Tuesday, February 20, 2018

Myths, the biopsy and your diagnosis


Mark Fraser

Myth: A prostate-specific antigen (PSA) blood test result level of 4ng/ml or less is normal and means that no prostate cancer is present.

Fact: No such thing as a “normal” PSA level exists. Estimates are 15 to 20 per cent of men with a total PSA result level of 4ng/ml (generally considered the normal limit) or less, actually have prostate cancer that requires immediate attention.

Myth: An elevated PSA result level means you have prostate cancer.

Fact: Not necessarily. Reports state that even getting a PSA blood test within 72 hours of sexual intercourse can cause a high result. The only way of knowing for sure if you have prostate cancer is for a sample of your prostate tissue to be taken and sent to a Pathologist (specialist in this area) to look at under a microscope and give a diagnosis.

Myth: The prostate biopsy exam will cause cancer to spread if cancer is present.

Fact: A prostate biopsy is ordered when a urologist suspects that prostate cancer may be present. There is no evidence that piercing the prostate with the biopsy needles will cause prostate cancer to spread.

Myth: A prostate biopsy exam will lead to erectile dysfunction.

Fact: During a prostate biopsy, usually 12 or more samples of tissue are taken. There will be some swelling and inflammation but this has no impact on erections. There will often be blood in the urine and semen for several weeks following biopsy, but this, too, has no effect on the ability to attain and maintain an erection.

What is also important to note is that unless the needle used to take the tissue sample gets into where the cancer is, cancer can be missed. This is why the number of samples that are taken averages around 12. The tissue samples will given a number from 1-5 called a “Gleason Grade” by the tissue specialist called a pathologist.

Because prostate cancers often have areas with different grades, the pathologist will give a grade to the “2” areas that make up most of the cancer. These 2 grades are added together to give you your “Gleason Score”, a number from 2 to 10. Gleason scores of 2, 3 and 4 are very uncommon, probably because the cancers are so slow growing that they seldom come to medical attention. Gleason scores of 5-6 are considered favourable with 6 being the more common. Gleason 7 is intermediate (in the middle) with Gleason scores of 8, 9, or 10 tending to be rapidly growing aggressive cancers. Your options for treatment are highly dependent on your Gleason Score.

Please note, many other things are taken into consideration before a decision on an appropriate treatment is made. Your general state of health and even the size of your prostate are two factors. It is recommended that before a treatment decision is made, patients should make sure they understand the answers to three questions:

1. What is my life expectancy and risk that cancer will progress without treatment?

2. How will my prognosis be improved with treatment?

3. What are the risks or side effects of the various treatment options?

Your doctor will refer you to an oncologist (cancer specialist) to discuss these issues.

For some treatment options in prostate cancer, send a blank e-mail to