Prostate Cancer: Diagnosis
“You have prostate cancer.” Just a few words from your doctor and suddenly you’re on an emotional roller coaster, all while trying to get the facts straight—lab reports, unfamiliar terms, this score and that score. It’s a lot to absorb.
Yet having a clear understanding of your diagnosis can help you chart your best course for the future. Read on for information that can help you put it all in perspective.
Staging your cancer
Prostate cancer begins in the prostate gland, the walnut-size structure that wraps around the urethra. Most of the time it grows slowly, but sometimes it can spread surprisingly quickly. That’s why determining where your prostate cancer belongs on the spectrum—that is, its stage—is job number one for your doctor. In addition to your PSA (prostate-specific antigen) level at the time of diagnosis, your urologist will consider other factors, such as:
Your Gleason score. To find your Gleason score, a pathologist will examine a sample of your prostate cancer cells under a microscope and assign it a number between 2 and 10. The lower your score, the less likely your cancer is to grow and spread rapidly. According to studies at the Prostate Cancer Research Institute in Los Angeles, a Gleason score is the best possible measure of how aggressive cancer cells are.
Your T, N, M classification. This is part of the standardized system doctors use to describe a particular cancer. The “T” is a measure of how big the main tumor is, and how far it has spread into your pelvis (T1, for example, means the lump is so tiny your doctor can’t even feel it, whereas T4 tumors have grown and spread into nearby tissues, like the bladder). The “N” number tells your doctor whether any cancer cells have spread to nearby lymph nodes (N1 means yes...N0 means no). And the “M”? That tells your doctor whether your cancer has metastasized—whether it has spread to far-flung areas, like your bones, liver or lungs.
Putting it all together
With all that information in hand, your urologist can then determine the stage of your cancer and suggest the treatment options that are best for you.
Prostate cancers range from Stage I to Stage IV. Stage I means your cancer is still small, hasn’t spread and may grow slowly. At the other end of the spectrum, a Stage IV cancer is one that’s already made its way into nearby tissues, lymph nodes or even distant organs. Luckily, prostate cancer is extremely slow growing, and most cases are diagnosed early on.
“When you get your diagnosis, make sure your doctor explains it thoroughly. Then take time to get over the shock before making decisions about your treatment,” suggests urologist Eric Klein, MD, chairman of Cleveland Clinic’s Glickman Urological and Kidney Institute.