With the recent diagnosis of Mr. Bidens’ prostate cancer, many positions use terms that may not be familiar to the average person. The stage, grade and Gleason score is all different indicators. The staging reflects how far cancer has already spread and presented as the I-IV stadium (in many cancers, there are also letters as modifiers), the higher numbers being worse. The exact propagation each cancer needs to reach a specific stage varies from cancer to cancer. He takes into account the size of the tumor, the location and the number of lymph nodes to which he spread, and if he established himself in the organs not adjacent to the original tumor. Stage IV is generally propagated to distant organs such as liver or bones. The highest value for prostate cancer is IVB.
The grade is how abnormal individual cells appear under the microscope. The more abnormal they seem, the faster the cancers. Consider it as a rolling -up to a cliff – the scene is how close the car is to the cliff – how it has already chased. The note is how fast the car is going. It can be far from the cliff, little if it goes fast, it will reach it earlier. However, different types of cancer have spread to different rates even if they are of the same quality.
The Gleason score is a system used specifically in prostate cancer. In a prostate biopsy, several nuclei generally come from different locations of the prostate which seem to have cancer. The notes of the two nuclei that occurs most often are added to give a score of 1-10. A higher score is worse. Mr. Biden could not have had cancer of stage 9, but it is possible to have a Gleason score of 9.
PSA is a specific antigen for prostate. It is generally high in prostate cancer, but its use of routine in men without symptoms has been controversial. Indeed, it is often high in men without prostate cancer and that it is not high in certain men with prostate cancer (estimates vary from numbers, but it is clear that there are many false positives and certain false negatives). The value of the test has also been questioned because prostate cancers are often indolent, pushing so slowly that even if there can be a small place of cancer, it can grow so slowly that he will never disturb the patient during his lifetime. The US preventive services working group has changed its recommendations over time concerning this test. It was once recommended for almost all men over fifty. Later, he was considered to be more harm than profit in most men. Currently, the directives are that the decision to order it should be based on a discussion with the patient, taking into account individual risk factors and preferences in men 50-69.
For men over 70, the PSA is not recommended at all. Most men (perhaps all) will develop small prostate cancer areas after this age, but because most of them are increasing so slowly, it is unlikely that man live long enough for it to bother it.
There are other factors used to assess the results of the PSA in addition to the absolute total PSA, but so far, I have not seen any of them mentioned in the media, so will not discuss. Digital rectal exams have been used in the past, but are less sensitive than PSA. It is done, generally the PSA is also recommended.
The above declarations concerning the PSA and the DRE only apply to men without symptoms and specific personal risk factors. If there are symptoms that suggest prostate cancer, or if the patient has a higher risk than the average, it is generally advisable to do tests.
Although prostate cancers generally progress slowly, this is not true in any case. As Mr. Biden is 82 years old, according to the USPSTF directives, he should not have been screened for prostate cancer in twelve years. This could be enough for him to have screening before the age of 70, but developed cancer after having “aged” routine screening. It is also possible that its cancer is one of the 5 to 15% of prostate cancers which are not associated with a high PSA.
(This is only a brief overview presented in the hope of giving a little context to allow non -medical readers to understand what they see in the media. I am a family medicine doctor. I am sure that urologists and oncologists can provide more details).
