Part Six: Prostate Specific Antigen (PSA), Gleason score and surgical options

It was at the very beginning of all of this that I first became acquainted with PSA numbers. As I mentioned before, I first began to have my prostate checked when I was about 35 through free screenings at my church. But this was only the digital exam (finger). It wasn't until 2006 at the age of 41 that I had a blood sample taken to check for the prostate specific antigen, which is a protein produced by the prostate cells. As is already known by many reading this blog, a PSA test is a blood test that's used to measure prostate health. High PSA numbers can be a sign of an enlarging prostate or prostate cancer. Normal levels vary based on age, but it's 0 - 2.0 for African American men, specifically in my age category (late 30s - early 40s). It is more common in African American men than any other race. My PSA at age 41 in October 2006 was 7.47! That's pretty high for my age. But, the good thing is that it was less than 10 which means it's a better chance that the cancer is confined to the prostate. Prostate cancer is known to be a very slow growing form of cancer as long as it's confined. Once it spreads outside the prostate (usually PSA levels higher than 10) it's more aggressive and spreads throughout the body into other organs. This diagnosis always requires more than just prostatectomy. Radiation and sometimes chemotherapy are necessary to slow down the spread of and eradicate cancer.


My diagnosis was in October, but I was able to wait until my surgery which was December 28. That brings me to surgery options. My biopsy urologist was going to be the surgeon at first and he was going to do a radical prostatectomy, which is the standard procedure where the surgeon makes a large incision and does a manual removal of the prostate. This results in a great amount of blood loss and a longer, tougher recovery among other things. But then the providence of God unfolded - again! My wife is a stay-at-home mom and runs a home pre-school. In November for only about 6 - 8 weeks she was watching two daughters of a lady who happened to be a nurse at UT Southwestern here in Dallas. She (the nurse/mother) was informed of my condition and immediately recommended one of the best urologists/surgeons who performs the robotic-assisted laparoscopic procedure. It is performed with slender, fiber-optic tools that only require small incisions in the abdominal wall that allow for less blood loss, shorter hospital stay, faster recovery, and no/minimal use of narcotic medication during the recovery period. That's when we made an appointment to meet with Dr. Claus Roerhborn and I chose to undergo the robotic procedure. There's actually a standard non-robotic laparoscopic procedure which specifically involves making a series of small incisions in the abdomen and manually operating the instruments that allow surgeons to see inside the abdominal area in order to dissect and remove prostate tissue. For the robotic, the surgical robot is called da Vinci ® [Intuitive Surgical, Sunnyvale, CA] and provides the surgeon with magnified 3D vision and miniature articulating robotic instrumentation. Robotic means that the tools are controlled with (you guessed it) robotic controls rather than with the surgeon's hands alone. Think of it as playing a video game with a controller - but in the operating room!


Studies now make diagnosis and survival probability more predictable with the Prostate Nomogram, which helps physicians and patients decide on the best treatment and which will result in the greatest benefit. After you receive a positive diagnosis for prostate cancer consult with your urologist about the nomogram and Gleason Scoring System, which is used to grade how far prostate tissue is from normal, healthy tissue. Samples taken during your biopsy are taken to a pathology lab where they are viewed under a microscope and tissue samples are graded on a scale of 1 to 5. The number 1 is for cells that look almost normal (slow growing cancer) and 5 is for cells that are least like normal prostate cells. Grades 2 to 4 are in between. My Gleason score was 3+4, which had a positive probability for early detection and survival. For more information and to have access to an online prostate nomogram calculator/prediction tool, visit this page of the Memorial Sloan-Kettering Cancer Center and after reading the information, click on "open calculator." You can only benefit from this calculator after being diagnosed with prostate cancer and getting a printout of your biopsy report.