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Prostate biopsies sometimes 'understage' cancers, hotline docs say

SALT LAKE CITY — With controversy swirling around screening for prostate cancer, some patients believe they just need to be observed once the diagnosis of cancer is made. But it's more complex than that, according to two urologic specialists who fielded 50 calls in two hours during the Deseret News/Intermountain Healthcare Hotline Saturday.

"Everyone's jumping on the observation bandwagon — and it's very appropriate for some," said Dr. Michael Mangelson, chief of the urology division at LDS Hospital. "But sometimes observation under appreciates the volume of cancer."

Once cancer is suspected based on an elevated prostate-specific antigen (PSA) test and a digital rectal exam, a biopsy is done to determine the volume of cancer cells and they are examined at the cellular level to see which characteristics are present, since there are five categories and that offers clues as to how aggressive a cancer will be. The resulting calculation is called a Gleason score.

But it's not all straight-forward from there, said Dr. Richard Matern, a urologist and surgeon at LDS Hospital. When prostate cancer is removed and examined by a pathologist, it often shows that the degree of cancer was "understaged on the biopsy." And that's what doctors try to be sure patients understand as they discuss treatment options, they said.

Mangelson likens it to showing a small section of a person's photograph. "Oh yeah, it's Phil." But when you're shown the entire picture, it might be "Oh no, it's actually Pete."

The big picture helps when determining treatments. Other factors that are considered include age, health, tumor type and volume, risk factors and what a patient is comfortable with. For some, potential complications of treatments are devastating. Fortunately, such complications are less common than they were, though they may still occur.

Many of the callers wanted a second opinion on whether the treatments they're undergoing make sense. A couple of callers have metastatic prostate cancer that has spread well beyond the prostate and they wanted to talk about realistic treatment options. One of them, in his 50s, said his cancer was more aggressive and deadly than it at first appeared to be.

Still, most people will die of something else. Prostate cancer is usually fairly slow in its progression. The trick is finding the cases where it's not.

And that, ultimately, is the goal of prostate cancer screening, Mangelson said. People do die from the disease and "our job is to find the men with the greatest potential" to do that, so it can be headed off before it's too late."

Intermountain Healthcare is offering free screenings this month for men who have no insurance or limited insurance and are at highest risk for the cancer. The screenings are for those 50 and older, 40 or older with a family history of the disease and African-American men over 40. Screening includes a PSA test and digital rectal exam. To schedule, call 801-507-3800. Space is limited and walk-ins will not be helped.

The screenings are from 5:30-7:30 p.m. and will take place Thursday, Sept. 15, at Intermountain Medical Center (5121 S. Cottonwood Street, Murray); Tuesday, Sept. 20, at Alta View Hospital (9660 S. 1300 East, Sandy) and Tuesday, Sept. 27, at Riverton Hospital (3741 W. 12600 South, Riverton). You'll get details on location when you make an appointment.

The hotline tackles a different health topic the second Saturday of each month.


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