Prostate cancer is the most common male cancer in the UK. The more I read about prostate cancer, its diagnosis and its management, the more confused I become. This is despite being married to a urologist who I seem to constantly bombard with questions about which tests to do and why treatment differs so much between cases.
I was therefore interested to read a recent study in the British Journal of Cancer. This was a study of nearly 850 men who had been treated with radical prostatectomy over a four year period. Just under half of these men had Gleason 3+3 on biopsy and so presumably were reassured in their clinic appointment. However, nearly one third of these men had extra-prostatic extension and for half of the men in this trial their prostate cancer was upgraded.
Prostatic biopsy is the only way to try and determine how aggressive an individual’s prostate cancer is. The results of the biopsy determine which treatment a patient is going to have. This means that some men will have a low Gleason score and may be recommended to have active surveillance as their choice of treatment. However, if this study’s results are representative of a wider population, then this means that some men will be recommended to have the wrong type of treatment. For example, some men will have a better prognosis if they proceeded to radical prostatectomy rather than active surveillance.
Clearly more work needs to be done to have better tests to define the nature and aggressiveness of the prostate cancer so men can be better informed about their prostate cancer. Some experts believe that targeted biopsies are much more accurate than random biopsies.