Bored to Death Recap: The Bubble Bursts
- The grade of a prostate cancer often can predict how well a patient will do long-term and the potential for spread of the disease beyond the prostate (metastasis).
- The stage of prostate cancer is determined by three factors: the characteristics of the tumor, whether there is nodal metastasis, and whether there is distant metastasis (for prostate cancer this often times bone).
- First, if it is Stage II, we know that the doctor was able to feel an abnormality at the time of the rectal exam. So the doctor in the episode has done a rectal and that an abnormality was felt, usually a nodule or an area of asymmetry.
- We don’t know the volume of the disease or the Gleason’s score. In other words we don’t know if it is small volume, unilateral (the prostate has two lobes, a right and left), and we don’t know if cancer was found on both sides (bilateral).
- We know he has had a PSA and that it was probably elevated and that he had a prostate biopsy and all the sequelae of a biopsy. That is an episode in and of itself. The could use my book for several episodes of this series.
- We know that because it is Stage II that there is no spread to the lymph nodes nor is there any metastasis to bones.
- We know that to the best of the knowledge of his doctors the cancer is confined to the prostate and that he is a candidate for all forms of therapy, including active surveillance.
- We know he had to have a CT scan and a bone scan to prove that the cancer was nowhere else. (Where is this in all the episodes?)
Stage II prostate cancer can be detected with a digital rectal exam (physical exam). In stage II, there is no evidence of spread of cancer outside the prostate to other organs. Stage II disease may also be further be sub-categorized as follows, depending on how much tissue in the biopsy harbors prostate cancer:
- T2a – The tumor involves half or less of one lobe (section) of the prostate.
- T2b – The tumor involves half or more of one lobe of the prostate, but not the other lobe.
- T2c – The tumor involves both lobes of the prostate.
The aggressiveness of prostate cancer is best shown by the Gleason’s score. Did you notice that this score is not included in this “Staging system?” The Gleason’s and PSA are included in the AJCC system but see if you can comprehend it. (Skip down to the Stage Two scenarios and see if you can follow it or place your self in a particular stage and then ask youself if it will help you or your doctor decide how to treat your cancer.) I have trouble with it and don’t quite see the clinical usefulness of it.
So…are all Stage II’s alike? Will all Stage II’s behave the same? Should all Stage II patients be treated the same?
Should you make your decision the way your brother, neighbor, or Ted Danson (an actor) does? That is why the book, “The Decision” is more about working out what is best for you based on the particulars of you, rather than touting a particular treatment. The word “beat”, “cure”, “survive”, is not in the title to entice you to purchase. It is a system to arrive at a decision best for you. And that is why the book is different from the others and a necessary arrow in your decision tree quiver.
Apples to apples-Prostates to prostates my friend.