Some people have never heard of a prostate, and even fewer know what it does. And yet, prostate cancer is the second leading cause of cancer death among men in the US, so I cannot overstate its seriousness. My purpose here is to provide a basic foundation of knowledge about the prostate and prostate cancer, and then try to provide a balanced view of common treatment options from my perspective.
The prostate is an organ found only in men. It secretes a fluid that feeds sperm. A tube called the urethra runs from the urinary bladder, through the prostate, to the penis. So when the prostate enlarges as we get older, the urethra gets compressed making it difficult to urinate. Running within a few millimeters or a tenth of an inch from the edge of each side of the prostate is a delicate structure called the neurovascular bundle. These two bundles are vital for obtaining and maintaining an erection. Because the nerves are so delicate (only 1-2 mm in size) and run so close to the prostate, treating the cancer without destroying the nerves is a challenge. Precision down to the millimeter is crucial to maintain good sexual function.
What is Prostate Cancer and How is It Graded?
I would give all prostate cancers an F, but I’m getting ahead of myself.
Fundamentally, cancer occurs when cells stop respecting their neighbors. They keep multiplying even when there are already too many of them. This occurs because of changes or mutations in their DNA.
After we take a biopsy, a pathologist looks at the cells under a microscope to determine how aggressive the tumor looks, and then assigns numbers that determine the Gleason Score. The Gleason score has two numbers. The first number describes what most of the cancer looks like, and the second number describes what the rest looks like. So if the cancer is mainly a 4 but also has some 3, the Gleason score is 4+3. Because 4 is worse than 3, a Gleason 4+3 is worse than a Gleason 3+4. Sometimes these scores are simplified by adding the two numbers together (e.g., Gleason 6 or Gleason 7). Gleason 6 and above is considered cancer.