PCa is diagnosed primarily through a combination of two widely used
diagnostic tests-Prostate Specific Antigen (PSA) and the Digital Rectal Exam
(DRE). A PSA of 4.0 ng/mL or less is less suggestive of PCa; however, the
cutoff value may be dependent on your age. A higher PSA level by itself
does not necessarily mean that you have PCa, and a lower PSA level does not
necessarily mean that you don't have PCa. The DRE enables your doctor to
feel the size, shape, and texture of your prostate to determine if you have
a clinically important prostate. However, you can have PCa without having a
palpable tumor, and palpable nodules or abnormalities are not always PCa.

Other diagnostic tests which your doctor may perform on a blood or tissue
sample include the PSA II or Free PSA, which should rule out prostatitis
and/or BPH. The Reverse Transcriptase-polymerase chain reaction test
(RT-PCR)test, which can determine the presence of small numbers of PCa
cells; the serum acid phosphate test, and the alkaline phosphatase test; or
the ProstaScint, which involves injecting a radioisotope into the
bloodstream
which attaches itself to the cancer, then using a gamma-ray camera to locate
the PCa, if any, in your body. None of these tests or procedures are 100%
accurate.

Even though much of the testing is controversial, most survivors prefer that
newcomers be diagnosed early in the hope that early diagnosis will give
greater choice of treatment and cure with fewer side or after effects.

High PSA's may also be the result of BPH, or a urinary infection, and
although the FDA has approved a number of PSA assays for monitoring (already
treated) men, the Hybritech Tandem PSA is the only assay which has had long-
time FDA approval for use as a diagnostic tool. It's thought of by most
professionals as the most accurate, reproducible PSA assay available. Know
that NO PSA assay is perfect!

At 57, my own Hybritech PSA was 15, the Gleason was 6, and I was diagnosed as
a T1c. After my Radical Prostatectomy it was upstaged to T2 with a Gleason's grade
of 3+4 for a score of 7

The results of one or more of these tests, including a suspicious DRE are
Good cause for a biopsy. If PCa is found in the tissue removed at biopsy, a
Gleason Score will be assigned. It will be someplace between 2 and
10, the higher number indicating a more aggressive PCa. The Gleason score
has two components, the GRADE and the SUM. The grade is based on how the
individual cells look under the microscope. The grades range from 1 to
5, with 1 being the closest to normal and 5 being bad. There are both
general and specific guidelines for each grade, but the experience of the
pathologist is key - which is why a second opinion on the biopsied tissue
is often a good approach.

When the pathologist reads a specimen, s/he looks at it to determine the
most common grade of tumor seen: that is the first number of the Sum Score.
Then the pathologist determines the next most common tumor area and assigns
a Gleason Grade to it. This is the second number. The two numbers together
give the sum. Close reading of the pathology report, will often indicate
both the Grade and the percentage of each grade, which may make you feel
better or worse than knowing the GSS (Gleason Sum Score) - but the GSS is
what is reported in most of the medical literature and used for comparisons.
So a 3+4 means more grade 3 than grade 4 and a 4+3 is just the opposite.
Also a 5+2 means more 5 than 2, etc. A few pathologists feel that if the
scores are not adjacent (like 5 and 2) there is something wrong with either
the sample or the reading and will often ask for an independent second
opinion. A final note; reviewing specimens after CHT is even more difficult,
and, should be sent to a specialist who sees a lot of this tissue.

                 CURRENT STAGING FOR PCA

Primary Tumor (T)
TX      Primary tumor cannot be assessed
T0      No evidence of primary tumor
T1      Clinically inapparent tumor not palpable nor visible by imaging
T1a     Tumor incidental histologic finding in 5% or less of tissue resected
T1b     Tumor incidental histologic finding in more than 5% of tissue
        resected
T1c     Tumor identified by needle biopsy (e.g. because of elevated PSA)
T2      Palpable tumor confined within prostate
T2a     Tumor involves one lobe
T2b     Tumor involves both lobes
T3      Tumor extends through the prostatic capsule
T3a     Extracapsular extension (unilateral)
T3b     Extracapsular extension (bilateral)
T3c     Tumor invades seminal vesicle(s)
T4      Tumor is fixed or invades adjacent structures other than seminal
        vesicles:including bladder neck, external sphincter, rectum, levator
        muscles, and/or pelvic wall.
        T4b     Invaded other areas near the prostate.

