Prostate cancer is the most common cancer (excluding skin cancer) diagnosed in American men. The American Cancer Society estimates some 200,000 new cases annually, with about 30,000 deaths from the disease. Most prostate cancers develop in older men and grow very slowly. However, other cases of the disease are found to more aggressive and cause symptoms in other areas of the body, and even death. The average age of men diagnosed with prostate cancer is around 72. Many patients with prostate cancer, especially those whose disease is confined to the prostate gland, may die of other illnesses or old age without ever having suffered significant disability from their cancer.

Survival rates for all stages of prostate cancer have steadily improved over the past 50 years. This rise can be attributable to the early detection of the disease, and careful planning of treatment and overall health of patients diagnosed. More than three quarters of men who have prostate cancer are expected to live at least five years from the time of cancer diagnosis. For those men whose disease has not spread beyond the prostate capsule, the five-year survival rate climbs to 99 percent.

Although prostate cancer is a very serious disease, it is one that a team of health care professionals can treat. Members of your health care team (doctor, nurse, etc…) are good sources of information if you have questions about your cancer treatment. The professionals associated with the UAB Multi-Disciplinary Prostate Clinic are able to provide valuable information to patients interested in learning more about prostate cancer. Many men and their families find it helpful to attend a support group meeting or an educational seminar to answer their questions about prostate cancer. All men are not the same, and therefore no diagnosis of prostate cancer is the same. Individuals should learn more about the disease when making a decision about treatment for prostate cancer.

For men diagnosed with prostate cancer, more than one treatment option can be considered. The selection of treatment for an individual patient depends on the varying circumstances regarding the diagnosis. Members of the healthcare team evaluate various treatment options depending on the patient’s age, expected survival, co-existing medical problems, method of diagnosis, stage, tumor factors, expected side effects of treatment, and the patient’s desires. Men in their 40s, 50s, or 60s should consider 10-year to 15-year survival rates when evaluating treatment options. It is also important to look at cure rates for men expecting to survive beyond 10 to 20 years.

There is much to consider when deciding the best way to treat or manage a diagnosis of prostate cancer. It is important to learn as much as possible about a particular stage of prostate cancer, and the treatment decision needs to take into consideration the extent and aggressiveness of the cancer, and the likelihood that a treatment will cure or control your cancer. It may take more than one visit with the doctor and the healthcare team to discuss all the options available as well as other concerns. Learn about the benefits and risks of each of the treatment options, and ask questions of the healthcare team if there is something not understood. The treatment plan may involve one or a combination of the following treatments—surgery, radiation therapy, and hormonal therapy. For some patients, watchful waiting/expectant management may also be an option.

Because prostate cancers differ so greatly in their potential for spread and in their impact on a man’s life, no single treatment is right for all men with the disease. There are three factors to consider in estimating the chances of recurrence of prostate cancer—clinical stage, Gleason scores, and PSA levels.

Clinical Stage- refers to how far the cancer is thought to have spread beyond the prostate. The stage is based on digital rectal examination (DRE), needle biopsy results, and transrectal ultrasound findings. It is important to note the clinical stage could underestimate the extent of cancer spread.

Gleason Scores – explains the method of classifying prostate cancer cells on a scale of 2 to 10. This system assigns a grade from 1 through 5 based on how much the arrangement of the cancer cells looks like a normal arrangement of prostate cells. A grade is assigned to the two areas that make up most of the cancer. These two grades are added together to give a Gleason score between 2 and 10. The higher the Gleason score, the faster the cancer is likely to grow and the more likely it is to spread beyond the prostate. Lower scores (2-4) mean the cancer cells look similar to the normal cells, and could be less aggressive and slower to progress. A score of 5-7 is intermediate, and a score of 8-10 are more likely to be aggressive.

PSA Levels – (prostate-specific antigen) the level or amount of protein may be up due to prostate cancer. The PSA test is also used to monitor the results of treatment. If the PSA level is less than 10, it is suggestive the cancer is probably confined within the prostate, but if the PSA is over 10, further tests or examinations are needed to evaluate the extent of the cancer.

Other tests used in evaluation of prostate cancer recurrence could be bone scans, computed tomography (CT) scans, or magnetic resonance imaging (MRI). Bone scan images suggest possible metastatic prostate cancer that has spread to the bones. The CT scan or MRI will indicate large pelvic lymph nodes and possible involvement of cancer beyond the prostate. Even if all those tests are negative, there is still a possibility the cancer has spread, although the concentration of cancer cells is not yet large enough to be picked up by the tests.

Based on these factors, a man’s recurrence risk can be estimated as low, intermediate, high, or very high. This risk is an important factor in considering the most appropriate treatment option.