In the world of text messages, “TMI” is the most-used shorthand for Too Much Information. It’s true that there are some things that people reveal to us—usually about their personal lives— that we wish we never knew. Once the cat is out of the bag, it’s too late to “unknow” it.

I’m a big believer in correct information, especially for cancer patients. It’s been my experience that when my patients have the big picture of what’s going on in their bodies, they are more likely to understand why one treatment vs. another is a better match for their disease, and to feel good about their choice of procedure.

The big picture includes important clinical characteristics defined by blood test (PSA and its variants), imaging (multiparametric MRI), tissue analysis (biopsy), and gene risk factors (biomarkers). These are like pieces of a jigsaw puzzle, and when assembled we get a portrait of the individual’s prostate cancer (PCa.). No two cases are identical. The tumor size, location, aggression level are considerations in treatment choice, as are the patient’s lifestyle and preferences. Altogether, we get the big picture and can develop a treatment plan.

The little picture

There’s another factor patients should know about, though it almost never factors into a treatment choice. That’s because it’s so common that it’s taken for granted—and it’s the type of PCa cells that over 95% of patients have. It’s called adenocarcinoma (A-deh-noh-KAR-sih-NOH muh, click on the speaker icon here to listen to pronunciation). Even though cancer cell type rarely impacts a prostate treatment decision, I want to provide information so you know what people mean when they talk about “garden variety PCa.”

Adenocarcinoma is a cancerous mutation in epithelial cells. These cells line many organs surfaces and produce particular fluid substances that serve the organ or gland’s healthy function. Organs with this type of lining include uterus, breast, colon/rectum, esophagus, lungs, pancreas, stomach—and prostate. In the prostate, the epithelial cells that can mutate into adenocarcinoma are the ones that produce and secrete semen, the fluid that carries sperm out of the body during male orgasm. Thus, if a biopsy diagnosis has the word adenocarcinoma in the report, it’s saying that patient has the most common type of prostate cancer.

Prostate adenocarcinoma characteristics

While there’s no such thing as a good cancer, it may come as some relief to understand the characteristics of prostate adenocarcinoma—by far and away the most prevalent PCa type.

Generally, it begins as a slow-growing and relatively “lazy” or indolent cancer. This is its main characteristic. However, there are a couple subtypes of adenocarcinoma, as well as other but rarer PCa cell types, that are aggressive. As the Cleveland Clinic summarizes adenocarcinoma, “It usually grows slowly, and many people don’t need treatment right away. But some types can spread quickly and are harder to treat.” I won’t get into the other types, but when biopsy slides are examined under a microscope, an experienced pathologist can tell the difference between “garden variety” adenocarcinoma cells and more dangerous types.

Besides being generally slow-growing, another tell-tale adenocarcinoma characteristic is a rise in PSA (prostate specific antigen). As such tumors gradually begin to enlarge, more PSA is released into the bloodstream. Thus, an annual PSA blood test is the most important way to monitor for early adenocarcinoma. Why does early matter? Because in its earliest stage, treatment has a strong probability of 100% success. Of course, other noncancerous conditions can also cause a rise in PSA, so it’s important to follow up a suspicious PSA result with a) a repeat test within a few weeks, and b) if still suspicious, mpMRI to visually determine if a biopsy is needed or not.

Treating adenocarcinoma

It bears repeating that the earlier prostate adenocarcinoma is diagnosed, the greater likelihood of treatment success. At that stage, virtually every intervention has comparable success data, so other factors such as lifestyle and patient preference are taken into account. In general, choices are:

• Whole gland (radical) therapies – surgical removal (prostatectomy), radiation
• Partial gland and focal therapies that use ablation (tumor destruction) to kill the cancer while preserving urinary, sexual, and bowel function
• Active Surveillance – holding off on treatment while adhering to a protocol of monitoring using PSA tests and mpMRI

At the Sperling Prostate Center, we do not offer radical treatments. However, we are experts in focal therapies, including Focal Laser Ablation, TULSA-PRO, and Exablate. In addition, our patients who opt to go on Active Surveillance can be confident in our monitoring protocol because we use an excellent lab for our PSA/biomarker services, and we are proud to have a state-of-the-art 3 Tesla magnet on site. When it comes to reading (interpreting) a patient’s scan, in addition to over 10 years of experience our imaging results are augmented by Artificial Intelligence for the greatest accuracy. If you or a loved one is diagnosed with adenocarcinoma of the prostate, contact us to learn the next-step advantages we offer.

NOTE: This content is solely for purposes of information and does not substitute for diagnostic or medical advice. Talk to your doctor if you are experiencing pelvic pain, or have any other health concerns or questions of a personal medical nature.