Prostate Cancer Therapy

The Basics: Gleason and PSA
The first step in laying out a course of action is figuring out where you are right now.  This means gathering all the relevant facts about your case.  Your Gleason score and PSA history are the most important when considering prostate cancer therapy.  These can be found in your medical record.  As a patient, you have the right to a copy of your medical record, and your doctor’s office will provide a copy upon request, usually in return for a nominal processing fee.

Gleason
The Gleason score is a measure of the aggressiveness of the cancer.  The Gleason score is comprised of the two most common Gleason stages found in your biopsy (or in the removed prostate if you have surgery).  It is expressed as a combination of two numbers, ranging from 1 to 5, as in “3+4=7”.  That would mean that the most common Gleason stage seen was 3, and the second most prevalent was 4.  Gleason scores range from 1+1=2, up to 5+5=10.   Gleason scores of 5 to 6 are considered mildly aggressive; 7 is moderately aggressive, and scores of 8 to 10 indicate very aggressive cancer.

PSA
PSA stands for prostate-specific antigen, a substance produced almost exclusively in the prostate, by both healthy and cancerous prostate cancer cells.  Cancer cells throw off a great deal more PSA than do healthy cells.  How high your PSA is and how fast it is rising (velocity) are both important to know.

Stage
Your cancer stage refers to how far the cancer has spread.  The most common form of staging is called TNM.  T refers to how far the cancer has spread locally.  N describes the extent to which lymph nodes are involved, if at all.  M describes the extent of metastasis.  For more on staging see the detailed guide from the American Cancer Society at: http://www.cancer.org/Cancer/ProstateCancer/DetailedGuide/prostate-cancer-staging

Your Gleason score, PSA, and stage, along with a few other factors (like how many cores of the biopsy were positive) help your doctor determine which prostate cancer therapy is right for you.  In a lot of cases these days (since the advent of PSA testing), prostate cancer is diagnosed at an early stage, and often with moderate Gleason scores.  Men who have cancer that is not highly aggressive, and that is caught early, often have a wide menu of treatment options.  These include active surveillance, surgery, radiation, cryotherapy, and HIFU; and for later stages, hormone therapy and chemotherapy.