Mr. Smith ... you have prostate cancer
Your worst fear has just occurred. Just recently you underwent a prostate biopsy and you have returned to your Urologist's office for an office visit. You are seated alone in a consultation room and the doctor walks in. If you are alone, he will probably ask you if you came to the office alone today. The doctor sits down behind his desk and says, "Mr. Smith, I am sorry to inform you that the biopsy came back positive and you do have prostate cancer.
Most patients have an overwhelming sensation come over them at this time. Their minds are racing and they just do not know what to say. At this point, hopefully your physician will start to reassure you about the outlook for this disease.
First and foremost, patients must remember that prostate cancer is a slow-growing tumor that is almost always curable when diagnosed in its early stages. There is a lot of controversy surrounding this disease and whether it needs to be treated at all, however, that is not the topic of this blog. Regardless of the controversy, the vast majority of patients in the US still do not feel comfortable without receiving treatment, especially if their disease is located in multiple areas of the prostate.
At this point, I try to be extremely reassuring for my patients. The fact that the disease is slow-growing means that most treatment paradigms are going to be successful with regards to rendering a cure. I have a discussion with my patients that involves the "where" and the "what" of the disease. The where of the cancer refers to the location of the cancer. Yes, we know it is located in the prostate; however is it multi-focal or has it spread outside of the prostate? Imaging studies are usually recommended depending on the grade of the cancer and the initial PSA and they may include a CT scan, an MRI or a bone scan.
The "what" of the cancer refers to the grade of the cancer. This is a microscopic description of the appearance of the cancer. The tumor is assigned two numbers between 1 and 5 representing the Gleason Grade of the tumor. The numbers are combined and a Gleason score is given. Most early prostate cancers have a Gleason score of either 6 and 7. More sever disease is associated with higher scores such 8, 9, or 10.
Next we begin a discussion regarding treatment options which are available. The options - active surveillance, radical surgery, cryotherapy, high intensity focused ultrasound external beam radiation therapy, and brachytherapy - are briefly discussed, however at this meeting I spare the patient the details of these treatments. The patients tend to be overwhelmed and are not likely to retain much of what is discussed.
So, Mr. Smith, I would like you to get the imaging studies that I have recommended. Once they are completed, please make a follow-up appointment so we can discuss your treatment options. At that time it would also be a good idea to have your spouse, significant other or friend accompany you as an extra set of ears.