Will It Kill Me And If So When

The recurrence and spread of prostate cancer usually follow certain pathways. If the cancer was removed surgically, microscopic bits of cancer may have been left behind where the prostate lay (called the bed of the prostate). If the cancer was treated with radiation, it may recur in portions of the prostate that did not receive enough radiation to kill all the cancer cells. At any point, the cancer may spread beyond the prostate to the seminal vesicles, adjacent lymph nodes, or bladder; this is called local spread. It may also spread more distantly, called metastasis. Bones, especially the spine, are favorite sites for prostate cancer metastases, but late in its course the cancer may also metastasize to the kidneys or virtually anywhere in the body.

The predictors of prostate cancer spread include the same factors

A Clerk in a Great Court

I try not to think about the number but I can't help doing it. PSA is like a clerk in a great court sitting in judgment on me, on my health or illness, my life or death. What terrible or wonderful message will this clerk deliver? Will I be condemned? Or rescued? And will the tumor be smaller? If so, how small? Will my side effects have been experienced in vain? Did I make a serious mistake in not selecting a prostatectomy? Or watchful waiting? Wait, wait, wait and see.

—Charles Neider, Adam's Burden that predict a serious cancer. Men who have a PSA greater than 20, a Gleason score of 8 to 10, or a large tumor that occupies both lobes of the prostate are at high risk for recurrence. Thus, a man with a PSA between 4 and 10 has an 11 percent chance of cancer recurrence at five years, whereas a man with a PSA over 20 has a 40 percent chance; in addition, the man with the higher PSA will have his cancer recur sooner. Similarly, a man with a Gleason score of 6 or less has a 3 percent chance of recurrence at five years, whereas a man with a Gleason score of 8 to 10 has a 38 percent chance. A man whose cancer occupies more than 20 percent of the prostate has three times the risk of recurrence as a man whose cancer occupies less than 10 percent of the gland.2

Several efforts have been made to put various factors together into a single schema to predict prostate cancer spread following surgery or radiation treatment. These schema are referred to as nomo-grams, which are merely graphic representations of risk based on the past experience of similar men. The simplest nomogram for men following surgery consists of the following:3

• Take your numerical Gleason score.

10 Ways To Fight Off Cancer

10 Ways To Fight Off Cancer

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