Gleason Score; What Does it Mean When it Comes to Prostate Cancer?

The Gleason score plays a major role in helping patients who have been diagnosed with prostate cancer determine their outlook and treatment plan.

After a doctor diagnoses prostate cancer, a biopsy of the cancer cells in the prostate will be done. The Gleason score is then used by the doctor to help explain the results, determine how aggressive the cancer is and to plan the best course of treatment.

What is a Gleason score?

The Gleason score is a grading system devised in the 1960s by a pathologist called Donald Gleason and it measures the progress of a cancer call from normal to tumorous.

Five decades ago Mr. Gleason discovered that cancerous cells fall into five different patterns; these patterns change from normal cells to tumorous cells. He determined that these patterns they could be scored on a scale of 1 to 5.

Low Gleason scores

Cells that score a 1 or 2 look similar to normal cells and are considered to be low-grade tumor cells.

High Gleason scores

Cells that score closest to 5 are considered high-grade. These have mutated so much that, in comparison to the low grade cells, they have mutated so much that they no longer look like normal cells.

How is the Gleason score worked out?

The results of a biopsy are used to determine the Gleason score. During a biopsy, the doctor takes tissue samples from different areas of the prostate. Because cancer is not always present in all parts of the prostate, several samples are taken.

Using a microscope to examine the samples, the doctor finds the two areas that have the most cancer cells and assigns the Gleason score to each of these separate areas. Each sample area is given a score of between 1 and 5. The scores are added together to give a combined score, often referred to as the Gleason sum. In most cases, the Gleason score is based on the two areas described above that make up most of the cancerous tissue. However, there are some exceptions to the way scores are worked out.

When a biopsy sample has either a great deal of high-grade cancer cells or shows three different types of grades, the Gleason score is then modified to reflect the prediction of how aggressive the cancer will be.

What do the results mean?

When a doctor tells a patient their Gleason score, it will be between 2 and 10. Although it is not always the case, generally the higher the score, the more aggressive the cancer tends to be. Typically, lower scores indicate less aggressive cancers.

In most cases, scores range between 6 and 10. When biopsy samples score 1 or 2 they are generally not used because they are not usually the predominant areas of cancer.

A Gleason score of 6 is usually the lowest score possible. Prostate cancer with a score of 6 is generally described as well-differentiated or low-grade. This indicates that the cancer is more likely to grow and spread slowly.

Scores between 8 and 10 are referred to as poorly differentiated or high-grade, and in these cases, the cancer is predicted to spread and grow quickly.

In some cases, a patient may receive multiple Gleason scores because the grade may vary between samples within the same tumor or between two or more tumors. In these instances, the doctor is likely to use the highest score as the guide for treatment.

UroNav Fusion Biopsy System Improves Prostate Cancer Detection and Treatment

A high-tech MRI-ultrasound imaging system can result in fewer biopsies and better treatment decisions for prostate cancer patients. Dr. Robert Gaertner and Dr. Christopher Knoedler are experts in the UroNav® fusion biopsy system and have this technology available for their patients.

UroNav is a unique technology that fuses images from magnetic resonance imaging (MRI) with ultrasound to create a detailed, 3-D view of the prostate. When physicians use this improved view, it helps them perform biopsies with much higher precision, and increases prostate cancer detection.

Many prostate cancer specialists feel that UroNav revolutionizes how they diagnose prostate cancer and make treatment decisions. Before UroNav was available, when prostate cancer was suspected due to results of a PSA blood test or digital rectal exam, a physician performed a prostate biopsy which typically involved sticking a needle into 12 different areas of the prostate. This traditional method can miss a tumor. Because of this fact, physicians were led to falsely conclude that either the patient didn’t have cancer, or they were forced to perform one or more additional biopsies to find the suspected tumor.

When this new fusion biopsy system is used, the patient undergoes a MRI exam before undergoing a biopsy. The MRI is used to detect and pinpoint lesions in the prostate that may be cancerous. The MR image is fused with ultrasound imaging in real time during the actual biopsy. The system employs GPS-type technology to let the doctor guide the biopsy needle directly to the exact lesions detected by the MRI, leading to significantly fewer needle biopsies.

This technology when compared with traditional biopsy techniques that randomly sample the prostate, is a vast improvement. It is instrumental in helping physicians detect hard-to-find and often aggressive prostate cancers and can help provide greater certainty regarding the extent and aggressiveness of the disease. In many cases it makes it possible for patients to avoid multiple and unnecessary repeat prostate biopsies.

