At the relatively young age of 50 my husband was diagnosed with prostate cancer. Due to the keen screening by my husband’s internist, a small nodule was discovered on the back left side of his prostate. That discovery lead to a biopsy and the scary confirmation that he had cancer.
If you or someone you know has been diagnosed with prostate cancer there are several numbers you will soon become familiar with. Your Gleason Score will be one of the most critical. The other will be your Clinical Staging. Lastly your age will be a factor. Of these, your Gleason score is the single most important prognostic indicator to help you determine your course of action. Together these factors will be critical to aid in your decision making.
The Gleason score is a system that assigns a grade to the two largest tissue samples obtained from a needle biopsy. Grades range from 1 to 5, with 1 being the least aggressive and 5 being the most aggressive. The two grades are combined to produce the total Gleason score. A score between 2 and 4 is considered low. Grades 5 to 7 are intermediate and Grades 8 to 10 are considered high.
Your CS or Clinical Stage is the second most important number in your diagnosis. This measures the tumor volume and the extent to which the cancer has spread in the gland. CS is divided into four major categories. These categories are ranked from lowest to highest as T1, T2, T3 and T4. Within each of these categories they are further divided, lowest to highest, as a, b, or c. T1a and T1b are signs that the prostate cancer is at its very earliest stage with less than 5% cancer. T2 typically involves palpable tumor detection during a DRE or Digital Rectal Exam and up to 50% or more of the cancer in the gland.
My husband’s Gleason score was 6 and his Clinical Stage was T2a. These numbers were cause for alarm and yet both were in the intermediate range which our doctors judged as allowing us ample time to make a thoughtful and not a hasty decision. I should note that my husband’s PSA (Prostate-specific antigen) score was a relatively low 1.4, and not an indicator of his prostate cancer. It was truly the smart observation by his internist that prompted his biopsy and early detection.
Your age will also have some bearing on your course of action. The younger and more physically fit you are typically the faster you’ll recover.
With these numbers in hand the most common choices a man has after being diagnosed are the following:
- Watchful Waiting: Typically with a Gleason under 4 and CS in the T1 range, you have time to watch and wait. You do not need to have hasty radiation or other form of therapy. Your cancer is probably slow growing and with quarterly screenings your doctor can observe the rate at which it is spreading.
- Radiation and/or chemotherapy: If your scores indicate your cancer is in the intermediate stage and you are of an advanced age and in physically fair to poor condition, radiation or chemotherapy may be your best option. Radiation involves the insertion of a hollow needle containing radioactive seeds and filled directly in the prostate gland. This procedure may be repeated over the next several days. The seeds remain in place permanently and overtime become biologically inert. The goal of these seeds is to kill the cancer (and often some of the surrounding cells) to rid the cancer.
- Hormone Therapy: For men who are at a very advanced age and/or have other physical ailments, hormone therapy may be the best treatment. This is one of the least invasive of treatments are typically for lower grades of prostate cancer. By lowering the level of the male hormone in the body the size of the cancer can be reduced. This primary use of this treatment may be to put this cancer at bay while treating other more serious illnesses in the patient.
- Radical Prostatectomy: Whether by traditional surgery or a newer form of surgery called the DaVinci robotic assisted surgery, this option involves the complete removal of the prostate. This is often for intermediate to low grade prostate cancers for men who still have a lot of living to do.
Our own decision was to have a radical DaVinci robotic assisted prostatectomy. This was based on third and fourth doctor opinions and multiple discussions with other prostate cancer survivors. We found a number of useful resources that provided names of other patients and survivors who freely shared their journey on this path including the prostate cancer education and support group, Us Too.
My husband is one month away from celebrating a year of being cancer free. We are happy with the decision to have the radical prostatectomy as this option fully contained and rid the cancer from his body. Quarterly screenings have indicated that the cancer has been fully removed.