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What Is Considered Low Risk Prostate Cancer

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The potential for invasion into adjacent anatomical structures and spread to distant sites are key attributes of cancer cells. Most manifestations of prostate cancer do not have either of these properties.


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Diagnosed With Prostate Cancer Four Big Mistakes Men Are Making

Its not the news you wanted to hear from your doctorYou have prostate cancer.

Fortunately, as with 97% of men diagnosed with this cancer, it hasnt spread to other parts of your body.


Even better news: Your cancer is classified as low risk, which means your risk of dying from it over the next 15 years is less than 1%.

Now you have to decide what to do. Treatment such as surgery, hormones or radiation entails side effect risks such as erectile dysfunction and urinary incontinence. These days, in a big change in medical practice, more and more men who are newly diagnosed with low-risk prostate cancer have options that entail not seeking immediate treatment.

But heres the problem: Many men make the wrong choices, according to a recent study. Heres what you need to know to make the right ones.

Your Cancer Care Team

People with cancer should be cared for by a multidisciplinary team . This is a team of specialists who work together to provide the best care and treatment.

The team often consists of specialist cancer surgeons, oncologists , radiologists, pathologists, radiographers and specialist nurses.

Other members may include physiotherapists, dietitians and occupational therapists. You may also have access to clinical psychology support.

When deciding what treatment is best for you, your doctors will consider:

  • the type and size of the cancer
  • what grade it is
  • whether the cancer has spread to other parts of your body

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What Is The Difference Between 3+4=7 And4+3=7

Gleason Score: 3 + 4= 7

Gleason Score 3+4=7 is considered low to intermediate risk because the 1st number is Grade 3. Grade 3 is less aggressive than Grade 4, and is the most common cell pattern found in the biopsy sample.

Gleason Score: 4 + 3 = 7

Whereas, Gleason Score 4+3=7 is considered intermediate to high-risk because the 1st number is Grade 4. Grade 4 is the most common cell pattern found in the biopsy sample and is more aggressive than grade 3.

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Do Cancers Really Disappear Spontaneously Or Are They Just Eluding Us

African American Disparities in Low

Cancer specialists are comfortable with the terms partial remission and complete remission when patients undergo some sort of aggressive therapy such as radiation or chemo.

But the concept of spontaneous remission is more problematic, especially with low-risk prostate cancers in patients like me on active surveillance who have had no treatment at all.

Back in May, Michael Scott, a patient advocate and layman with loads of expertise with prostate cancer, went out on a limb to suggest in his blog that spontaneous remission was real and worthy of the attention of serious researchers.

Scott, founder of Prostate Cancer International and its Active Surveillance Virtual Support Group, mentioned my case and that of a man whose name he couldnât recall.

I asked other men in two virtual support groups for men on AS if they had experienced spontaneous remission. James Simms, 72, a retired banker from Tampa, was the only one to reply. As it happens, he had described his case at Scottâs group.

Simms and Scott gave me a new perspective on what might have happened with my âlameâ cancer, as my urologist calls it.

My case

So my cancer potentially disappeared sometime in 2011, though that was not acknowledged at that time.

My urologist, Brian Helfand, MD, PhD, of NorthShore University HealthSystem in Glenview, Illinois, joked last year that if my PHI were any lower, I wouldnât have cancer at all. Was he inadvertently on to something?

Simmsâ case

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Focal Therapy For Prostate Cancer

With recent advances in MRI and targeted biopsy, we are better able to locate the exact area of prostate cancer. Men who do not have an enlarged prostate, who have prostate cancer that is detected only in a single region of the prostate and have intermediate grade cancer can be a candidate for focal therapy. This type of therapy treats only the cancerous tissue and spares the normal prostate, thereby preserving urinary and sexual function

Here at UCLA we commonly use cryotherapy or HIFU to focally treat prostate cancer. Given that this is a relatively new form of treatment, we have established rigorous post-treatment protocols using MRI and biopsies to ensure that the cancer has been adequately treated.

Active Surveillance May Help Your Quality Of Life

With this approach, you have regular checkups, including a PSA test and rectal exam. Youll get a prostate biopsy if needed. You can start treatment at any time if the cancer starts to grow.

