Ruling Out Prostate Cancer
- Former president Joe Biden, 82, is undergoing further evaluation after a small nodule was found in his prostate, a spokesperson confirmed to ABC News on Tuesday. For men experiencing this common health issue, it may be comforting to know that many lumps are found to be benign, or non-cancerous —but as far as next steps for men in this situation, typically a biopsy is used to determine whether or not there are cancerous cells present in the lump.
- Getting a prostate biopsy is a fairly short procedure and you’ll be home the same day. A needle is inserted into the rectum in order to reach the prostate gland and MRI imaging can be used to guide the ultrasound probe.
- A pathologist will investigate the tissue samples taken to determine whether cancer cells are present and how much is there. Then the pathologist will determine a Gleason score, which is a way to describe the aggressiveness of the cancer cells (if any are found) and how normal or atypical they look under the microscope.
- It is important to remain calm and busy your mind while you are going through this process, as stressing over the situation may be for nothing, should the further testing come back favorable. And if cancer is determined to be present, remember, catching a diagnosis early is always most optimal. Most prostate cancers are so slow-growing that more and more doctors are using active surveillance to keep an eye on it — and it may not require surgery.
“In a routine physical exam a small nodule was found in the prostate which necessitated further evaluation,” the rep stated.
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So what are the next steps for someone in Biden’s position?
Finding a Lump: A Biopsy Isn’t Fun — But Can Ease Your Mind
Getting a prostate biopsy is a fairly short procedure and you’ll be home the same day. A needle is inserted into the rectum in order to reach the prostate gland and MRI imaging can be used to guide the ultrasound probe.
A pathologist will investigate the tissue samples taken to determine whether cancer cells are present and how much is there. Then the pathologist will determine a Gleason score, which is a way to describe the aggressiveness of the cancer cells (if any are found) and how normal or atypical they look under the microscope.
Dr. David Wise describes a pathologist’s report
“The more they look like a normal prostate gland, the less dangerous they are,” explained Dr. David Wise, a medical oncologist at NYU Perlmutter Cancer Center, who previously spoke with SurvivorNet.
If the biopsy of your prostate comes back positive, or malignant, “the next step is the staging of your prostate cancer, determining the extent of the disease and ultimately the treatment of your disease,” Dr. Matthew Rettig, medical oncologist and Chief, Division of Hematology-Oncology, Veterans Affairs Greater Los Angeles Healthcare System and one of the leading VA researchers on prostate cancer, previously told SurvivorNet.
Prostate Cancer Overview
Prostate cancer is the most common cancer in men. Roughly 1 in 8 men will be diagnosed during their lifetime, and most cases occur in men 65 or older.
Prostate cancer starts in the walnut-shaped prostate gland, which is located between the rectum and bladder and produces the fluid that nourishes sperm.
In the United States, most prostate cancer is caught with screening examinations. Prostate cancer can behave differently from one man to another.
Sometimes, it is called “low-risk” and can be slow-growing and treatment might not be necessary. In other men, the cancer may grow faster or be more aggressive and will require treatment. Because this cancer can behave so differently from one person to the next screening and treatment decisions are individualized for each person.
Certain factors make you more likely to develop prostate cancer. These include:
- Age
- Race
- Family history
- Genetics
Finding that you’re peeing more often or waking up in the middle of the night to use the bathroom may indicate that you should make a doctor’s appointmentthough these may be signs of another problem, such as a urinary tract infection or diabetes. In any case, having to urinate more often at night should prompt a conversation with your doctor.
Screening for Prostate Cancer, Dr. Edward Posadas explains the process to SurvivorNet
Other warning signs of prostate cancer are:
- Blood in your urine
- Trouble getting an erection
- Pain or burning when you urinate
- Pain in your back, hips, thighs, or other bones
- Unexplained weight loss
- Fatigue
What is a PSA Test?
A prostate-specific antigen (PSA) test is one of the most commonly used screening tools for prostate cancer. It is also used for tracking the disease following diagnosis and during treatment. To perform the test, your doctor will take a blood sample just like any other routine blood test.
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The test checks for the level of PSA circulating in the blood. While the PSA protein is produced by normal prostate cells and usually present at low levels in the blood, it can also be made by cancerous prostate cells. As the cancer cells grow and become more active than normal prostate cells, they can cause PSA levels to spike. However, PSA can also be elevated for non-cancerous reasons too.
What is an Abnormal PSA Test?
Typically a PSA level of 4.0 ng/mL or higher is considered high and requires further workup. However, many men with a PSA above 4.0 do not have prostate cancer and some men with a PSA below 4.0 ng/mL can have prostate cancer. It’s crucial to review your test results with your care team to understand what they mean and if you need any follow-up.
For some men, an elevated PSA is normal. Numerous factors can cause a rise in PSA level too, including:
- Increasing age
- Enlarged prostate
- Benign prostatic hypertrophy (BPH)
- Infection of the prostate
- Recent biopsy
- Recent ejaculation
It’s worth noting that some medications can actually lower PSA levels. These include drugs used to treat hair loss or urinary problems, such as finasteride and dutasteride.
Who Should Get Prostate Cancer Screening?
The decision of when to begin screening with the PSA test varies between males — who should always consult with their doctor and discuss their personal and family history. However, the American Cancer Society recommends the men begin screening at the following ages:
- Age 50 for men with average risk of prostate cancer
- Age 45 for high-risk men, including African American men and men with a father or brother diagnosed with prostate cancer at a young age (younger than 65 years old)
- Age 40 for very high-risk men with a father or brother who died from prostate cancer at an early age
You’ve Been Diagnosed with Prostate Cancer — Now What?
If you’ve been diagnosed with prostate cancer, your doctor can help with a variety of decisions to navigate the treatment process effectively.
- Treatment choice: This conversation will consider your age, health condition, and personal preferences to determine the most suitable option.
- Risks and benefits: This includes potential upsides as well as side effects and impacts on quality of life, such as urinary and sexual functions. This helps you understand what to expect and how it aligns with your life goals.
- Evaluating other options: If your cancer is localized, your doctor might discuss less invasive options like partial gland ablation that targets only the cancerous part of the prostate, potentially offering fewer side effects and quicker recovery.
- Post-treatment management: After treatment, the doctor will guide you through the recovery process, including managing side effects, follow-up care, and monitoring for any signs of recurrence.
- Long-term health: Your doctor will outline a long-term plan to monitor your health after treatment.
Cancer recurrence: If your cancer comes back, your doctor will help you decide the best course of action to move forward.
How can you get the most from your doctor?
Getting ready for your appointments is a key step in managing your prostate cancer journey.
- Gather questions: Compile a list of questions to ask including topics like treatment success rates, side effects, and lifestyle impacts.
- Organize medical records: Bring any relevant medical history, test results, and a list of current medications.
- Bring support: Think about bringing a trusted family member or friend for emotional support and to help you remember what you and your doctor discuss.
- Document symptoms: Keep a record of any symptoms or changes in your health which can help your doctor assess where you are.
This preparation empowers you to have productive and informative discussions with your doctor, ensuring you’re an active participant in your care.
Contributing by SurvivorNet staff.
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