The most common scale used to evaluate the grade of prostate cancer cells is called a Gleason score. Gleason scoring combines two numbers and can range from 2 nonaggressive cancer to 10 very aggressive cancer , though the lower part of the range isn't used as often. Most Gleason scores used to assess prostate biopsy samples range from 6 to A score of 6 indicates a low-grade prostate cancer. A score of 7 indicates a medium-grade prostate cancer. Scores from 8 to 10 indicate high-grade cancers.
In addition, genomic testing is increasingly being used to more accurately assess risk and detect aggressive prostate cancer.
Mayo Clinic physicians and researchers are leaders in the development of biomarkers for prostate cancer. Doctors in Mayo Clinic's Center for Individualized Medicine are advancing research on the use of biomarkers in blood and in prostate tissue to better individualize and optimize treatment for men with prostate cancer. The technology helps caregivers distinguish between insignificant and significant prostate cancer, as well as identify particularly aggressive prostate cancer in men undergoing surgery.
During a transrectal biopsy, a biopsy gun quickly projects a thin needle into suspect areas of the prostate gland, and small sections of tissue are removed for analysis. Once a prostate cancer diagnosis has been made, your doctor works to determine the extent stage of the cancer. If your doctor suspects your cancer may have spread beyond your prostate, one or more of the following imaging tests may be recommended:.
At Mayo Clinic, caregivers can also turn to prostate-specific membrane antigen PSMA studies to help detect the extent of newly diagnosed prostate cancer and whether the disease has spread to nearby lymph nodes. Mayo clinicians also use recent 7 Tesla 7T magnet imaging technology advancements to differentiate between prostate cancer that does or doesn't require immediate intervention. Not every person should have every test.
Advantages and disadvantages of surgery
Your doctor will help determine which tests are best for your individual case. Your doctor uses the information from these tests to assign your cancer a stage. Prostate cancer stages are indicated by Roman numerals ranging from I to IV. The lowest stages indicate the cancer is confined to the prostate. By stage IV, the cancer has grown beyond the prostate and may have spread to other areas of the body.
After a diagnosis of prostate cancer
The cancer staging system continues to evolve and is becoming more complex as doctors improve cancer diagnosis and treatment. Your doctor uses your cancer stage to select the treatments that are right for you. Your prostate cancer treatment options depend on several factors, such as how fast your cancer is growing, how much it has spread and your overall health, as well as the potential benefits or side effects of the treatment. For men diagnosed with low-risk prostate cancer, treatment may not be necessary right away.
Some men may never need treatment. Instead, doctors sometimes recommend active surveillance. In active surveillance, regular follow-up blood tests, rectal exams and possibly biopsies may be performed to monitor progression of your cancer.
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If tests show your cancer is progressing, you may opt for a prostate cancer treatment such as surgery or radiation. Active surveillance may be an option for cancer that isn't causing symptoms, is expected to grow very slowly and is confined to a small area of the prostate. Active surveillance may also be considered for someone who has another serious health condition or who is of an advanced age that makes cancer treatment more difficult. Active surveillance carries a risk that the cancer may grow and spread between checkups, making the cancer less likely to be cured.
Surgery for prostate cancer involves removing the prostate gland radical prostatectomy , some surrounding tissue and a few lymph nodes. Radical prostatectomy can be performed in several ways:. Radical prostatectomy carries a risk of urinary incontinence and erectile dysfunction.
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Ask your doctor to explain the risks you may face based on your situation, the type of procedure you select, your age, your body type and your overall health. Radiation therapy uses high-powered energy to kill cancer cells. Prostate cancer radiation therapy can be delivered in two ways:.
Side effects of radiation therapy can include painful, frequent or urgent urination, as well as rectal symptoms such as loose stools or pain when passing stools. Erectile dysfunction can also occur. Hormone therapy is treatment to stop your body from producing the male hormone testosterone. Prostate cancer cells rely on testosterone to help them grow.
Cutting off the supply of testosterone may cause cancer cells to die or to grow more slowly. Hormone therapy is used in men with advanced prostate cancer to shrink the cancer and slow the growth of tumors. In men with early-stage prostate cancer, hormone therapy may be used to shrink tumors before radiation therapy, which can increase the likelihood that radiation therapy will be successful.
Side effects of hormone therapy may include erectile dysfunction, hot flashes, loss of bone mass, reduced sex drive and weight gain.
During cryosurgery for prostate cancer, small needles are inserted in the prostate using ultrasound images as guidance. A very cold gas is placed in the needles, which causes the surrounding tissue to freeze. A second gas is then placed in the needles to reheat the tissue. The cycles of freezing and thawing kill the cancer cells and some surrounding healthy tissue.
Initial attempts to use cryosurgery for prostate cancer resulted in high complication rates and unacceptable side effects. However, newer technologies have lowered complication rates, improved cancer control and made the procedure easier to tolerate. Cryosurgery is more frequently used as a salvage therapy for men who haven't been helped by radiation therapy. Chemotherapy uses drugs to kill rapidly growing cells, including cancer cells. Chemotherapy can be administered through a vein in your arm, in pill form or both. Chemotherapy may be a treatment option for men with prostate cancer that has spread to remote body locations.
Chemotherapy may also be an option for cancers that don't respond to hormone therapy. Permanent prostate brachytherapy involves placing many radioactive seeds within the prostate to treat prostate cancer. During the procedure, an ultrasound probe is placed in the rectum to help guide the placement of seeds. The seeds emit radiation that dissipates over a few months. Biological therapy immunotherapy uses your body's immune system to fight cancer cells. One type of biological therapy called sipuleucel-T Provenge has been developed to treat advanced, recurrent prostate cancer.
This treatment takes some of your own immune cells, genetically engineers them in a laboratory to fight prostate cancer, then injects the cells back into your body through a vein. Some men do respond to this therapy with some improvement in their cancer, but the treatment is very expensive and requires multiple treatments.
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Explore Mayo Clinic studies testing new treatments, interventions and tests as a means to prevent, detect, treat or manage this disease. No complementary or alternative treatments will cure prostate cancer. However, complementary and alternative prostate cancer treatments may help you cope with the side effects of cancer and its treatment.
Nearly everyone diagnosed with cancer experiences some distress at some point. If you're distressed, you may feel sad, angry or anxious. You may experience difficulty sleeping or find yourself constantly thinking about your cancer. Discuss your feelings and concerns with your doctor. In some cases, treatment for distress may require medications. When you receive a diagnosis of prostate cancer, you may experience a range of feelings — including disbelief, fear, anger, anxiety and depression. With time, each person finds his own way of coping with a prostate cancer diagnosis.
If you have signs or symptoms that worry you, start by seeing your family doctor or a general practitioner. If your doctor suspects you may have a problem with your prostate, you may be referred to a urinary tract specialist urologist. If you're diagnosed with prostate cancer, you may be referred to a cancer specialist oncologist or a specialist who uses radiation therapy to treat cancer radiation oncologist.
Because appointments can be brief, and because there's often a lot of ground to cover, it's a good idea to be prepared. Here's some information to help you get ready and what to expect from your doctor. Your time with your doctor is limited, so preparing a list of questions can help you make the most of your time together. List your questions from most important to least important in case time runs out.
For prostate cancer, some basic questions to ask your doctor include:. In addition to the questions that you've prepared to ask your doctor, don't hesitate to ask other questions during your appointment. Your doctor is likely to ask you a number of questions. Being ready to answer them may allow more time later to cover other points you want to address.
Your doctor may ask:.