Diagnosed with prostate cancer - Now what?

Receiving a diagnosis for prostate cancer inevitably brings about many questions.

Dr. Jon LaPook, CBS News chief medical correspondent, discussed the different options that prostate cancer patients have when they receive the news with Dr. Herbert Lepor, Martin Spatz chairman of the department of urology at NYU Langone Medical Center in New York City. Lepor is also co-author of the book,"Redefining Prostate Cancer: An Innovative Guide to Diagnosis and Treatment." 

In 2013, about 238,590 cases of prostate cancer were diagnosed in the U.S. and 29,720 men died from the disease, according to federal estimates. More than 60 percent of prostate cancers are found in men over the age of 65, and it is rare to find someone under 40 who has the disease.

As with many medical conditions, the disease is never the same for two individuals. Lepor pointed out his youngest patient was diagnosed at 37, while just a few weeks ago he saw an 85-year-old man who had just been diagnosed. 

Some men want to be cured of the cancer no matter what, while others would prefer to risk living with it and avoid the potential side effects from surgery and radiation, which might include erectile dysfunction and incontinence.

 Prostate cancer is often detected by a doctor using the controversial PSA screening test that looks for levels of a protein called prostate-specific antigen (PSA) in the blood. But some of the cancers that are detected are growing too slowly to ever become life-threatening, and may lead to unnecessary treatments that cause harmful side effects. The U.S. Preventative Services Task Force, which advises the government on medical treatment guidelines, recommended against the PSA test for healthy, symptom-free men because of this risk.

When a man is found to have prostate cancer, the cancer is ranked on a Gleason scale of 2 to 10, with 10 being the most severe cancer. The National Cancer Institute explains that the Gleason score is based on how different the cancer cells look from normal cells and how likely it is that the cancer will spread.

Patients and their doctors face a difficult choice when the Gleason score comes back in the middle range, around a six, which doesn’t necessarily mean that the person has a lethal disease.

Some doctors may recommend active surveillance in such cases, which means that patients go in for routine check-ups and biopsies to see if their cancer progresses. Others may decide to have their prostates surgically removed or get treated with radiation, getting rid of the cancer but risking unfortunate side effects.

“I think as our imaging gets better and our molecular risk stratification -- looking at the various genes -- we’re going to be able to determine where that cancer it is, how aggressive it is, and we’re going to have [treatment options] in between nothing and everything,” said Lepor. "I believe that is going to help us treat this disease more effectively." 

For now, speak with your doctor about the most effective treatment strategies for your individual case.

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