What is cancer?

This taboo word is actually thought to originate many centuries ago when the very peculiar disease was named after the crab, we think because of its imperceptible movement and its claws, which resembled the spreading nature of cancer.

Today we still don’t really know what this disease is. What we do know is that it’s the result of an abnormally high reproduction of cells in some part of our body.

Normally, cells grow and mature within healthy tissue. But when cells change and they don’t differentiate and mature properly, they reproduce rapidly and cause a tumour– in this case, prostate cancer.

Is there a more predominant type of prostate cancer?

Cells from the tumour can then spread to the lymphatic system or to the blood, which causes metastasis in lymph nodes or organs. The cells invade the new areas, adapt to the new tissue and begin to grow again.

The prostate

The prostate is the size of a walnut. When standing, it’s located below a man’s bladder and in front of the rectum (the last part of the large intestine) and behind the base of the penis.

The prostate surrounds the tube (urethra) through which urine and semen flow to the penis.

The prostate’s anatomical position explains the symptoms caused by abnormal prostate growth, especially affecting the flow of urine.

Is there a more predominant type of prostate cancer?

In fact, more than 95% of cases are adenocarcinoma cancers; that is, tumours originating in glandular cells found, in this case, in the prostate.

What’s the Gleason score?

The Gleason score is a very important classification system used to make decisions regarding the type of treatment and establishing a prognosis for prostate cancer.

The Gleason score determines the grade (the likelihood for spreading and growth) of prostate cancer.

How is the Gleason score determined?

To determine the Gleason score, the pathologist studies two areas of the prostate tissue using a biopsy (see Diagnosis). Pathologists try to choose areas representative of the tumour.

For each sample area the pathologist then assigns a grade from 1 to 5. Grade 1 corresponds to cases with a low likelihood for the tumour to spread (cancer cell groups are similar to normal prostate glands).

On the contrary, grade 5 is assigned to cancer cells which are most different from normal ones. Grades 2 to 4 represent middle-range cases, from lower likelihood of spreading to higher.

To determine the Gleason score for each case, the two grades determined for each tissue area are added up. For example: 3+4 =7.

Gleason scores of 0 or 1 don’t exist, as the minimum is 2. (1 + 1).

The most important thing to keep in mind is that the lower the Gleason score is, the lower the likelihood is that the prostate cancer will be of an aggressive nature, therefore growing slower and spreading less.

At the other extreme, the higher the Gleason score, the higher the possibility of having an aggressive tumour.

Gleason scores between 2 and 4 are considered to correspond to the least aggressive tumours, 5 and 6 are middle-range and tumour aggressivity increases from 7 to 10.

What are the symptoms for prostate cancer?

The symptoms depend on the stage (or extent) of the cancer.

At very early stages, when the cancer is very small, there are no symptoms. This explains why many men might have this cancer in very early-stage form and might go their whole lives without ever finding out.

At early stages, some men are diagnosed with prostate cancer by chance, either during a routine exam or surgery for benign prostate growth. Sometimes, this benign growth might have an area which is diagnosed as prostate cancer.

As the size of the tumour grows, urinating becomes more and more difficult, and this can eventually lead to urinary obstruction or make urinating impossible.

Effected lymph nodes near the prostate don’t show particular symptoms.

In contrast, in cases where prostate cancer has been diagnosed, bone pain can be a sign that the cancer has spread to the skeleton, a common area for metastasis of prostate cancer.

Nowadays the model for initial diagnosis of prostate cancer has changed a lot. A few years ago, almost 8 out of 10 patients developed bone metastasis. Since the clinical introduction of PSA (see PSA and early diagnosis), prostate cancer has been able to be detected at earlier and earlier stages.