Biopsies guided by MRI/ultrasound fusion will also enable physicians and patients to opt for active surveillance, instead of surgery when appropriate. When patients are put under active surveillance, they hold off on having surgery or radiation and instead undergo periodic digital rectal exams, PSA tests and ultrasounds to see whether the cancer is growing.

No increase for the risk of prostate cancer for men who undergo a vasectomy according to Mayo Clinic Study

According to Mayo Clinic researchers in a study published in July of 2017, published in the journal JAMA Internal Medicine, there is no association between vasectomy and any form of prostate cancer. The researchers who published the story were from the main Mayo Clinic in Rochester Minnesota.

In the past, studies about the association between vasectomy and prostate cancer have shown conflicting results.

A number of studies in the late 1980s and in the early 1990s suggested an association between vasectomy and the risk of prostate cancer. In recent years, some studies have reported an association and some have not; all this discrepancy has contributed to the debate over whether there is indeed a link.

The Mayo Clinic researchers conducted a comprehensive review of previous studies and did a meta-analysis to determine if a vasectomy is associated with any form of prostate cancer, including high-risk prostate cancer, advanced prostate cancer, and lethal prostate cancer. A meta-analysis covers the combined findings of multiple studies.

Several types of research, including cohort, case-control and cross-sectional studies were covered by the study.

The definition of a cohort study is one that covers people who share a common characteristic or experience in a particular period. A case-control study compares two groups whose disease outcomes are different to try to find a reason for the difference. A cross-sectional study looks at information about a population at a point in time.

The Mayo Clinic analysis included 16 cohort, 33 case-control, and four cross-sectional studies. Together, the 53 studies covered almost 14.7 million patients.

The researchers wrote: “Of these, seven cohort studies (44%), 26 case-control studies (79%), and all four cross-sectional studies were deemed to have a moderate to high risk” of biased findings.

When the team focused on studies they considered to have a low risk of bias, they found a week association between vasectomy and prostate cancer in seven cohort studies. They also found an insignificant association between the two elements in six case-control studies.

“The association between vasectomy and prostate cancer was stronger when studies with moderate to high risk of bias were included,” the team wrote.

Overall, the findings supported the notion that there is no association between vasectomy and high-grade, advanced-stage, or fatal prostate cancer.

The study concluded: “Although patients should be appropriately counseled, concerns about the risk of prostate cancer should not preclude clinicians from offering vasectomy to couples seeking long-term contraception.”

The How’s and Why’s of Prostate Cancer Recurrence

Why and how does prostate cancer return? It’s important to face your fears and learn the facts.

With an overall five-year survival rate of close to 98 percent, prostate cancer is considered one of the most “curable” forms of cancer. However, many men continue to have the fear that their cancer persists long after the cancer itself may be gone. It is human nature to wonder “What if it comes back?” Some research studies done have estimated that as many as 70 percent of cancer patients are plagued with anxiety over a relapse. Patients should discuss these feelings, deal with them, and have a conversation with their doctor about their risk level.

Risk Factors for Prostate Cancer Recurrence

Before patients start worrying they need to understand what their risk of recurring prostate cancer really is. According to the Prostate Cancer Foundation, about 90 percent of all prostate cancer cases are diagnosed in the local or regional stages, when the five-year survival rate is nearly 100 percent. The majority men will be cancer-free throughout that time and beyond. Around 20 to 30 percent of cases, the cancer will relapse after the five-year mark.

If prostate cancer does come back, it may return in (or close to) the site of the original cancer, which is called a local recurrence. The cancer may also show up in the bones or other distant places, which is called a metastasis.

Listed below are risk factors that can help determine if a man’s prostate cancer is likely to return:

• The stage of your cancer at diagnosis. The higher the stage of prostate cancer at diagnosis, the greater the likelihood of a recurrence.
• Where the cancer spread. If your prostate cancer spread to the lymph nodes, you may be at an increased risk of recurring prostate cancer.
• The tumor itself. The larger the tumor at diagnosis, the greater the risk of a prostate cancer recurrence.
• Your Gleason score. This system measures what type of cancer cells are in the tumor, and how aggressive they are. The higher the score, the greater the risk of prostate cancer recurrence.

At the time of the initial diagnosis there are also certain warning signs that the prostate cancer could recur. Doctors might find certain measures of aggressiveness during the biopsy that initially diagnoses prostate cancer, and these could indicate the likelihood of a recurrence. Very aggressive tumors have more tendency to recur.

If Prostate Cancer Returns There Are Treatment Options Available

The prostate cancer treatment that is best for you will depend on the treatment you first received to battle the cancer. Hormone therapy, radiation and chemotherapy are all options to treat recurring prostate cancer.