Primary Tumor, Pathologic (pT)
pT2     Organ confined
        pT2a    Unilateral
        pT2b    Bilateral
pT3     Extraprostatic extension
        pT3a    Extraprostatic extension
        pT3b    Seminal vesicle invasion
pT4     Invasion of bladder, rectum

Regional Lymph Nodes (N)
NX      Regional lymph nodes cannot be assessed
N0      No regional lymph node metastasis
N1      Metastasis in regional lymph node or nodes

Distant Metastasis (M)
MX      Distant metastasis cannot be assessed
M0      No distant Metastasis
M1      Distant metastasis
        M1a     Nonregional lymph nodes
        M1b     Bone(s)
        M1      Other site(s)

PCa is generally treated by three kinds of doctors: You probably will see a
UROLOGIST first. If the diagnosis indicates that the cancer has not escaped
the gland, it would be wise for you to see a RADIATION ONCOLOGIST for
a second opinion. If the cancer has escaped the gland, a MEDICAL ONCOLOGIST
might be the source of a second opinion. Some patients seek a medical
oncologist for another opinion even though the cancer has not escaped
the gland--sort of a "neutral," professional opinion. You're lucky to have
found this source of information before you, friend or relative submitted to
therapy. Even though you may be "anxious" to "get on with it", you can
postpone treatment for a brief period until you have done your home work.
You need to know everything about each of these PCa treatment modalities:

         1. Proton Beam Radiation
         2. Radiated Implants, permanent (often referred to as "seed
             implants", or "SI"), or temporary (often referred to as "high
             dose radiation", or HDR")
         3. Three-Dimension Conformal Therapy
         4. Radical Prostatectomy
         5. Cryosurgery
         6. External Beam Radiation
         7. Neutron Radiation
         8. Chemo - limited, and highly experimental
         9. Alternative-Supplemental Treatments, such
             as: Acupuncture, nutritional and/or herbal
             supplements, Essiac & green teas, Positive
             Mental Attitude, Hyperthermia,
             meditation, visualization, spiritual
             healing groups, humor, and lots of prayer.
        10. Combined Hormonal Therapy (CHT) Many
             medical professionals do not consider CHT a
             cure, but an excellent temporary measure
             which may keep your PCa on hold.
        11. Watchful Waiting

A number of therapists are experimenting with a variety of treatment
combinations, especially CHT with other treatment modalities. This approach
seems promising, but only time will tell!

The diagnosis of PCa is almost always accompanied by the FUD factor--FEAR,
UNCERTAINTY and DOUBT! You can get rid of the FUD factor by taking charge;
learn all you can learn, so that YOU can decide which therapy YOU want.

A number of good PCa books have been published. THE PATIENT'S GUIDE
TO PCa by Dr. Mark B.Garnick; and PCa:A NON-SURGICAL PERSPECTIVE by
Dr. Kent Wallner. Also by: Dr.Patrick C. Walsh, THE PROSTATE A GUIDE FOR MEN AND
THE WOMEN WHO LOVE THEM.

After you've decided on the therapy of YOUR choice, you should seek the most
skilled, experienced practitioner available. Most survivors agree that no
matter what therapy YOU choose, you should do your homework and be assured
that the contemplated practitioner has done several hundred successful
procedures.

I had my RP done by Joy G. Paul Torrance CA 310-542-0199.
I regained full continence just 21 days after the catheter was removed.
My PSA one year post RP is still <.03. That is as good as it get's. I hope it will remain so.

Other names are Proton Beam Radiation with Dr. Carl Rossi at Loma Linda
Medical Center in California. Others will choose Brachytherapy, and seek the skill
and experience of Drs. Michael Dattoli, in Tampa; Kent Wallner, John Blasko
in Seattle; or Dr. Richard Stock, in NYC.

Dr. Patrick C. Walsh, in Baltimore. Peter Scardino, Herbert LePor in NYC are among the most sought,
experienced and skilled Urological Surgeons in the U.S.

A listing of PCa SUPPORT GROUPS and several PCa Internet sites are listed below.

Finally, E-Mail AFUD (admin@afud.org) and ask for their
free PCa RESOURCE GUIDE. You can also find the guide at: www.afud.org