I just got diagnosed with prostate cancer. Now what?
The answer to this is not easy, and requires careful careful discussion with a specialist in prostate cancer. The reason is because prostate cancer is a spectrum of disease - ranging from very very slow growing types to highly aggressive.
How would I know if it's the slow growing type vs. aggressive?
Again, this requires careful decision making. In my practice, I take into account a patient's 1) gleason score, 2) volume of cancer 3) prostate size 4) digital exam results 5) age 6) PSA level.
Are there other tests which can be done to determine if it's aggressive?
Yes. These could include things like 1) endorectal MRI of the prostate 2) genomic tests like Oncotype Dx and Prolaris.
What about active surveillance?
I have many men in my practice undergoing active surveillance and believe it to be very appropriate for the right person. However, who is a candidate for this is not as simple as some would suggest. For example, just having gleason 6 doesn't men it's "non-aggressive". In many cases I utilize some of these newer genomic tests to further asses risk of progression.
What constitutes active surveillance is quite variable. For example, at some institutions they recommend a yearly followup biopsy. At other places they may not do another biopsy for several years. And now, in the era of these genomic and biomarker tests, the entire paradigm of active surveillance is changing.
Having said that, I believe that these changes are a good thing because they are allowing us to get more information with less invasive methods.
What about radiation treatment?
Again, this is an established treatment. Radiation could include seed implantation (brachytherapy), or external beam therapy (such as IMRT, proton therapy, Cyberknife, etc)
What about surgery?
For many men, particularly those who are young, have a long life expectancy, and who have more aggressive cancers, surgery is the treatment of choice. Today, most of radical prostatectomies are being done robotically. Although I have expertise in this technique, I certainly don't believe it is right for everyone.
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