Prostate Cancer Management Options

Active Surveillance

Curative Treatment Options for Prostate Cancer

Prostate cancer localized to the prostate gland can be managed in several different ways. The best option for you depends upon the assessment of several factors: the aggressiveness of the cancer, your prostate size and bladder function, and your age and general health.

Evaluation

The aggressiveness posed by the cancer is evaluated by three parameters:

  1. PSA – a level of less than ten is preferable. PSA >20ng/mL is higher risk i.e. it is more likely that the cancer has already spread to other pars of your body.
  2. Prostate examination - this assesses whether a nodule of cancer can be felt and if so then whether the cancer has penetrated the capsule of the prostate gland. An MRI scan may help to clarify this.
  3. Speed of Growth of the cancer - This is referred to as the Gleason Grade of the cancer and is obtained from the biopsy. The Gleason grade ranges from 6-10. Six is a slow growing cancer, seven an intermediate speed of growth and eight, nine and ten are faster growing cancers.

Incorporation of these three measurements allows your urologist to put your cancer into a 'risk group'; low, intermediate or high risk. The risk group you are in helps determine the best management strategy for your cancer.

We will cover the pro's and con's of all management options as they apply to your situation. Surgery is usually an excellent choice for men requiring treatment for prostate cancer. There are a number of advantages to surgery, not least the fact that it is more likely than the other treatments to cure prostate cancer.

Management

Outline of Management Options:

Low Risk Prostate Cancer

  • Active Surveillance, Prostatectomy, Brachytherapy (internal seed radiotherapy), External Beam Radiotherapy

Active surveillance is most appropriate for men with small, slow growing cancers.

Intermediate Risk Prostate Cancer

  • Prostatectomy +/- pelvic lymph node removal, Brachytherapy (internal seed radiotherapy), External Beam Radiotherapy plus androgen deprivation therapy

High Risk Prostate Cancer

  • Prostatectomy plus pelvic lymph node removal, External beam radiotherapy plus androgen deprivation therapy, High dose rate brachytherapy plus androgen deprivation therapy.

Surgery is an excellent initial treatment for high-risk disease. It can be followed by external beam radiotherapy if required.