Dealing With Your Fear

Make sure to discuss your concerns about prostate cancer recurrence with your doctor. It’s important not to let fear and anxiety lead to depression and other emotional and mental health issues. Talking about your concerns and being educated on your risks and treatment options can help in preparing for what may happen.

Prostate Cancer: Coping With the Disease By Using Relaxation Techniques

It’s been proven that simple relaxation techniques can actually help ease the stress and anxiety of prostate cancer diagnosis and treatment.

Patients who have received a diagnosis of prostate cancer can feel stress, anxiety and even depression. It may seem overwhelming to deal with a diagnosis of prostate cancer, the treatments for it, and the side effects. These feelings are perfectly normal. Learning to manage that stress is can be an important positive step to managing your condition.

According to a recent study, easing stress prior to prostate cancer surgery could help speed up both physical and psychological recovery. Researchers followed more than 150 men and found that those who underwent stress management sessions prior to their treatment experienced higher immunity and improved mental health months after the operation.

If you feel like your stress and anxiety are completely out of hand, by all means talk with your doctor. But there are some simple steps you can take to help you feel more calm.

Learn Some Techniques to Help You Relax

Four great ways for patients to learn to help themselves are through relaxation, breathing, medication, and guided imagery. The beauty of these tools is that they can help you get through almost any kind of stress over and above medical issues. Meditation can help center a person and give them balance and a calm feeling. Prostate cancer patients have many ways to teach their bodies to relax and release stress.

• Guided imagery. When you feel stressed or anxious, try creating a picture in your mind of peace and calmness.

• Relax your muscles. This is an exercise you can do just about anywhere. Focus on your body then tighten and release the muscles section by section. Once you experience how different each sensation feels, you can become more aware of a relaxed feeling. Many people start by relaxing their toes and work up to their head and neck.

• Breathe slowly and deeply. Take a long, slow, deep breath in through your nose. Breathe in until your chest and lungs are full of air. Hold it and then after a second or two, slowly breathe out.

• Meditation. This is another exercise that you can do just about anywhere. Even while resting, walking, receiving treatment, or simply sitting in your doctor’s office. Clear your mind of all thoughts to relieve stress.

How These Relaxation Techniques Help Prostate Cancer Patients

There are physical health benefits that come as a result of alleviating stress. Reductions in stress can slow heart and breathing rates, lower blood pressure levels, reduce muscle tension, and increase blood flow in the muscles.

Patients who practice these relaxation methods are often:
• More energetic.
• Able to do more during the day.
• Experiencing less pain.
• Experiencing less anger.
• Better able to concentrate, problem-solve, and make decisions.

Prostate Cancer; When Watchful Waiting is the Answer

Patients are used to asking the question, “When do we starting treating it and what type of treatment will we use?”. But with prostate cancer in many cases the answer could be “We’re not going to treat it.” The “wait and see” approach may well be the right option for your prostate cancer.

Watchful Waiting/Active Surveillance

Also called “active surveillance” the term “watchful waiting” describes one way to “treat” prostate cancer. It is used to describe cases where the prostate cancer patient has opted to refuse surgery, radiation, hormone therapy, and any other medication to treat the prostate cancer. Instead of treatment doctors will rely on prostate-specific antigen (PSA) tests and digital rectal exams (DRE) to monitor disease progression. If and when one of these tests show that the cancer is progressing, at that time other more active treatment options may be considered.

Certain types of prostate cancer can be very slow to progress; some men who have it will never experience any symptoms or problems. Occasionally the disease can actually be less damaging than the treatment. Prostate cancer can be monitored regularly with frequent testing — about every six months — and without surgery or radiation. According to a large, long-term study of nearly 800 men with prostate cancer, the risk of dying from a “low-risk” tumor is similar whether you choose observation or treatment.

Are You a Good Candidate for Watchful Waiting?

Not all patients are good candidates for watchful waiting. Younger men or men who have aggressive prostate cancer are often recommended to take a more proactive approach to treatment, but older men who are concerned about side effects — commonly, impotence and incontinence —may want to consider watchful waiting.

The following are other factors that can indicate whether watchful waiting is a viable treatment method for a prostate cancer patient:

Early stage diagnosis. The earlier the stage at diagnosis, the more time a prostate cancer patient may have in determining what treatment plan is best.
Short life expectancy. If a man has a life expectancy of less than five years for other medical reasons he may opt for watchful waiting.
Having another serious health condition. If a patient is struggling with another disease or health condition, they may not want to proceed with surgery or radiation for prostate cancer at the same time.
Gleason score. When the cancer is not aggressive and is slow to progress, a man may have a low Gleason score. This patient may consider watchful waiting as an option.

