or to make notes so that you can read them in your own time. There is also support available.

Back to contents

Rare types of prostate cancer
As well as giving the Gleason score, a biopsy also looks at the type of cancer cells. For most men who are diagnosed, the type of prostate cancer is adenocarcinoma, or acinar adenocarcinoma. You might see this written on your pathology report. There are other types of prostate cancer, which are very rare. These include:

small cell prostate cancer (neuroendocrine prostate cancer)
large cell prostate cancer (neuroendocrine prostate cancer)
ductal prostate cancer (ductal adenocarcinoma)
mucinous prostate cancer (mucinous adenocarcinoma)
signet ring cell prostate cancer
basal cell prostate cancer (adenoid cystic prostate cancer)
prostate sarcomas, such as leiomyosarcoma.
If you are diagnosed with one of these rare kinds of prostate cancer, you can read more here. Speak to your doctor or nurse about what it means and about the treatments available to you.

Back to contents

Questions to ask your doctor or nurse
What is my PSA level?
Will I need a biopsy? What type of biopsy will I have?
What are the risks and side effects of having a biopsy?
What are my Gleason grades and Gleason score?
Will I need an MRI, CT or bone scan?
What is the stage of my cancer? What does this mean?
What treatments are suitable for me?

To view the original of this article CLICK HERE
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Regards,
Greg_L-W.
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 Please Be Sure To
& Link to my My Blogs
To Spread The Facts World Wide To Give Others HOPE
I Have Been Fighting Cancer since 1997 & I’M STILL HERE!
I Have Cancer, Cancer Does NOT Have Me
I just want to say sorry for copping out at times and leaving Lee and friends to cope!
Any help and support YOU can give her will be hugely welcome.
I do make a lousy patient!

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If YOU want to follow my fight against Cancer from when it started and I first presented with symptoms in 1998 see The TAB at the Header of this Blog. called >DIARY of Cancer ….< just click and it will give you a long list of the main events in chronological order, many linked to specific blog postings.
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Posted by: Greg Lance-Watkins

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PROSTATE CANCER, Treat? Cut? or Ignore?

PROSTATE CANCER, Treat? Cut? or Ignore?
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To Treat or Not to Treat Prostate Cancer: That Is the Question

January 18, 2012

By Durado Brooks, MD, MPH

Imagine being told by your doctor, “You have cancer.”  Then imagine that their next words are “… but we probably don’t need to do anything about it.”  Many people would immediately start looking for another doctor. But hold on just a moment.
Last month the National Institutes of Health (NIH) brought together experts from around the world for a summit to examine the state of our scientific knowledge on “active surveillance” as a management strategy for prostate cancer. For those of you who are unfamiliar with the term, active surveillance essentially means monitoring the cancer closely and delaying active treatment (surgery or radiation, for instance) until there are signs it is needed; the delay may be months, years, or forever. This summit pointed out that while there is still much we need to learn about this once-controversial approach, there is a wealth of data supporting the potential value of active surveillance for a large number of the 240,000 men in the United States who are diagnosed with prostate cancer each year. 
Not treating cancer?
To most individuals, the idea of having cancer and choosing not to treat it smacks of fatalism, or just giving up. In order to understand why this is not the case, it is important to appreciate that all prostate cancers are not created equal. 
There are many prostate cancers that can be singled out as likely to be slow growing and posing a low risk to the affected man;  these can be identified by looking at a man’s PSA level (prostate specific antigen; a protein made by the prostate gland and measured in the blood), Gleason score (a numerical representation of how a man’s tumor looks under the microscope), and other factors (size of the tumor, how much of the prostate gland is invaded by cancer, etc.). The vast majority of men with these low-risk tumors will end up dying of something other than prostate cancer, and few of these men would ever experience any harm from their cancer if it went untreated (or if it was never found in the first place).  
It’s estimated that as many as half of the prostate cancers diagnosed each year in the US fit into this low-risk category. However, to most people the term “low-risk cancer” sounds like an oxymoron.  This quandary prompted a number of summit speakers to question whether this type of tumor should even be called “cancer,” or if the scientific community should come up with a new, less frightening term to describe these slow growing prostate lesions.  
For most men who are told that they have prostate cancer the first question is, “How soon can we get rid of it?” In the US, 90% of these men move very rapidly to what is viewed as definitive therapy, usually prostatectomy (surgical removal of the prostate gland) or killing the cancer cells with radiation treatment. These treatments come with the risk of side effects and complications, most commonly damage to bladder or bowel function, and sexual difficulties.  A recent report from the US Preventive Services Task Force estimates that 1 or more of these complications occur in up to 30 of every 100 men treated for prostate cancer; the same report indicates that 1 of every 200 men who undergo surgical removal of their prostate dies within 30 days of their surgery.  These numbers point to why it’s so important to explore alternative approaches to managing this disease.

