Several questions immediately came to mind on the day I was diagnosed with prostate cancer. How serious is it? Is it likely to kill me? If so, when? This chapter provides information you need to begin answering such questions. Those who wish to skip the more technical discussions will find a summary at the end of the chapter.
Prostate cancer is cancer. It affects the walnut-sized gland that sits beneath the bladder and contributes some of the fluid making up the semen; a detailed description of the prostate can be found in Appendix A. Prostate cancer should not be confused with benign prostatic hypertrophy (BPH), the other common—indeed, almost universal—prostate affliction of older men. For benign prostatic hypertrophy, the operant word is benign. It is an enlargement of the prostate that can cause symptoms such as frequency (having to urinate often), urgency (difficulty in holding your urine), a weak flow, and starting and stopping of the flow. Benign prostatic hypertrophy can be treated with medications or surgery. Sometimes, in the course of surgery for BPH, it is discovered incidentally that the enlarged prostate has cancer as well, but the two conditions are unrelated.
The following discussion assumes that the type of prostate cancer with which you have been diagnosed is an adenocarcinoma. More than 95 percent of all prostate cancers are of this type. The other 5 percent include small cell, squamous cell, sarcomas, and other rare types; all tend to be more aggressive and to have worse prognoses than adenocarcinomas.
The three most widely used indicators of severity in men with newly diagnosed prostate cancer are total prostate specific antigen (PSA) level; whether the cancer can be felt on digital rectal exam (often abbreviated as DRE) and an estimate of the cancer volume; and the appearance of the cancer cells obtained by biopsy (Gleason score). Other indicators of severity are not as widely used but may also be very useful; these are described below.
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