It is important to know the stage of your cancer before you decide on the best treatment. The stage of prostate cancer is determined by the extent (how far cancer has spread) using T, N & M categories and the PSA level (Grade Group).
Doctors use risk groups to determine if further tests are necessary and to guide treatment options. The risk levels range from very low-risk to very high-risk. In addition, cancers that are in lower-risk groups have a greater chance of spreading and growing than those in higher-risk groups.
When evaluating treatment options, other factors such as age, health, life expectancy, personal preferences, and lifestyle are taken into consideration. For example, many doctors consider the possibility of a man being treated based on his stage and the likelihood of cancer returning (recurrence) following treatment.
Ask your doctor about the factors considered when discussing your treatment options. For example, many men with prostate cancer have the option to participate in clinical trials of newer treatments.
Very Low-Risk Group:
These prostate cancers are tiny (CT1c: Cancer is detected on either or both prostates with an ultrasound biopsy but cannot be perceived) and haven’t grown beyond the prostate. They have a grade of one (Gleason score of less than 6) and have low PSA amounts (Less than 10) and a few other criteria to classify them. They typically grow slowly and are not likely to cause indications or other health issues.
Most of these cancers are discovered when a prostate biopsy is performed to determine an elevated PSA and not due to the patient feeling a lump on examination or an abnormality detected in scans.
For those who do not have any serious health issues, active surveillance is usually advised. If a man wants to begin the treatment process, radiation therapy (external beam or brachytherapy) or radical prostatectomy could be an option.
For those with severe medical issues, observation is an alternative to this.
Low-Risk Group:
These prostate cancers haven’t yet spread beyond the prostate. They are in an average grade of 1 (Gleason score that is less than that) and have low PSA amounts (Less than 10). However, they are bigger (cT1 up to cT2a) than the cancers that are very low risk.
Most prostate cancer patients who are considered to be low-risk and do not have significant medical issues may be offered active monitoring. Other options, based on your preference, likelihood of the cancer advancing, as well as the risk and benefits of treatment, are radiotherapy (External beams or brachytherapy) and radical prostatectomy.
If the results of surgery indicate that cancer has characteristics that increase the likelihood to return, one of the following options could be looked at:
- External beam radiation, with or without androgen deprivation therapy (ADT)
- Follow-up on a regular basis when the PSA levels and the goal to begin treatment with radiation when the PSA levels begin to climb up.
The observation is usually a great alternative for men whose cancer has not caused any symptoms or other health issues that are serious.
Intermediate-Risk Group:
This type of prostate cancer is visible during an examination or visible in the scan. Cancer may be detected in more than half the prostate on one side (cT2b) or two sides of the prostate (cT2c) or have a grade of two or three (Gleason score of 7 or more) or either having a PSA that is between 10-20 mg/ml. Other classification criteria divide the intermediate-risk group into positive & undesirable.
Radiotherapy (external beam, also known as brachytherapy) is an option for males in this category. It is typically administered in conjunction with the aid of ADT.
The radical prostatectomy accompanied by the dissection of pelvic lymph nodes (PLND) is also an alternative. Based on the results of the surgery, possible treatments that could be discussed could include:
- ADT may be used with or without radiation therapy. If cancer is discovered in lymph nodes.
- Radiation therapy using external beams using or without ADT if the cancer is not detected in lymph nodes but has characteristics that increase the likelihood to return
- Close observation to monitor the PSA level, with the intention to begin radiation once the PSA increases.
Active monitoring is an option available to men with cancers that are characterized by favorable characteristics. But those who have intermediate-risk prostate cancer and positive characteristics who are under active surveillance must keep in mind that there is a greater likelihood of cancer spreading when compared to receiving radical prostatectomy.
Men with serious medical issues may opt for more gentle treatment options like radiation by itself, radiation combined with ADT.
High-Risk Group
Prostate cancers that are in a high-risk category have expanded beyond the prostate (cT3a) OR have a grade between 4 & 5 (Gleason score between 8 & 10)
Cancer patients in this group could receive:
- Therapy for radiation (External beam using brachytherapy, or external beam radiation by itself) together alongside the use of ADT for up to 3 Years
- Prosthetic radical surgery using PLND. If cancer is discovered in the lymph nodes removed during the procedure, ADT with or without external beam radiation could be suggested. This is when the cancer isn’t present inside the lymph nodes but has features that increase the likelihood of returning. In certain cases monitoring the PSA closely following surgery could be considered in conjunction with the decision to provide ADT or radiation treatment if the PSA increases.
For those with serious health problems or symptoms of prostate cancer, ADT is the best option. For those who do not have signs of cancer or are suffering from serious health issues, ADT along, external beam radiation therapy by itself, and monitoring are the best choices that you can avail yourself of.
