What constitutes early-stage prostate cancer? Research is under way to find better methods of detecting micrometastases. Such micrometastases cause no symptoms initially but may do so in future months to years, as they grow into tumors. What is going on? It is likely in these situations that individual cancer cells (micrometastases) shed from the tumor early on, but at levels too small to be detected by computed tomography or bone scans or by physical examination (see “Likelihood of progression,” below). Even the experts do not agree about which men with such cancers should be treated, which treatment method is best - or whether, for some tumors, any treatment is even necessary.Īt the same time, every doctor knows that some men who undergo treatment for early-stage prostate cancer, and are considered “cured” on the basis of follow-up PSA tests, suffer relapse or “biochemical recurrence” (as measured by PSA levels) years later - indicating that the original cancer spread (metastasized) without being detected and has become active. There is no one-size-fits-all treatment for early-stage prostate cancer. But you owe it to yourself to do whatever you need in order to remain calm and take things one step at a time. The emotional impact of cancer can be devastating - there’s no question of that. What I often hear from patients who have just received a prostate cancer diagnosis are statements like “I want this out!” or “I just want to get on with my life.” Yet all too often when I meet with patients who are diagnosed with early-stage prostate cancer, I find that they want to rush into treatment without fully considering the ramifications of their decisions. Does the Time from Biopsy to Surgery Affect Biochemical Recurrence after Radical Prostatectomy? BJU International, 2005 96:773–6. Source: Boorjian SA, Bianco FJ, Scardino PT, Eastham JA. This held true even for men at high risk for relapse, based on their clinical profile. The time the men took to make a treatment decision did not affect likelihood of relapse (measured by a rising PSA level, known medically as a biochemical recurrence). Researchers at Memorial Sloan-Kettering Cancer Center analyzed medical records of 3,149 men with early-stage prostate cancer who underwent a radical prostatectomy within a year of diagnosis. So it may surprise you to know that one respectable study indicates that you can take up to one year to evaluate the options before choosing a treatment, and it will not affect your long-term likelihood of remaining cancer-free (see “Time to decide,” below).
(See “What constitutes early-stage prostate cancer?” below.) You may even be feeling as though your life depends on making a treatment decision as quickly as possible. If so, it is likely that you are feeling overwhelmed by your diagnosis and all the treatment options for early-stage prostate cancer, and are wondering what to do next. Thanks to more widespread prostate-specific antigen (PSA) testing, today nine out of 10 men diagnosed with prostate cancer have tumors that are detected at the earliest stage, when they are still confined to the prostate gland and are so small they can be detected only through a biopsy. Garnick, M.D., discusses issues and controversies about early-stage prostate cancer