Pathology expert shares vital information about prostate cancer

Requesting a copy of your pathology report, asking questions of your doctor and playing an active role in decision-making are important ways that men should take control of their health.

This is critically important in the case of prostate cancer, says Michael J. Misialek, MD, FCAP.

A fellow of the College of American Pathologists, Dr. Misialek is associate chair, Department of Pathology, Newton-Wellesley Hospital, and a clinical assistant professor in pathology, Tufts University School of Medicine in Massachusetts.

Faced with a diagnosis of prostate cancer, men should "know the right questions to ask, understand their disease and fully engage in a two-way conversation with their doctor," advises Dr. Misialek. "Patients can help make the best decisions for their own care."

What You Need to Know About Prostate Cancer

Diagnosis: Dr. Misialek explains that prostate cancer most often is diagnosed on finding elevated levels of PSA (Prostate-Specific Antigen) in a blood test or discovering an abnormality in a physical exam.

After an initial suspicion of prostate cancer, your doctor will perform a biopsy and your tissue will be sent to a laboratory where a pathologist will diagnose the type of cancer and collect other crucial information.

The pathologist: "In addition to being instrumental at the beginning of the patient's entry into the health care system for prostate cancer," says Dr. Misialek, pathologists are with the patient throughout their entire care, whether the patient realizes it or not."

Care Plan: "Every patient is unique," Dr. Misialek says. The pathologist and several other clinicians involved in your care will create a care plan especially for you. The pathologist will remain involved as repeat PSA tests and additional biopsies are ordered.

Treatment: "There are many options," says Dr. Misialek. Depending on the pathologist's diagnosis, the first option might be "active surveillance," watching to see if the cancer is growing rapidly or becoming more aggressive. Surgical options include removal of the prostate gland using an open procedure, laparoscopic, or robotic techniques. The newest option, robotic surgery, involves a smaller incision, less blood loss and a quicker recovery, according to Dr. Misialek. With newer procedures, there is less chance that impotence or incontinence would occur.

Radiation, chemotherapy, or hormonal treatment or even a newly developed prostate cancer vaccine might follow surgery. Each treatment plan is uniquely tailored to a patient's particular disease characteristics, based on the pathologist's findings.

The pathologist's advice: Depending on whether you have a family history of cancer, you may not need to be screened immediately, according to Dr. Misialek, but "if you're an average man over 40, it's time to begin a conversation with your doctor about prostate cancer screening."