Diagnosis, Staging and Grading of Prostate Cancer
The widespread use of the Prostate Specific Antigen or PSA test has resulted in more frequent and earlier diagnosis of prostate cancer. The PSA is a protein produced by both benign and malignant prostate cells. In general, its value will relate to the presence of prostate disease and to some extent the type of prostate disease. Values of 0 to 4 are considered normal. Values between 4 and 10 are usually BPH or prostatitis, but may also be prostate cancer. Values of 10 to 20 are highly suspicious for cancer and values above 20 are most likely cancer. However, there is tremendous overlap and 30 per cent of prostate cancer patients have normal PSA’s. The presence of an elevated PSA usually results in a urologist recommending a prostate biopsy or series of needle biopsies.
The controversy surrounding routine PSA screening of middle aged or elderly men has to do with what I mentioned previously about the usual course of prostate cancer. Many men die of another disease never knowing they had a prostate problem. If prostate cancer is found in some of these men as a result of an elevated PSA, they may be urged into unnecessary and dangerous treatments that may actually shorten their lives or at least reduce quality of life. If, however, the PSA is used to alert the physician and patient that lifestyle changes and other complementary prevention and treatment steps need to be taken, the PSA can be very useful, in my opinion.
The presence of prostate cancer on biopsy usually results in a search to determine if the cancer is confined to the prostate gland or has spread beyond it. An ultrasound of the prostate gland or other imaging procedures may help to answer this important question. The type of conventional treatment recommended is dependent on the location of the cancer, which is described by the stage of the disease. Prostate cancer has 4 stages. In Stage A, the prostate cancer is confined to the prostate gland and their is no palpable hard swelling on the physician’s digital rectal examination. Stage is A is usually discovered when a biopsy is done because of an elevated PSA, in spite of no prostate nodule on physical examination or when the surgical specimen for BPH turns out to have some cancerous cells. In Stage B, the cancer is also confined to the prostate gland, but there is also a palpable nodule on rectal examination. In Stage C, the cancer has spread beyond the prostate capsule to one or more neighboring structures like the seminal vesicles. Finally, in Stage D, the cancer has spread or metastasized to more distant structures, such as lymph nodes, the bones, the lungs or the liver.
Generally, the more the cancer has spread the worse the prognosis and the less likely the disease will be controlled. In contrast to the staging of the disease, which refers to the location of the cancer, the grading of prostate cancer relates to how the cancer cells look under the microscope. The higher the grade, the more abnormal the appearance of the cells and the more likely a poor prognosis. The conventional treatment for stages A or B is usually either a radical prostatectomy or external beam radiation. These procedures are both highly invasive and result in significant complications and adverse reactions. For stage C or D, the appropriate conventional treatment is some type of anti-hormonal therapy, which reduces the effects of the male hormone testosterone because the removal of the effects of testosterone usually results in improvement of the patient, although this effect is generally only temporary.