Prostate cancer

Question 1

What does an elevated PSA level mean, and does it definitely mean I have cancer?

Accepted Answer

An elevated PSA level does not definitely mean that cancer is present. A PSA test is a blood test. It checks for a protein called PSA, made by the prostate. A high PSA level may be a sign of prostate cancer. But many other things can also cause a high PSA level. This means a high PSA does not always mean cancer is present. A PSA test is a screening test, not a diagnosis. Screening only shows whether cancer might be present; it does not diagnose it on its own. If a screening test shows a possible sign of cancer, more tests usually follow. A prostate biopsy is the only way to actually diagnose prostate cancer. During a biopsy, a doctor removes a small tissue sample with a needle. The sample is then studied under a microscope for cancer cells. Your care team can explain what your PSA result means and what tests, if any, might come next.

Question 2

What is a Gleason score, and what does it tell me about how serious my prostate cancer might be?

Accepted Answer

Your care team looks at several pieces of information to understand how serious prostate cancer might be. One key test is a biopsy. During a biopsy, a doctor uses a hollow needle to take tissue from the prostate. That tissue is studied under a microscope to look for cancer cells. Prostate cancer often grows slowly. Slow-growing cancer may not cause serious problems. But sometimes prostate cancer grows quickly and spreads to other parts of the body. That kind of prostate cancer is considered serious. A screening test, like a PSA test, only tells you whether you might have cancer. It does not diagnose cancer or show how serious it is. If a screening test shows signs of cancer, more tests are needed. Those extra tests help show how serious the cancer may be. Your care team also looks at your age and general health when planning treatment. Ask your care team about your Gleason score and what it means for your own results.

Question 3

What is a PSA test, and why do doctors have different views on who should get screened and when?

Accepted Answer

A PSA test is a blood test. It measures PSA, a protein made by the prostate. A high PSA level may be a sign of prostate cancer. But many other things can also raise PSA levels. Screening means having tests that look for cancer before you have symptoms. A screening test only tells you whether you might have cancer. It does not diagnose cancer on its own. If a screening test looks unusual, you will need more tests. These may include a digital rectal exam, where a doctor feels the prostate for anything unusual, or a biopsy. A biopsy is the only way to truly diagnose prostate cancer. Prostate cancer often grows slowly and may never cause health problems. Some people live long lives with prostate cancer and never notice it. In other cases, it can spread and become serious. The goal of screening is to find cancers more likely to spread, so they can be treated early. Which tests are right depends on age, family history, and other risk factors. Because of this, screening is a personal decision made together with your care team.

Question 4

What is active surveillance for prostate cancer, who is it right for, and what does it involve?

Accepted Answer

Active surveillance is a way to closely watch prostate cancer. Instead of treating it right away, doctors use regular tests. It is one type of a plan called observation. With observation, a doctor checks on the cancer over time. Doctors often suggest observation for people who are older. It also fits when the cancer is unlikely to grow quickly. It may suit people with no symptoms or other health conditions. Prostate cancer often grows very slowly, and it may not cause serious problems if it does not spread. Active surveillance means having regular tests to check for change. If tests show the cancer growing, treatment begins to try to cure it. Treatment also begins if new symptoms appear. Watchful waiting is the other type of observation. It uses little or no testing, and only treats symptoms, not the cancer. Your care team can help you decide if active surveillance fits you.

Question 5

If I'm diagnosed with prostate cancer, what does that mean, and why might doctors recommend watching and waiting instead of treating it right away?

Accepted Answer

A prostate cancer diagnosis means cancer cells have formed in the prostate gland. The prostate is a gland below the bladder that makes fluid for semen. Doctors confirm this with a biopsy, removing a small piece of prostate tissue to study under a microscope. Prostate cancer often grows very slowly and may never cause health problems. A person can live a long life with prostate cancer and never know it. But sometimes prostate cancer grows quickly and spreads to other parts of the body. Cancer that spreads this way is considered serious. Doctors may recommend watching the cancer instead of treating it right away. This approach is called observation, and it has two forms. Watchful waiting means having little or no testing unless symptoms appear. If symptoms begin, treatment relieves them, not the cancer itself. Active surveillance means having regular tests to watch for changes in the cancer. If tests show growth, treatment begins to try to cure it. Doctors often choose observation for people whose cancer is unlikely to grow quickly. It is also used when a person has no symptoms or other health conditions. Your care team can help you weigh observation against other treatment choices.

Question 6

If my PSA level goes up after I've had prostate cancer treatment, what does that mean and what's the next step?

Accepted Answer

A rising PSA test after treatment does not always mean cancer is back. PSA is a protein made by the prostate. A blood test measures how much PSA is in your blood. By itself, a test result does not diagnose cancer. If a test shows a possible sign of cancer, more tests are needed. These find out if cancer is really there. A higher PSA can be a sign of prostate cancer. But many other things can also raise PSA levels. To look closer, your care team may use a physical exam. They may also use imaging tests or a small tissue sample. This sample test is called a biopsy. A biopsy is the only way to know for sure if cancer is present. If cancer is confirmed, treatment depends on your age and general health. It also depends on how serious the cancer is. Treatment options can include observation, surgery, radiation, hormone therapy, chemotherapy, targeted therapy, or immunotherapy. Talk with your care team about what your PSA result means. Ask them what tests or next steps make sense for you.

Question 7

How is prostate cancer different depending on whether it's localized, locally advanced, or metastatic?

Accepted Answer

Prostate cancer can behave very differently from person to person. Some prostate cancer grows slowly and stays only inside the prostate gland. This kind often does not cause serious health problems. Other prostate cancer grows quickly and spreads to other parts of the body. Doctors call this spread metastatic cancer. This kind is more serious and usually needs more treatment. Because of this, doctors look closely at whether the cancer has spread outside the prostate gland. Surgery to remove the prostate may be an option in some cases. This depends on whether the cancer has spread outside the prostate. Your treatment choices also depend on your age and your overall health. Your care team will explain what your test results mean for your situation.

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