Erectile Dysfunction and Prostate Cancer

Erectile Dysfunction and Prostate Cancer

Sexual function is an important topic but one that men might not put at the top of their priority list after receiving a diagnosis of prostate cancer. Many men fear impotence as a side effect of the treatment/disease.

Prostate Cancer Treatment; Why Erectile Dysfunction May Occur As A Result

The side effect of impotence may be a result of the treatment options for prostate cancer which may include surgery or radiation. Both of these two treatment options can affect the nerves surrounding the prostate that enable a man to have an erection.

One of the primary reasons for impotence as a side effect is that the prostate gland surrounds the base of the bladder and the base of the penis, and consequently nerves that are related to both sexual function and urinary function can be damaged either by the prostate cancer cells themselves or by the treatment. An impact on these nerves is fairly common; it all depends on where the cancer is located.

In a radical prostatectomy, the nerves may be removed or they may become damaged. In some occasions even when there is no nerve damage, impotence may still occur in men who have had surgery to treat prostate cancer. In these cases it could be that the veins and blood vessels in and around the penis have sustained damage during surgery, which can affect the ability to have an erection.
When undergoing radiation therapy, prostate cancer patients may experience damage to the blood vessels to the penis, and therefore issues with impotency may occur over time.

Which Men Are Affected?

Your age, sexual health and the type of treatment that you received can all determine wow likely you are to become impotent following prostate cancer treatment.
Younger me (40 to 49) and those men who have had healthy erections before prostate cancer treatment are more likely to be able to achieve erections after treatment. Men with tumors that have grown beyond the prostate are more likely to experience erectile dysfunction.

The risk of impotence is much lower if the patient has nerve-sparing surgery. However, if the nerves are damaged during this type of surgery, many men may still experience some temporary erectile dysfunction for 2 to 18 months afterward.

What You Can Do About Erectile Dysfunction

A strong relationship with your partner in addition to patience and the passing of time can help improve your sexual health after prostate cancer treatments. Most men feel anxious and worried about this side effect, but doctors should be counseling patients and advising them that the nerves around the prostate require time to heal.

Studies have shown that couples counseling can be of great help to men after prostate cancer treatment. There are also several medications and devices that may help:

• Prescription medications. A number of prescription medications that can be taken orally, including such brand names as Levitra, Cialis and Viagra. These drugs help to increase blood flow to the penis. They work best in prostate cancer patients who still have healthy nerve bundles on each side of the prostate.

• Medication injections. To help increase blood flow and stimulate an erection there are medications that can be injected into the side of the penis. Once a doctor shows you how to administer them the injections can be given at home by a partner.

• Surgical implants. Some men choose a permanent penile implant that can be surgically inserted in the penis to facilitate erections.

• External devices. A pump attached to a tube that covers the penis and creates a vacuum is an option. This stimulates an erection by increasing blood flow to the penis. For a short period of time s ring may also be placed on the penis to maintain an erection.

It is important to note that not every man who gets treated for prostate cancer will experience erectile dysfunction. Men should talk with their doctor about treatment options and medical devices and drugs that can be used post-surgery.
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African-American Men; Prostate Cancer Risk

Men of all ages should be concerned about and aware of the signs of prostate cancer. It’s recommended that men talk to their doctors about when they should be screened based on their family history and other risk factors. Early screening is especially important if a man has one or more risk factors and is at an increased risk of developing prostate cancer.

Statistically it is a fact that men of African-American descent are at a higher risk of developing prostate cancer than white men. 19 percent of black men, almost one in five — will be diagnosed with prostate cancer. Five percent of that group will eventually die from the disease. Prostate cancer is the fourth most common reason for death in African-American men.

The risk for prostate cancer in African-American Men is greater, but how much greater?

No one is certain of the reasons why black men are at an increased risk of developing and dying from prostate cancer. In part this group is more likely to die from prostate cancer in part because of delayed diagnosis and also because of limits in access to treatment. One recent study suggests that there may be a genetic link.

If there is a family history of prostate cancer for an African-American man, their risk increases dramatically. Those with an immediate family member who had prostate cancer have a one in three chance of developing the disease. This risk rate increases to 83 percent if two immediate family members have had the disease.

It’s so important to have early prostate cancer screening, and here is why:

By the time noticeable symptoms of prostate cancer appear, the cancer is likely in an advanced state so early prostate cancer screening is of utmost importance. The changes of recover increase the earlier the prostate cancer is caught.

