Select Page

Prostate Cancer Treatment

June 2, 2023

what are the Treatments for Prostate cancer?

you may not need medications at all

by Jamal Ross

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.

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.)

Jamal Ross

Dr. Jamal Ross is an internist and pediatrician who possesses a passion for prayer and preventative medicine. He has worked in the fields of primary care and hospital medicine.

Related Posts

When Should I Get a Biopsy of My Prostate?

When Should I Get a Biopsy of My Prostate?

The decision to get a biopsy of your prostate is a big one. There can be anxiety while awaiting results. Once results are obtained, a cancer diagnosis can carry a heavy weight. These drawbacks are especially concerning when we consider a large number of prostate cancers are slow growing and will not cause death. Notwithstanding, there are some prostate cancers that are aggressive and deadly. Therefore, a prostate biopsy becomes an important means to identify and separate slow growing cancers for aggressive ones. Lest find out more about when you should consider getting a biopsy of your prostate.

MRI of the Prostate Before the Biopsy?

MRI of the Prostate Before the Biopsy?

You have decided to get a PSA blood test and it is higher than expected. The test is repeated, and remains elevated. When you look at you PSA blood test year over year, it has increased with time. You have a discuss with your primary care doctor and it is their recommendation that you consider a biopsy. A referral is placed to a urologist. Yet, before seeing the urologist you ask yourself: “should I consider an MRI of my prostate before undergoing a biopsy?” The answer in most case is “yes.” Let’s find out why.

When Should I Get a PSA?

Prostate cancer is one of the most common cancers worldwide and in the United States. About 1,600,000 men worldwide, and 165,00 men in the United States, are affected by prostate cancer each year. Typically, a blood called a PSA, or Prostate Specific Antigen, is used to screen for prostate cancer. The chances of being affected by prostate cancer increases as men get older. Therefore, it is important to know the right time to be screened for prostate cancer. With this in mind, the timing of prostate cancer screening depends of whether a man is considered an average or high risk for this disease. Let’s find out more about the when one should be screened for prostate cancer.

Prostate Specific Antigen

Prostate Specific Antigen

When you go to your doctor for a yearly visit, you may be offered a blood test to search for prostate cancer. This blood test is called a Prostate Specific Antigen (PSA). Nowadays, some professional societies recommend against using digital rectal exam to search for prostate for cancer. We have found the blood test is more helpful than using our finger to find cancer in average risk men, but the blood test is not perfect either. When receiving your test results, it is not enough to know if you test was “positive” or “negative.” You need to know your number. There are 3 different cut offs you should remember when looking at your PSA results.



Submit a Comment

Your email address will not be published. Required fields are marked *