(continued from previous page) What else does the pathologist look for? In all prostate tissue samples, a Gleason grade is assigned by the pathologist. What is prostate adenocarcinoma? Prostate adenocarcinoma accounts for 95 percent of all prostate cancers. It starts in the prostate gland and, if not treated successfully at an early stage, can spread to other parts of the body. Other than skin cancer, prostate adenocarcinoma is the most common cancer in American men, with 217,730 cases diagnosed each year, according to the American Cancer Society. Who is most likely to have prostate adenocarcinoma? Prostate adenocarcinoma becomes more common in men over age 50. Age is the most common risk factor, with nearly 63 percent of prostate cancer cases occurring in men over age 65, according to the National Cancer Institute. African-American men have an above average risk. A family history of prostate cancer and a high-fat diet also increase risk…
What else does the pathologist look for? In all prostate tissue samples, a Gleason grade is assigned by the pathologist. This important number, which ranges from 2 (best) to 10 (worst), is a strong measure of how aggressive the prostate cancer is and can be used to help determine prognosis and type of therapy. Physicians often look at a combination of your Gleason grade, clinical stage, and serum PSA level (how fast your PSA is rising) in deciding on the best treatment. For needle biopsies and prostate chips, the pathologist will also report the amount of tissue involved that is cancerous and this finding can influence treatment. For radical prostatectomy tissue, pathologists define the stage or extent of the cancer and whether the cancer is at the tissue edge (margins). These findings are very important for prognosis and will influence the decision as to whether additional treatment is needed after surgery. Stages in the radical prostatectomy can be 2 (better) or 3 (worse), with spread into seminal vesicles (structures attached to the back of the prostate) or lymph nodes removed before or during surgery indicating a worse prognosis. Physicians also perform clinical staging tests (radiology or x-ray studies), usually before surgery, to try to tell if the cancer has spread. How do doctors determine what surgery or treatment will be necessary? This decision depends on the state of your prostate cancer. For the majority of patients whose cancer looks like it is still in or near the prostate, the decision is based on the Gleason grade assigned by the pathologist, the serum PSA, the clinical stage, your age, any other medical problems, and treatment or management preference. What kinds of treatments are available for prostate adenocarcinoma? Prostate adenocarcinoma is treated through one or more of the following: watchful waiting, surgery, chemotherapy, hormonal therapy, and radiation therapy. It’s important to learn as much as you can about your treatment options and to make the decision that’s right for you. Watchful waiting is most appropriate for older men with low-grade tumors and low PSA readings. With this approach, men hope to outlive the slow- growing cancer and avoid treatments and side effects including incontinence and impotency. Men choosing watchful waiting should receive DREs or PSAs every three to six months and may need periodic biopsies, as well. The most common treatment for prostate cancer is surgery, which can remove the cancerous prostate from the body. Surgery is generally recommended for men with early stage or low-grade cancers but is sometimes used at advanced stages to relieve symptoms. The most common surgical procedure is radical prostatectomy, the removal of the entire prostate gland….
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