Can We Tell them Apart?
The Dangerous Prostate Cancers from Insignificant Ones?
Gleason Score can help: Gleason Score is a histology grading pattern used to grade the biopsy sample. Lower scores (one and two at left of diagram) are associated with better prognosis. Higher scores (4 and 5 to right of diagram) are associated with worse prognosis with more aggressive behavior of the tumor. Diagram courtesy of Donald F Gleason MD PhD.
How to Treat the Aggressive Cancers and Ignore the Others
Watchful Waiting vs. Active Surveillance
One of the major problems with prostate cancer screening with PSA, is the inability of this test to differentiate the clinically insignificant cancers that don't require treatment from the dangerous cancers that do.
Various authors have suggested refinements by using parameters such as PSA velocity, Free PSA ratio, and of course, the Gleason score, a form of histology grading, applied to prostate biopsy sample to provide this discrimination. Using these refinements, some doctors such as Laurence Klotz have advocated Active Surveillance based on PSA velocity. Dr Klotz offers treatment for cases having a PSA Doubling Time of 3 years or less (based on a minimum of three determinations over 6 months). Others, such as Soloway , feel that Gleason score upgrade or histologic evidence of tumor aggression is the most important parameter, and have offered radical treatment if this is found at repeat biopsy. The obvious goal is to identify and treat aggressive tumors before they invade the prostatic capsule and beyond. This is not so simple and may require discovery of new biomarkers.
A new bio-marker in prostate cancer cells called Hsp-27 protein indicates an aggressive type of prostate cancer that requires treatment. The absence of the Hsp-27 protein suggests a silent type of cancer that does not require immediate treatment.
Do these new protocols and tools work any better than the old ones? We don't know yet. It may take another ten years to find out.
Preventing Prostate Cancer -Diet and LifeStyle Modification
Given the reality that PSA screening for early detection for prostate cancer is a misguided adventure which leads to overdiagnoisis and does more harm than good, perhaps another approach to prevention is warranted. Such an approach is suggested by urologist Ronald Wheeler at the Sarosota Prostate Center. Dr Wheeler advocates a nutritional program for prostate cancer prevention with Vitamins C, B6, E, zinc, selenium, Saw palmetto, Pygeum africanum, stinging nettle, pumpkin seed, Echinacea purpurea, garlic, ginkgo biloba, Amino acids� ��"L-glycine, L-alanine, L-glutamic acid and Modified Mediterranean Diet (link).
Left Image: Prostate specimen with median lobe hypertropy courtesy of wikimedia commons.
Results of Diet and Nutrition Program on PSA
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