How Doctors Determine Prostate Cancer Risk and Select Treatment

What factors do doctors use when determining prostate cancer risk and treatment options?

prostate cancer riskDoctors examine a wide range of factors when determining prostate cancer risk. These include consulting National Comprehensive Cancer Network guidelines, the cancer’s determined Gleason score, X-ray imaging and the initial staging of the disease. From there, doctors determine the risk of the cancer’s spread to other organs. If a prostate cancer is determined to be low-risk and unlikely to spread, treatments like active surveillance can be deployed.

If, however, a cancer is deemed higher risk and more likely to spread doctors will take a more aggressive treatment approach. But again, doctors will consider many options and  recommend for you and what NCCN and other physicians have recommended. It is essential for doctors to use all of the available data when considering what your options are and the best options may be for your risk factor.

 Video Transcript

Richard Bevan-Thomas MD: In order for us to evaluate the cancer and come up with the best treatment options, we are going to classify that cancer. And we are going to classify that cancer according to what we call “risk.” And that risk stratification uses all of those things we’ve discussed. It looks at the Gleason score, it looks at the staging system, it also looks at potentially any other X-rays we’ve done on them. It pulls all of these things together and it will classify you in terms of the risk stratification and the risk that you have that this cancer will not only grow but potentially come back if we don’t treat this.

How does that work? We actually use what are called NCCN guidelines. That stands for National Comprehensive Cancer Network guidelines. And those guidelines have been put together by a group of urologists and they give recommendations in terms of patients with cancer. And more importantly, patients with prostate cancer. OK, so we’re looking at prostate cancer and we need to know, what is your risk of having this cancer not only just grow but potentially coming back? We start with very low risk, we go to low risk, intermediate, and high-risk.

Again, we’re going to thinking of all those things that are put as part of this puzzle. Grade, stage, any other abnormalities that we may or may have not have seen actually on the imaging studies. Let’s start with very low risk. Very low risk means that those patients with very low risk have low Gleason grade, Gleason 6, with a low volume of disease. So, if you are a patient with low grade disease and a low PSA (below 10) and potentially what we call a small or a low PSA density, which means that your PSA is appropriate for the size of your prostate there is a reasonable chance that you would potentially be in the very low risk category.

The good news about that is that you’ve got all the options in the world. And one of those is potentially active surveillance. We’re gonna talk about active surveillance in another video. But that means that this cancer can be slow-growing and so slow-growing that we don’t necessarily have to treat this right off the bat. Low-grade and low-risk actually means again low risk is where its not a very low risk but it means that you have a Gleason 6 prostate cancer, there is potentially more of that cancer or that PSA is a little bit higher than what we would expect for the size of your prostate. So, when we look at that we want to make sure that you fit into that category. So if you fit into the low-risk category, you very well might be a candidate for active surveillance. But, again, we have to look at that in the entire confines of the Gleason grade and as well as the Gleason score.

OK, finally there is the intermediate and the high grades. This is where it becomes important, because if we start seeing a patient with either an intermediate grade of the disease, meaning that they’ve got a Gleason 7, those patients we tend to recommend, as a matter of fact we always recommend, a more aggressive treatment for those patients. We don’t want to risk the fact that when you come in with prostate cancer, if that cancer is is still contained within the prostate, if we wait too long and that cancer gets outside of the prostate we can’t cure you of that disease. We can keep you around for a long time but we can’t cure you. So we don’t want to take that risk if you are at a high intermediate or a high risk of disease.

Then we have the final one, which is the high risk. And the high risk of the patients with a high grade disease or the PSA that is higher or we’re seeing other questionably higher areas actually on the imaging study, and for those patients we almost invariably require a very aggressive treatment. So we look at those pathways and those pathways let us know what we are going to recommend for you and what NCCN and this group of physicians have recommended using all of the available data and what are your options and what are the potential best options for your potential risk factor for your particular disease.

Dr. Richard Bevan-Thomas
Dr. Bevan-Thomas is the Medical Director for Prostate Cancer Live. A graduate of Duke University, Rich received both a master’s degree in anatomy and his medical degree from St. Louis University School of Medicine. He completed residency training in urologic surgery at the University of Texas Houston Health Science Center and the renowned MD Anderson Cancer Center, also in Houston. In 2002, he received two top honors in his field; the Pfizer Scholar in Urology and the Gerald G. Murphy Scholar in Urology. Dr. Bevan-Thomas will remain on the leading edge of robotic surgery and cryosurgery at USMD Prostate Cancer Center and will continue offering patients the latest clinical trials in prostate cancer treatment. He continues his teaching and physician proctoring interests as well as instructing in robotic surgery.


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