MEDICAL BLOGS:PROSTATE CANCER (PART 2)

IF SCREENING (Prostate Surface Antigen(PSA)/Digital Rectal Exam(DRE) SUGGEST PROSTATE CANCER, WHAT NEXT:


If cancer is seen, it will also be assigned a grade. This is often expressed as a Gleason score.

What do the numbers in the Gleason score mean, for example 3+4=7 or 3+3=6?

Grades 2 through 4 have features in between these extremes.  Since prostate cancers often have areas with different grades.
Whether the cancer has spread outside the prostate.

1)   Transrectal ultrasound (TRUS)

·      A small ultra sound probe (about the width of a finger) is placed in the rectum after lubrication.

·      The probe gives off sound waves that enter the prostate and create echoes. The probe picks up the echoes, and a computer turns them into a black and white image of the prostate.

·      This procedure often takes less than 10 minutes and is done in as an OPD procedure. There is no pain but uncomfortable sensation may be there.

·      TRUS is not used as a screening test for prostate cancer because it can’t always tell the difference between normal tissue and cancer.Instead, it is most often used to look for prostate cancer when a man has symptoms or has an abnormal PSA level or digital rectal exam (DRE).

·      It is also used during a prostate biopsy to guide the biopsy needles into the correct area of the prostate.

    2) Prostate biopsy

·      A biopsy is a procedure in which small samples of the prostate are removed and then looked at under a microscope.

·      A core needle biopsy is the main method used to diagnose prostate cancer.

·      It is usually done by an urologist, a surgeon who treats cancers of the genital and urinary tract, which includes the prostate gland.

·      Using TRUS to “see” the prostate gland, the doctor quickly inserts a thin, hollow needle through the wall of the rectum and into the prostate.

·      When the needle is pulled out, it removes a small cylinder (core) of prostate tissue. This is repeated several times. Most urologists will take about 12 core samples from different parts of the prostate.

·      Though the procedure sounds painful, each biopsy usually causes only a brief uncomfortable sensation because it is done with a special spring-loaded biopsy instrument. The device inserts and removes the needle in a fraction of a second.

·      Most doctors who do the biopsy will numb the area first with local anesthetic.

·      The biopsy itself takes about 10 minutes and is usually done as an OPD procedure.

·      The Urologist may prescribe antibiotics to take before the biopsy and for a day or 2 after procedure, to reduce the risk of infection.

·      For a few days after the procedure, there maybe some soreness in the area and one may probably notice blood in urine.

·      There may also be some light bleeding from the rectum, especially if one has hemorrhoids.

·      Many men notice blood in their semen or have rust-colored semen.

·      Biopsy samples will be sent to a lab, where they will be looked at with a microscope to see if they contain cancer cells. This normally takes 2-3 days.

·      Adenocarcinoma is the commonest form of prostate cancer which occurs in the glandular part of the prostate.

What is the Gleason grade or Gleason score? 

Pathologists grade prostate cancers using numbers from 1 to 5 based on how much the cells in the cancerous tissue look like normal prostate tissue under the microscope.This is called the Gleason system.

·      Grades 1 and 2 are not often used for biopsies − most biopsy samples are grade 3 or higher.

·      If the cancerous tissue looks much like normal prostate tissue, it is graded as 1.

·      If the cancer cells and their growth patterns look very abnormal, it is graded as 5.

·      The grades are assigned to the 2 areas that make up most of the cancer.

·      These 2 grades are added to yield the Gleason score (also called the Gleason sum).

·      The first number assigned is the grade that is most common in the tumor. For example, if the Gleason score is written as 3+4=7, it means most of the tumor is grade 3 and less is grade 4 and they are added for a Gleason score of 7.

·      The highest a Gleason score can be is 10.

·      The higher the Gleason score, the more likely it is that your cancer will grow and spread quickly.

What does it mean to have a Gleason score of 6 or 7 or 8-10?

·      The lowest Gleason score of a cancer found on a prostate biopsy is 6. These cancers may be called well-differentiated or low-grade and are likely to be less aggressive – they tend to grow and spread slowly.

·      Cancers with Gleason scores of 8 to 10 may be called poorly differentiated or high grade. These cancers tend to be aggressive, meaning they are likely to grow and spread more quickly.

·      Cancers with a Gleason score of 7 may be called moderately differentiated or intermediate grade. The rate at which they grow and spread tends to be in between.

How important is the Gleason score?

The Gleason score is very important in predicting the behavior of a prostate cancer.

However other factors are also important, such as

·      The PSA level, 

·      Findings on rectal exam, 

·      How much of each core is made up of cancer, 

·      The number of cores that contain cancer, 

·      Whether cancer was found in both sides of the prostate, and 

Even when taking many samples, biopsies can still sometimes miss a cancer if none of the biopsy needles pass through it. This is known as a false-negative result.

If your doctor still strongly suspects you have prostate cancer (because your PSA level is very high, for example) a repeat biopsy may be needed to help be sure.

Prostate biopsy results are sometimes called suspicious.

Suspicious results mean that the cells don’t look like cancer, but they don’t look quite normal, either.

If the biopsy results come back suspicious, doctor may want to repeat the biopsy.

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Author- 

   

Dr. Ganjoo 

Head-Yoddhas Medical Expert Panel