How Do I Know What My Prostate Cancer Risk Means for Me?

Dr. Leanne Woods-Burnham:

So, prostate cancer, an initial diagnosis can be overwhelming, and there’s a lot of different variables that you have to take into consideration. So you’re going to hear a lot of terms, right?

PSA is typically, what is flagged to have a patient receive follow-up and see, is there a chance that this person has prostate cancer? PSA stands for Prostate Specific antigen. So just know when you go to the doctor, this PSA, this is a biomarker that can circulate in your blood if you are having something going on with your prostate that is causing inflammation. So then, after you have an elevated PSA, and you have a biopsy, and then that pathologist scores the tissue that they’re seeing, that from there, that’s when they really know, do you have prostate cancer or not, because they’re basing it off of the biopsy.

However, even after that, if you have the biopsy and you have confirmed prostate cancer diagnosis, the PSA number does provide some sort of indication, of how advanced the prostate cancer may be. Now, you can’t tease out the smaller numbers as much, you know, a difference between a PSA level of a 4 versus a PSA level of a 6 or something like that. But if you have somebody who has a PSA of, let’s say, 2000, you would have a pretty good indication that it is, a lot more advanced than something that was probably more early stage. So the PSA number is a critical first number that your doctor pays attention to.

Then there’s the Gleason score. Gleason score is a way that a pathologist looks under a microscope, looks at your personal tissue taken from your prostate that they collected during a biopsy, and they look to see how that tissue looks. Depending on how that tissue looks, your prostate tissue receives a score.

And a Gleason score, the higher the score, the more aggressive the prostate cancer is decided to be. Another thing that you need to keep in mind is where is the prostate cancer located? So, your doctor might order for you to have an imaging test. They want to see, is your prostate cancer confined to just your prostate? Has it spread in the surrounding areas? Has it spread even further? Is it in your bones at this point? Has it gone to your brain? Something like this. So there’s different imaging techniques, where their doctors can see where the prostate cancer is exactly located.  

That is crucial to what we call staging of prostate cancer, and knowing where you are in that process. But then there’s also the final thing I want for everyone to consider is genetic testing and or genomic testing.

So, this type of a testing, especially if we’re looking at genetic diseases, diseases that we know are hereditary, and for prostate cancer, we do know that there’s a strong hereditary component. There are certain genes that we know are more likely to cause a person to have aggressive prostate cancer.

So, one of those genes, we talk about the BRCA genes. Um, we know when we hear about that when it comes to breast cancer in women. Well, it also plays a big role in men who have prostate cancer. So, if you’re a man and you have been diagnosed with prostate cancer,   I strongly suggest that you ask,  whether you are a candidate for genetic or genomic testing, um, because if they can see that you have certain genes that are more likely to cause aggressive prostate cancer, that’s gonna affect how they track your testing and track your follow-up throughout the process. 

The good news of it, if I can call it good news, because cancer, we don’t usually associate with good news, but as a scientist, to me, what is good news is if you happen to have a certain gene, and there is a drug that is designed to target that specific gene, then that is something that is, positive, because you can, have an additional treatment assigned to you that someone who may not express that same gene, they wouldn’t be eligible for that treatment. So you may be eligible for more treatment options than the average person.

So, these are all things,I know it’s a lot of information. I try to speak it slowly and clearly and succinctly as I can, but this is sort of what goes into a prostate cancer diagnosis in terms of trying to figure out how aggressive your cancer is to you as an individual. 

I would love it in a perfect world, if everyone could receive genomic testing.

There’s a term that we use called precision medicine, which is really trying to advance treatment options for every single person and tailor it. Another word for precision medicine is personalized medicine. We’re trying to personalize it for each person. And so, ideally, everyone would be asked to have this testing, but these are things we need to consider.

First of all, you have to consider where your healthcare facility is, and do they offer the genomic testing. Not everybody has access to a clinic that is offering that is offering that. Sometimes your doctor may have, a way for you to receive a kit and to do genomic testing, and that your results of the DNA testing that they do would be sent to your doctor, and they may not be the, your doctor may not do the actual testing, but they certainly can help you to interpret the results.

The other thing to consider is what insurance is gonna cover or not, or if you even have insurance or not because genomic testing is not, inexpensive, and so there’s that factor to consider. So, based on insurance status and access to healthcare, these are the types of things that can be limiting factors to somebody getting genomic testing.

So, yes, I wish everybody could have it, but unfortunately, it’s the way that it is set up currently, in the United States is not necessarily an option for everybody.