Active surveillance is a good choice for many men with low-risk prostate cancer, because they can avoid the side effects of treatment. This is an especially important choice if you are older or in poor health.

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Staging Of Prostate Cancer

The stage of a cancer describes its size and how far it has spread. The results of your tests help your doctors decide on the stage and plan your treatment.

We understand that waiting to know the stage and grade of your cancer can be a worrying time. Were here if you need someone to talk to. You can:

Macmillan is also here to support you. If you would like to talk, you can:

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Definition Of Clinically Insignificant Prostate Cancer

Prostate Cancer: Evaluation and Management of Low Risk Disease

Low-risk prostate cancer has been defined by DAmico as Gleason score of 6 or less, PSA less than 10 mg/ml, and a tumor that is either non-palpable or only palpable in less than half of one lobe of the prostate . Very low-risk disease has been defined by Epstein as low-risk patients who have only one or two positive cores, no more than 50% involvement of any one core, and a PSA density of < 0.15 . This definition is based on data demonstrating that these patients have a very high likelihood of clinically insignificant prostate cancer. A key concept is the pathologic definition of clinically insignificant prostate cancer. For 30 years, this has been defined as Gleason score of 6 or less, prostate cancer with a prostate tumor volume < 0.5 cc, based on work by T. Stamey on cystoprostatectomy specimens . There is much evidence that this is an overly stringent definition. Recently, the ERSPC group performed a similar analysis based on the ERSPC patients . Their conclusion was that the threshold for clinically insignificant disease was a cancer volume < 1.3 cc. This has major implications. It means that a better test for prostate cancer would ignore small volume disease, and identify cancers of 1.3 cc or greater.

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Active Surveillance And Watchful Waiting

If prostate cancer is in an early stage, is growing slowly, and treating the cancer would cause more problems than the disease itself, a doctor may recommend active surveillance or watchful waiting.

Active surveillance. Prostate cancer treatments may seriously affect a person’s quality of life. These treatments can cause side effects, such as erectile dysfunction, which is when someone is unable to get and maintain an erection, and incontinence, which is when a person cannot control their urine flow or bowel function. In addition, many prostate cancers grow slowly and cause no symptoms or problems. For this reason, many people may consider delaying cancer treatment rather than starting treatment right away. This is called active surveillance. During active surveillance, the cancer is closely monitored for signs that it is worsening. If the cancer is found to be worsening, treatment will begin.

ASCO encourages the following testing schedule for active surveillance:

  • A PSA test every 3 to 6 months

  • A DRE at least once every year

  • Another prostate biopsy within 6 to 12 months, then a biopsy at least every 2 to 5 years

Treatment should begin if the results of the tests done during active surveillance show signs of the cancer becoming more aggressive or spreading, if the cancer causes pain, or if the cancer blocks the urinary tract.

Use The Menu To See Other Pagesdoctors Use Many Tests To Find Or Diagnose Cancer

Here are 10 more facts about prostate cancer. They also do tests to le. Its important to understand what is a. Nearly 2 million american adults each year are diagnosed with cancer. But hearing the words can still be scary. What is prostate cancer grading, and what does your gleason score mean? Grading is an important part of the evaluation of your prostate cancer. If you receive a diagnosis, your schedule can quickly start to fill up with doctors appointments, medical procedures and pharmacy visits. Use the menu to see other pages.doctors use many tests to find, or diagnose, cancer. Prostate cancer occurs when cells in the tissue of the prostate gland become abnormal and grow out of control. The earlier the detection of prostate cancer, the better the patients chance of survival is. However, as with other types of cancer,. It may grow slowly and its typically treatable.

Creating a checklist of things. Prostate cancer is a common type of cancer in men, according to the mayo clinic. They also do tests to le. It may grow slowly and its typically treatable. If you or someone you love recently had a biopsy of the prostate, youll notice numbers on the pathology report.

