Today we start the process of evaluating your prostate cancer and making a decision on how best to treat it. For now at least you have options. For those unfortunate men in Canada, the UK and anywhere else where socialized medicine is the norm, you get what they tell you they will pay for. Think about that closely when you read about how President Obama and the Democratic Congress want to change health care. They will swear on a stack of bibles that it won’t happen, but rationing of care and restriction of choice is the backbone of a socialized medicine system. I know, as I worked in the US military for a decade. If you care about your ability to chose you doctor and your treatments, then make your voice heard. Otherwise you will find yourself with a major case of buyers’ remorse and the best medical care in the world will be compromised by the the talking heads in Congress and the White House who don’t have a clue about medicine or the delivery of medical care.

Depending upon your risk stratification, your evaluation after your diagnosis of prostate cancer may be minimal to quite involved. For the average man who is low risk (PSA < 10, Gleason’s sum 6 or less) very often no further evaluation is necessary.

Dr. Alan Partin of John’s Hopkins University Department of Urology has simplified what used to be rather tedious decision making. Based upon his research looking at thousands of patients, we can now give our patients their percentage risk for probability of having lymph node involvement or cancer outside of the confines of the prostate. This has obviated much of the testing that was traditionally done for patients diagnosed with prostate cancer.

Still, there are patients that will need further evaluation prior to making specific treatment decisions. If the PSA is high or the Gleason’s sum is over 6, many urologists will recommend obtaining a baseline whole body nuclear bone scan. Because one of the common landing sites for metastatic prostate cancer in the skeleton, a whole body nuclear bone scan will often help identify this aspect of disease before it ever becomes symptomatic. Again, for patients with high risk disease, some urologists will obtain abdomen and pelvic CT scans looking for obvious enlargement of the lymph nodes that “live” near the prostate gland. It needs to be understood that a CT scan is only good for finding gross enlargement of these lymph nodes and has no ability to pick up microscopic disease. The Prostatscint scan which is another test similar to the whole body nuclear bone scan which is more sensitive than either a bone scan or a CT scan but is not even close to being a “perfect” test for determining if the prostate cancer has spread past the confines of the prostate gland.

In most cases which are low risk, it is common to proceed directly to definitive management of the disease. All treatments of prostate cancer impact urinary function. Some treatment options which we will discuss in future blogs have more impact on voiding function than others. Because of this many urologists will recommend a urinary flow test and check of post void residual urine to get a better idea of the functional capacity of the lower urinary tract. Should this test be abnormal, cystoscopy, or endoscopic evaluation of the urethra, prostate and bladder would be the next logical step. A flow test is a non-invasive study that requires the patient to urinate in a machine which measure the peak an caliber of the urinary stream. While cystoscopy involves instrumentation of the urinary tract and is somewhat uncomfortable, for the majority of patients the test takes only a few minutes and can be done with local anesthesia rather than sedation or general anesthesia.

Our next discussion will outline all of the various options for treating prostate cancer. After that, we will go further in-depth into each of the ways that prostate cancer can be attacked.

Until then, enjoy your summer, tend your garden, cheer for the Orioles and keep your fingers crossed that the Ravens get Terrell Suggs signed before the July 15 deadline to the contract extension that he so richly deserves. (And rich he will be after signing it.)