By: Yousef Issa

Having cancer is something that well changes your life. It requires you to start making some hard decisions that can affect your daily life in significant ways for many years to come. If you or someone you love has been diagnosed with prostate cancer, you'll be faced with a number of different therapy options, all of which might be equally effective, but each of which also has its upsides and downsides. More than 200,000 men in the United States will be diagnosed with prostate cancer this year, and each and every one of them will need to make very personal and individualized decisions about which treatment might be right for him. Do I undergo? Treatment? If yes, which treatment? Surgery? External radiation? Radiation seed implantation? Hormones? Chemotherapy? Or is active surveillance the right choice? In this Chapter, we'll review the basic background material you need to know about a diagnosis of prostate cancer. We'll talk about PSA (prostate specific antigen) and Gleason score, which factors might be important in determining outcomes and prognosis, and, most importantly, we'll talk about why you need to surround yourself with a team of prostate cancer experts, comprising a wide variety of practice specialties, to help you find the path that's right for you.

Making Sense of the Diagnosis

If you're like many other men who are diagnosed with prostate cancer, you went to your doctor for a routine check-up and had a PSA and DRE (digital rectal exam) to screen for prostate cancer. Something irregular showed up, and your doctor sent you for a biopsy. Then, a few days after the biopsy, you were told that prostate cancer was found. Or, you might have noticed changes in your urinary or sexual function and asked your doctor about it. Then, after a full work-up, including a biopsy, the diagnosis of prostate cancer was made. But what exactly did the doctor looking at your biopsy see? Why is it important for you to know what your tumor cells look like? After all, cancer is cancer, right? In fact, the way your cells look under the microscope can tell a lot about your disease, and will often drive some very important decisions about treatment options. Under normal conditions, your prostate cells, just like all other cells in your body, are constantly reproducing and dying. And each new prostate cell that grows has the same shape and appearance as all of the other prostate cells. But cancer cells look different, and the degree to which they look different from normal cells is what determines the cancer grade. Low-grade tumor cells tend to look very similar to normal cells, whereas high-grade tumor cells have mutated so much that they often barely resemble the normal cells. The Gleason grading system accounts for the five distinct patterns that prostate tumor cells tend to go through as they change from normal cells. The scale runs from 1 to 5, where 1 represents cells that are very nearly normal, and 5 represents cells that don't look much like prostate cells at all. After examining the cells under a microscope, the pathologist looking at your biopsy sample assigns one Gleason grade to the most common pattern, and a second Gleason grade to the next most common pattern. The two grades are added, and your Gleason score, or sum, is determined. Generally speaking, the Gleason score tends to predict the aggressiveness of the disease and how it will behave in your body. The higher the Gleason score, the less the cells behave like normal cells, and the more aggressive the tumor tends to be.

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