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Types of prostate cancer

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Jim Marshall (not a doctor) began his talk at this morning's teleconference by pointing out that all prostate cancers are not the same ...

Though all types of prostate cancer start in the prostate, there are many kinds of prostate cancer.

At the very simplest level, some doctors informally divide prostate cancers into "pussy-cat" and "tiger" varieties; the first only has a gentle effect on the man, the second races and rages.

The next division is made by taking samples from the prostate with a biopsy. The cancers are classified by how messy the cells look. If the cells have neat outlines, and are packed fairly neatly, they are called "well differentiated"; if they have messy outlines and are messily packed they are called "poorly differentiated". Donald Gleason gave doctors a way of scoring the messiness, with the most messy getting higher Gleason scores (10 is the highest).

Looking carefully at the prostate biopsy cells under the microscope identified half a dozen or so different types of prostate cancer cells by their shape – one "small cell" type turning out to be particularly active.

Doctors experience has led them to recognize different types of prostate cancer by the way they show themselves. One doctor, for instance, reports that men whose PSA is always very low as their disease clearly progresses are very difficult to treat successfully; men whose PSA suddenly goes very high often have lymph-node only progression, and are often successfully treated by radiation to the lymph nodes.

Most recently we have the ability to examine the very combinations of molecules (the genes in the DNA) that help make up prostate cancer cells. At last count I heard reported some 28 different strains of prostate cancer found this way.

Adding to this complex picture, men have been reported to have more than one of these strains in their prostate, and indeed, sometimes more than one of these strains in a single biopsy core sample.

This variety of prostate cancer types is one reason that every man's prostate cancer journey is different.

... end Jim

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