Prostate Cancer Treatment

There are many types of treatments for prostate cancer. Along with other medications, some men are treated with surgery or radiation. At other times, prostate cancer does not need to be treated. It can be “watched,” or monitored from year to year. In our previous blog and podcast, we discussed how the Gleason score can help guide a treatment course for prostate cancer. In addition to the Gleason score, there are other factors, such as the PSA level and tumor stage, that will be help plan a path to treat prostate cancer. Let’s find out how the Gleason score, PSA level, and tumor stage are used to help formulate a plan to treat prostate cancer.

With a low Gleason score, low PSA level and low tumor stage, prostate cancer typically does not need to be treated with medications, radiation or surgery. In this case, prostate cancer can be “watched” from year to year. This is called active surveillance. Active surveillance involves getting a PSA blood test about every 6 months to help determine if the prostate cancer is becoming more aggressive. With active surveillance you may also require a repeat MRI or biopsy of your prostate. (1) Those with a Gleason score is 6 or below, and PSA blood level less than 10 and a tumor stage of 1 or 2 can be treated with active surveillance (2).

If the Gleason score is 7, PSA blood test 10-20 and tumor stage 2 or 3, your risk is in the middle of the road. This is called intermediate risk prostate cancer. In this case, radiation or prostate removal, also called prostatectomy, are options for treatment of prostate cancer. The choice for radiation or prostatectomy should be an individual choice.  Side effects from radiation include irritation or inflammation of the small bowels and bladder, but these side effects are short lived. Both radiation and prostate removal carry a risk of erectile dysfunction. Men who undergo prostate removal also have a risk of urinary inconvenience, or difficulty holding urine, at times. (2)

If the Gleason score is 8 or above, PSA blood test over 20 and tumor stage 3 or 4; this is considered higher risk disease. In the case, men can be treated with two types of radiation. As discussed previously, men in the lower risk groups also receive radiation. The type of radiation received by men in lower risks group is called external beam of radiation. This is when a ray of radiation is directed at the prostate. Once we reach a higher risk group, men can also receive brachytherapy in addition to external beam radiation. Brachytherapy involves implanting radiation beads into the prostate. In this highest risk group, men not receive external beam radiation and brachytherapy, but also ADT, which stands for androgen depravation therapy. Prostate cancer is a hormone driven caner. Therefore, one of the ways to treat this cancer at its higher stages is to lower the level of androgens, or testosterone, in the body. This is done with the use of medications such as Leuprolide (Lupron). Prostate removal is also an option for treatment in this higher risk group. (2)

The path of treatment for prostate cancer depends upon three factors: Gleason score, PSA level and tumor stage. Depending on these factors, men can expect to receive radiation or surgery with prostate removal. If prostate cancer is in a higher risk category, medications to decrease the amount of testosterone in the body can also be helpful. When discussing treatment options with your doctor, know you Gleason score, PSA level and tumor stage. In this way, you gain a greater understanding of reasoning for a proposed treatment course and have high level conversations with your doctor.

REFERENCES
1. In Alguire, P. C., & American College of Physicians, (2021). MKSAP 18: Medical knowledge self-assessment program.
2. Eric KA. Localized Prostate Cancer: Risk Stratification and Choice of Initial Treatment. In: UpToDate, Vogelzang N, Lee RW, Richie JP (Eds), UpToDate, Waltham, MA. (Accessed on March 6, 2022.)