Watchful waiting and active surveillance

Prostate cancer is primarily a disease of older men, and many men diagnosed with the disease already have multiple health problems (and in some cases a limited life expectancy).  Given these circumstances it has long been the practice of doctors who treat prostate cancer to weigh these factors and to recommend to some men that, as opposed to beginning treatment shortly after diagnosis, they be observed by their doctors and begin treatment only if they develop symptoms that suggest that their cancer is getting worse.  This approach is known as “watchful waiting.”

Over time, evidence emerged that most men who were observed in this fashion did well for a number of years.  This information, combined with the growing number of low-risk tumors being diagnosed as a result of having widespread PSA screening for prostate cancer, raised the question as to whether younger, healthy men might also benefit from a delayed treatment approach. 

Managing the cancer in these men evolved from simple observation to more intensive follow up, including repeated PSA tests and regular biopsies of the prostate gland, treating the cancer only if it begins to grow or spread. This approach has become known as “active surveillance” (differentiating it from the more passive watchful waiting).  Research studies were undertaken to find out about the impact of both of these approaches on the long-term outcomes of men with prostate cancer, and speakers at the NIH summit described findings from a number of such studies.


‘A viable option’ for low-risk patients
In one of these studies, the Prostate Cancer Intervention vs. Observation Trial (PIVOT), men diagnosed with low-risk prostate cancer were given the option of prostatectomy or observation; these men were then tracked over time. PIVOT used a traditional watchful waiting approach: men were simply observed and treatment was begun only if symptoms developed or if the man requested it.  After approximately 10 years of follow up the risk of dying from prostate cancer was small (less than 10%), and was essentially the same whether a man chose surgery or observation.  The risk of death from any cause, including both prostate cancer and other diseases (referred to as “all cause mortality”) was also about the same between these groups. 
A number of other studies have been carried out to look at outcomes of active surveillance, using observation combined with repeat PSA tests and prostate biopsies to look for whether the cancer was spreading or getting worse. These studies, some of which have been underway for 15 years or more, have found that only a small proportion of men diagnosed with low-risk disease will show signs of significant cancer progression. 
Like PIVOT, most active surveillance studies have found low rates of death from prostate cancer among men with low-risk disease. They have also found similar rates of all cause mortality in men who choose active surveillance when compared to men who got immediate treatment. In addition, men who choose an observational approach (active surveillance or watchful waiting) avoid or delay the side effects associated with surgery or radiation. Based on the strength of the accumulated evidence the NIH expert panel concluded that “active surveillance has emerged as a viable option that should be offered to all low-risk patients.”

Bottom line
So why do 9 out of 10 men with prostate cancer in the US end up being treated shortly after they’re diagnosed? It turns out that many prostate cancer patients have never heard of active surveillance or watchful waiting, and are never told that observation is an option they could consider for their cancer. In other cases active surveillance is discussed as a potential management option but is presented in an unfavorable manner (i.e., “we can treat your cancer or we can just do nothing”). 
Even in circumstances where active surveillance is discussed in a fair, objective manner there are a number of other factors that may influence the likelihood of men choosing and sticking with this option.  These include whether or not their physician supports their choice, support from family and friends, and the patients’ personal perceptions of and experience with cancer (whether they themselves have had other types of cancer in the past, or observed friends or family go through cancer treatment).
So if you or someone close to you has been diagnosed with prostate cancer – slow down! After getting past the shock, start asking some questions. Find out all that you can about the tumor, and determine whether the cancer fits into the low-risk category. Be sure to explore all treatment options, including active surveillance. In some cases of prostate cancer “no treatment” may turn out to be the best treatment.

Ti view the original article CLICK HERE

The NIH expert panel draft report can be accessed at http://consensus.nih.gov/2011/prostate.htm.

Brooks is director of prostate and colorectal cancers for the American Cancer Society.

 .
 Please Be Sure To
My Blogs
To Spread The Facts World Wide To Give Others HOPE
I Have Been Fighting Cancer since 1997 & I’M STILL HERE!
I Have Cancer, Cancer Does NOT Have Me
I just want to say sorry for copping out at times and leaving Lee and friends to cope!
Any help and support YOU can give her will be hugely welcome.
I do make a lousy patient!

.
If YOU want to follow my fight against Cancer from when it started and I first presented with symptoms see The TAB just below the Header of this Blog. called >DIARY of Cancer< just click and it will give you a long list of the main events in chronological order.
.
Thoughts and comments will be in chronological order in the main blog and can be tracked in the >ARCHIVE< in the Right Sidebar.

You may find the TABS >MEDICAL LINKS< and also >CANCER LINKS< of help.
.
YOU are welcome to call me if you believe I can help in ANY way.
.

Posted by: Greg Lance-Watkins
tel: 01594 – 528 337
DO MAKE USE of LINKS & >Right Side Bar< Also:
General Stuff: http://gl-w.blogspot.com  
  TWITTER: Greg_L
  
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