One year ago, I was diagnosed with early stage, low risk prostate cancer.
Following that diagnosis, I attended several prostate cancer group meetings. It is common for men to not discuss their health issues and in those group sessions we were encouraged to talk about prostate cancer with our friends and family members in order to better prepare men for this health issue. I have debated whether I wanted to address this topic in this blog and clearly I have decided to do so. Simply, it is useful for me to have a sort of diary of my experience and I want to share what I’ve learned about the current practices used for diagnosing and treating prostate cancer. Perhaps someone else can benefit from that.
Not that anyone would welcome a cancer diagnosis, however, for a man, if you were told that you will have cancer but you can pick the type, you would probably want to choose prostate. Generally, it is significantly less life threatening than any of the other commonly occurring cancers even though treatment for prostate cancer can have unpleasant consequences. First, some background. What led to my diagnosis?
As part of my annual wellness check, the routine blood work included a PSA test. PSA stands for prostate-specific antigen and the PSA test measures the amount of this substance that has been released into the blood from the prostate gland. A higher amount of PSA in the blood does not always indicate prostate cancer but in most cases the presence of prostate cancer will be accompanied by a higher PSA. Therefore, an annual PSA test along with a Digital Rectal Exam (DRE) are the primary diagnostic tools used to test for the possibility that a man has prostate cancer. To the dismay of men, the DRE is still an invaluable part of a prostate exam and involves the physician inserting his finger in the patient’s rectum in order to feel the prostate to assess the size and to check for nodules or bumps which might be present.
Looking at my PSA history, I’ll begin in November 2009, when my PSA was 2.55 which is considered in the normal range. Moving ahead to July 2010, my PSA test showed 3.26, a marked increase but still considered OK. Then by March 2012, my PSA had advanced to 5.02, above normal and high enough that I was referred to an urologist. Later that year, in August my PSA reading was 5.57. It was at this point that the urologist recommended that I should undergo a needle biopsy. In a future article I will address the topic of the role of biopsies in diagnosing prostate cancer but it is almost universal that a urologist will recommend a biopsy when the PSA is elevated. So on November 13, 2012, I underwent a biopsy of the prostate which was negative for cancer.
Throughout 2013 and 2014, my PSA continued to increase reaching 8.9 when tested on April 6, 2015. At this time I was encouraged to once again undergo a needle biopsy. This was completed on May 19th. The biopsy involved the use of 12 needles to collect tissue samples from various parts of the prostate. The result showed evidence of cancer in 2 of the 6 needles from the right lobe of the prostate. The pathologist assigned a Gleason score of 6 to the cancer detected.
The Gleason score is a grading system for prostate carcinoma developed by Dr. Donald Gleason in 1977. For us lay people it is a protocol used by the pathologist based upon the microscopic appearance of the cancer cells and indicates the degree to which they are differentiated from the normal tissue of the prostate. The Gleason score can range from 2 to 10 but in practice would rarely be reported less than 5 since these scores would not indicate cancer. A Gleason score of 6 or less is considered to be a “good prognosis” in that it indicates an early stage, non-aggressive tumor.
So the bottom line for me from the biopsy was this: PSA less than 10, Gleason score of 6, only 2 needles with evidence of cancer and the greatest percentage of cancer in a single core was 22%. These factors combine to indicate a most likely small, early stage, non-aggressive, low risk tumor. Essentially, if you are diagnosed with prostate cancer you would prefer this diagnosis over almost any other.
In future articles I will talk about what has happened since the diagnosis as well as some of the issues around diagnosis and treatment of prostate cancer.