When caught early, prostate cancer is highly treatable. Nearly 100 percent of men who are diagnosed with prostate cancer in its earliest stage will be alive five years later.

African American men should have prostate cancer screening at young age.

For African American men, routine prostate cancer screening should start at a young age; the American Cancer Society recommends that these men discuss testing with their doctor at age 45, or at age 40 if they have several close relatives who have had prostate cancer before age 65.

There are some different types of screening tests and those can include a prostate-specific antigen (PSA) blood test and/or a digital rectal exam (DRE). A family doctor can usually perform both tests.

The signs and symptoms of prostate cancer are important for all men to know. These symptoms can include urinating in the middle of the night, urinating more frequently than normal, and feeling like the bladder doesn’t completely empty. Also blood in the urine may be a sign of prostate cancer.

If men experience these symptoms it is important for them to talk to their doctor about diagnostic testing for prostate cancer.

Weighing Your Prostate Cancer Treatment Options

Men diagnosed with prostate cancer now have many treatment options available to them, including radiation, surgery, and drugs that stop the growth of the prostate cancer.

With so many choices, all of which have their own benefits and risks, choosing the best prostate cancer treatment can be difficult. The most appropriate therapy will depend upon the size and aggressiveness of the cancer, as well as whether it has spread to other parts of the body. In some cases, multiple treatments are used.

Watch and Wait: Active Surveillance of Prostate Cancer

Improved screening and detection of prostate cancer means that many cancers are found long before they are likely to pose a serious threat.

When theprostate tumor is very small or slow-growing (early stage), many men opt to “watch and wait,” an approach known as active surveillance.

This doesn’t mean do nothing. Your prostate cancer will be monitored regularly for changes in its size or growthusing:

  • exams
  • blood tests
  • imaging (such as MRI)
  • follow-up biopsies.

Radiation Treatment for Prostate Cancer

Radiation can be used to kill prostate cancer cells. Improved methods have allowed doctors to use higher doses of radiation, but with fewer side effects. The two main types are:

  • External beam radiation therapy (EBRT).X-rays are aimed at the prostate cancer from outside the body.
  • Radioactive material implants(Brachytherapy). Thisinvolves placing radioactive material (or “seeds”) inside the prostate gland.

Prostate Surgery

During prostate surgery, the prostate gland is removed (radical prostatectomy), along with any nearby lymph nodes (part of the immune system) that have become cancerous.

While any surgery has a risk of complications, minimally invasive techniques, such as robotic prostatectomy using the da Vinci® Surgical System, combines the latest robotic and surgical techniques. Prostatectomy performed using the robot has many benefits, such as:

  • less pain and blood loss
  • fewer complications
  • shorter stay in the hospital
  • faster return to your normal activities.

Success of this procedure depends on both the skill and experience of the surgeon, as well as the technique used.

Hormone Therapy for Prostate Cancer

Hormone therapy blocks or reducesthemale hormones, such as testosterone, that fuel the growth of prostate cancer. Side effects include decreased sex drive and loss of muscle mass. This treatment can involve:

  • Androgen deprivation therapy (ADT), which blocks the production of testosterone using either medicines or removal of the testicles (the place where testosterone is made).
  • Anti-androgens, medicines that keep the prostate cancer cells from using testosterone.

Treatment Options for Advanced Prostate Cancer

If the prostate cancer moves beyond the prostate gland (metastasis)—such as into the lymph nodes or other organs—doctors may use multiple types of therapies in order to treat this aggressive form of cancer.

In addition to hormone therapy, another treatment option is chemotherapy, which uses special drugs to slow or stop the growth of prostate cancer cells. These drugs are usually given in cycles, such as every 21 or 28 days.

The main side effects of chemotherapy are:

  • nausea and vomiting
  • temporary hair loss
  • drop in white blood cells which increases the risk of infection.

Men’s Prostate Health Event – Dec. 12th in River Falls

Know Your Stats Conference - Dr. Gaertner, Dr. Knoedler

Dr. Gaertner and Dr. Knoedler have been invited to speak at the Dec. 12th Men’s Prostate Health Event in River Falls, WI. The event will be held at River Falls Area Hospital Conference Rooms. At the conference, Dr. Gaertner and Dr. Knoedler will present on the latest advancements in prostate screenings and other risk factors, options and treatments. The event will contain patient stories, presentations and videos.

One lucky attendee will with a $100 Cabellas gift card!

To register call 715-307-6060. Space is limited.