3. The geeky bit

Mr T

So, let’s try and make some proper prostate geeks out of you lot. Now this account is not extensive (it might impress in your pub quiz but your doctor may roll his eyes or run you out of his office).  What it will do is give you a good understanding of the terms and events coming up later.

The prostate is a gland that only blokes have (lucky us). It is the size and shape of a walnut. The tube we pee out of, the urethra, runs through it. At the base of it is a valve that stops us leaking or wetting ourselves. Either side of the prostate, like hands with fingers spread wide, are the nerves that controls the man’s hydraulics. The prostates main function is to supply fluid for the bad boys when they are ejaculated. Think swimming pool with no water in it – not going anywhere soon.

Cancer is never a good thing as we all know but as far as they go prostate cancer is different in that it is self-contained within the prostate unless it ruptures. It may grow slow enough that it may never cause any problems for some men and medication can be used to keep it in check.

An enlarged prostate or prostatitis may be where the man may start experiencing the symptoms commonly associated with this cancer. Remember the urethra running through it? Well as the prostrate gets bigger it could be constricting it making peeing and bladder control difficult. While blood in the pee could indicate that the prostate has begun to rupture. Having said all of that a high majority of men have no symptoms at all (I didn’t).

To check if the prostate is working properly there is a simple blood test that measures the prostate specific antigen (PSA), a specific protein in the blood usually found in small quantities. As the man gets older this PSA value may also raise slightly. A high PSA level is the first indication that something could be wrong.

The PSA test on its own is not very accurate as a number of factors can affect the value. If the man got lucky the night before (whoop. whoop), he has been doing vigorous exercises or is on certain medication – these can all affect the result. So it’s used as a guide to determine if you need further tests.

In the UK a PSA score of 3.5 or above will automatically set the ball rolling to further testing such as a physical examination or digital rectal examination (DRE), ultrasound, urine flow test, MRI and ultimately a biopsy. A Biopsy is the most invasive procedure and only done if the other tests do not give enough information to make a good determination

If a tumor is found then another important scoring system kicks in. This is called the Gleason score. The Gleason score is in the range six to ten but it is actually an addition of two numbers. The first number is the primary grade and describes the cells that make up the largest part of the tumor and the second part of the number is the secondary grade and that describes the next largest area. For example, you may see a Gleason score written as 3+4=7. This means the biggest tumor area is grade 3 and the next biggest area is 4 so the total is 7. The higher the Gleason score the more likely the cancer will grow and spread quickly.

If cancer is found its either localized (still within the prostate), locally advanced (started to break out of the gland and spread to the area just around it) or advanced (it’s started to spread to other parts of the body) these can also be referred to stage 2, 3 and 4 respectively. There will also be what’s called a Gleason grade which is a number between 6 (least aggressive) and 10 (most aggressive). This indicates how aggressive the cancer is likely to grow.

There are a couple of others scoring/grading systems but they will not be used in this book.

I think you have earned that tea and biscuit now !

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