Geoff McLennan, MPA, Prostate Cancer Patient and Advocate

How is prostate cancer (PCa) detected?

You or a male relative or friend just got a high PSA test result or a DRE finding from your general practitioner (GP). The GP recommends further testing and provides a referral to a local urologist. You are on your way to the screening process for PCa. Stop for a moment. What is your best strategy when working with any doctor? Yes, a good relationship that incurs trust and communication. So, ask away about the urology referral, be satisfied with what you learn, and move on in trust.

As you’re prepping for the initial meeting with your urologist, bring a list of questions with you. A few questions I recommend you ask your doctor can be found below:

• When can I get tested and where? Think about where you live in relation to the testing office. Most urologists offer some basic screening tests right in their office.
• What are genetics tests for prostate cancer and what can they tell me about my cancer?
• How or should I involve my family? This is a personal decision, but it’s constructive and can help to have a “second pair of eyes and ears” at the doctor’s office.
• Should I join a PCa support group? I recommend it because outside of the doctor’s office, you are likely to be asked questions about PCa. Most support groups have patient advocates who can answer your questions online or over a phone call. Many hospitals feature PCa group meetings that you can attend and meet other men who can offer their PCa experience.

It’s important to familiarize yourself with basic procedures and language most urologists will use when screening you for PCa:

Ultrasound– This is a procedure where the urologist will insert a thin probe into your anus and along the rectum that uses soundwaves to create an image of your prostate and any growths or irregularities.

The Biopsy– Often accompanies an ultrasound where inside the probe are tiny probes that punch through your rectal wall into the prostate and take 12-18 samples of tissue for microscopic viewing to provide your PCa diagnosis.

Gleason Score or Grade– A radiologist or urologist or both will view your biopsy tissue samples and score your test from grade 1-5. Grade 1 is low/very low risk, Grades 2 and 3 are intermediate or moderate risk, and Grades 4 and 5 are high risk. Similarly, Gleason grades are scored as a total of the dominant and the nondominant cell pattern, such as 3+3 being low, 3+4 being moderate and 5+5 being very high risk. These test results are initially sent to your urologist for review and then discussed with you at an appointment with your urologist.

What do I do once I receive a PCa diagnosis?
Here are the most common treatment options after the screening test results.

• Active Surveillance– recommended for patients who are considered as low risk for cancer progression and involves annual review and possible testing at the direction of your urologist.
• Treatment– Treatments may involve surgically removing the prostate, radiating the prostate, and treating the prostate with medicines designed to slow cancer growth or help other procedures be effective.
• Second Opinion– You may ask the doctor for a review by another urologist just in case something was accidentally overlooked in your results. Most insurance will pay for this quality review.
• Do Nothing– PCa can be slow growing but ignoring the facts about your screening results might be dire. Take the next step and discuss options with your doctor.

One of the best pieces of advice I got 11 years ago when diagnosed with PCa was “don’t worry or rush when deciding.” My best advice as you enter the screening stage is: no matter how bad or good your screening news is, your chance of outliving the cancer is good given recent medical advances. Recent research findings indicate that nearly 97% of men survive prostate cancer after 15 years whether treated or not. Most men will get this cancer by age 70 and die from other illnesses. Remember, you are the coach, and your team of medical specialists is strong, suited up, and ready to play ball for you. Game time, Sir. Take the family out to a local high school or collegiate game.

Thank you for reading this post.

Best, Geoff McLennan

Read more like this: Biomarker Testing: Empowering Patients in Prostate Cancer Management

Geoff McLennan, MPA, Prostate Cancer Patient and Advocate

Author Bio:

Geoff is dedicated to helping families and friends support a prostate cancer patient. He joined the board of Active Surveillance Patients International (ASPI) in 2018 and is an 11-year PCa patient. As a PCa patient advocate, he envisions providing a broad understanding of how patients can collaborate with clinicians for realistic medical care. He enjoys meeting and learning from his clinicians, cancer researchers, providing free online programs for patients, and reminds us that “to live, learn and thrive with PCa” is the motto of ASPI. He is glad he took science courses for understanding a healthy lifestyle that includes exercise and diet.

Geoff also volunteers as a board member and past chairman of the Placer County Mental Health Advisory Board where his interest includes therapy and resources for AS men, and a broad oversight of community mental health programs and innovations. He is married to Constance McLennan, a fine artist, has a grown son, and lives in Northern California.

*Disclaimer: The views expressed in this blog are solely those of the author, and do not represent the views or opinions of Myriad Genetics or its affiliates. It is important to consult with your healthcare provider.