A central challenge in diagnosing and treating prostate cancer is distinguishing fast from slow, aggressive from indolent. Consider the experience of Gerald Alexander.
A former Air Force surgical service specialist who completed several tours of duty in Iraq and Afghanistan, Alexander was preparing to retire from the military and make a transition to teaching high school in Warner Robins, Georgia. As part of a routine pre-retirement physical exam, his doctors performed a PSA (prostate specific antigen) test, and the PSA level was high. A biopsy in early 2013 revealed the clear presence of cancerous cells. The Gleason score (see glossary), a measure of how aggressive tumor biopsy samples look to a pathologist, was 9 out of 10.
Alexander was having frequent back pain, which he thought was from arthritis. Based on his back pain and some suggestive bone scans, a radiation oncologist in Warner Robins suspected that the cancer had already metastasized. He was told to “get his affairs in order.” However, another of his local doctors didn’t agree and to resolve the uncertainty, he came to Winship Cancer Institute.
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