Getting a diagnosis of any cancer brings many questions with it. Prostate cancer is the number one cancer type in terms of incidence around the world. Since usually, the detection is made when the patient has no symptoms. Hence many have a difficult time to accept and go through with the treatment. In this blog, I will try to go over some of the common questions that need to be answered when you have a prostate cancer diagnosis.

Question 1: What kind of prostate cancer do I have?

Most of the prostate cancer cells develop are adenocancers but there are very rare other types such as squamous or sarcomatoid, which actually tend to be much more aggressive. Even if the result is an adenocancers, not all of them are the same. They have differentiations in terms of aggressiveness and response to therapies.

Question 2: How aggressive is my cancer?

Your pathology report will give a clue as to how aggressive the tumor cell type is. There is a cell scoring system called the Gleason Scoring system. The higher the score the more aggressive is the tumor. But even the grading system is not enough for assessing the sole aggressiveness of a tumor. Many other factors such as age, a tumor extension out of the prostate gland, any other additional diseases that you may have.

Question 3: What does my pathology report say?

Your initial diagnostic pathology report will tell if you have cancer or not; the type of cancer and the cell characteristics of your cancer. The cell characteristics usually are evaluated by the Gleason Scoring system. Two numbers appear on the Gleason scoring: the initial number is the most common cell type and the second one is the second most common cell type. This gives your doctor the probable aggressiveness degree as well as an idea about the responsiveness of the cells to different types of treatments. The needle biopsy generally does not give further details as to the extent of the tumor, etc.

Question 4: What are my treatment options?

This is the key question that you need to be having with your doctor since the answer is totally dependent on your individual case. There are many factors that should be taken into account:

  1. Is the aggressiveness of your tumor to decrease your expected life span?
  2. Is the tumor confined to the prostate or is there extension outside the neighboring or even to distant tissues, lymph nodes or bones
  3. Are there any limitations to any treatment types like a serious cardiac disease that would not allow a surgical option?
  4. How willing are you to embrace side effects like erectile dysfunction for the specific treatments?
  5. Can you afford certain treatments or will your insurance cover some of the more expensive options?
  6. Will you be willing to stick to strict follow-up procedures?

Any cancer detected in the early stages of cancer can be almost 99% totally treatable. This can be achieved by surgery or in some cases with radiotherapy. Once the tumor is locally or distally extended the options are still surgery to a limited degree, androgen deprivation therapy (ADT), radiotherapy (RXT), high intensity focused ultrasound therapy (HIFU), cryotherapy or active surveillance.

Question 5: What would be the best option for me and when should I start?

Frankly, this is a personal decision. We as doctors will provide you with the best treatment option which we think is right for you, but, before going ahead with any treatment please read and evaluate your options yourself and have more than one conversation with your doctor about what to expect and the possible side effects or the prognosis. As stated earlier for any definitive therapy (surgery or radiotherapy) there is a waiting period of up to 6 weeks after your initial prostate biopsy due to the healing process of the biopsy sites. You can take your time for the decision. For some cases such as the risk of bone fractures or severe pain due to bone metastasis, lymphedema due to lymph involvement the treatment may be initiated right away.

Question 6: What is the goal of the treatment? To cure, to make me feel better or both?

If you are in the early stages of the disease it is curable. If the tumor has extended beyond the line where it can be cured, the therapy aims at limiting the growth of the cancer cells, preventing any complications that may endanger your life span or quality of life, which needs to make you feel better. Sometimes, “no treatment” is also a good treatment due to specific qualifications of prostate cancer. It is not easy to explain the fact: “Sir, you have prostate cancer but we will not do anything for it.”  A “watchful waiting” or “active surveillance” can be good options to many patients who do not want any treatment-associated side effects or when the beneficial effects of the treatments will not increase the life span or quality of life of the patient. Prostate cancer, especially with low Gleason scores and in patients over the age of 70, tend to grow very slowly and in most cases, they are called “insignificant cancers. With close follow-up, if the cancerous cells change in behavior (which can happen), treatment can be initiated then.

Question 7: Who will be involved in my treatment team and what will they do for me?

Prostate cancer treatment requires a multidisciplinary action plan. Your urologist will be orchestrating the team for you. Your urologist will make the first diagnosis, will inform you and will refer you to the relevant departments for further investigations or treatments. Usually the rest of the team involves the urology nurse who will follow you up on your appointments and make reminders of your control tests, a radiology specialist to evaluate your imaging studies which are crucial to the treatment planning and follow-up; a nuclear medicine specialist, who are like radiologists but perform imagines with radioactive materials, a pathologist, for a reliable diagnostic and follow-up program, a radio-oncologist  who decides on the type and dosage of the radiotherapy when needed, a medical oncologist, to plan a medical oncological treatment protocol for your situation when needed.

Question 8: How will the treatment affect my daily life, sexual life, and fertility?

Even with the new developments in all fields of oncological treatments, none of them are that innocent. Depending on the choice of therapy you might experience problems relating to daily life, sexual life, and fertility. The basic aim of therapy choice is to give you the maximum benefit with minimum side effects. But, generally, treatments associated with prostate cancer involve fewer side effects than well-known chemotherapies.

The earlier the better…

Don’t be disappointed with your diagnosis. Please read and talk to your doctor in detail. Even though it is the most common cancer, it is manageable with new techniques and treatment modalities. The most important thing is to be able to catch any prostate cancer when it is treatable. At this moment it should be your social duty to talk to people around you about regular prostate check-ups.

– By Prof. Dr. Haluk Kulaksizoglu