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Radiation Therapy And Androgen Deprivation Therapy

A recent publication demonstrates an increasing trend of under treatment of high-risk prostate cancer, with many high-risk patients receiving ADT alone rather than curative treatment consisting of radiotherapy or radical prostatectomy.3 A Scandinavian randomised phase III trial, SPCG-7/SFUO-3 , showed that the addition of radiotherapy to total androgen blockade improved rates of survival and disease-free survival for high-risk patients .35 The National Cancer Institute of Canada and the United Kingdom Medical Research Council together randomized 1,057 patients with high-risk prostate cancer receiving lifelong ADT to pelvic radiotherapy or no further treatment . Similar to the results of the SPCG-7/SFUO-3 study, the addition of radiotherapy improved overall survival and prostate cancerspecific survival .36 This corresponds to very favorable number-needed-to-treat to prevent one prostate cancerspecific death .

I Have Heard That Other Factors May Be Included When Evaluating Treatment

Histological Findings in Very Low Risk Prostate Cancer Patients Managed ...

Yes, other factors such as the number of biopsies and the presence of Gleason Score 7 versus a Gleason Score may influence the treatment decision. The number of + biopsies is also strongly predictive of outcomes but not typically part of the risk grouping systems. An example would be a person with a multiple + biopsies Gleason 7. His cancer would be considered a High Intermediate Risk and require a combination of External Beam and radiation while another patient with only a few + biopsies could be a Low Intermediate Risk patient and be a good candidate for an implant alone. These factors should be discussed with you doctor.

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Screening For Prostate Cancer

There are no tests available with sufficient accuracy to screen populations of men for early signs of prostate cancer. However, early detection and treatment can significantly improve prostate cancer survival.

The test most commonly used to aid early detection of prostate cancer is the prostate specific antigen blood test. This is not a diagnostic test as it can only indicate changes in the prostate. If you are concerned about prostate cancer you should talk to your doctor and make an informed choice about whether to have one of the tests designed to find early signs of prostate cancer, in view of the potential risks and benefits.

There are no proven measures to prevent prostate cancer.

Active Surveillance And Focal Therapy For Low

Laurence Klotz

Division of Urology, Sunnybrook Health Sciences Centre, University of Toronto, Canada

Correspondence to:

Keywords: Active surveillance focal therapy low risk prostate cancer minimally invasive conservative management biomarkers

Submitted Jun 01, 2015. Accepted for publication Jun 05, 2015.

doi: 10.3978/j.issn.2223-4683.2015.06.03

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What Will Happen After My Treatment

You will have regular check-ups during and after your treatment to check how well it is working. You may hear them called follow-up appointments. Youll have regular PSA blood tests ask the people treating you how often youll have these. If your PSA level goes down this usually suggests your treatment is working.

Tell your doctor or nurse about any side effects youre getting. There are usually ways to manage side effects.

Make sure you have the details of someone to contact if you have any questions or concerns between check-ups. This might be your specialist nurse or key worker. You can also speak to our Specialist Nurses.

Read more about follow-up after prostate cancer treatments.

Are There Other Treatment Options

What to Expect: Low-Risk Prostate Cancer

There hasn’t been enough good research on other treatments such as “high intensity focal ultrasound” , cryotherapy or hyperthermia treatment . Because of this, medical societies in Germany don’t recommend using them in the treatment of prostate cancer, or only recommend using them for research purposes.

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Physical Emotional And Social Effects Of Cancer

Cancer and its treatment cause physical symptoms and side effects, as well as emotional, social, and financial effects. Managing all of these effects is called palliative care or supportive care. It is an important part of your care that is included along with treatments intended to slow, stop, or eliminate the cancer.

Palliative care focuses on improving how you feel during treatment by managing symptoms and supporting patients and their families with other, non-medical needs. Any person, regardless of age or type and stage of cancer, may receive this type of care. And it often works best when it is started right after a cancer diagnosis. People who receive palliative care along with treatment for the cancer often have less severe symptoms, better quality of life, and report that they are more satisfied with treatment.

Palliative treatments vary widely and often include medication, nutritional changes, relaxation techniques, emotional and spiritual support, and other therapies. You may also receive palliative treatments similar to those meant to get rid of the cancer, such as chemotherapy, surgery, or radiation therapy.

Learn more about the importance of tracking side effects in another part of this guide. Learn more about palliative care in a separate section of this website.

Surveillance A Good Option In Very Low

Men with low-risk prostate cancer monitored by active surveillance are not likely to have their disease spread to other organs or die of their prostate cancer.

Men with low-risk prostate cancer monitored by active surveillance are not likely to have their disease spread to other organs or to die of their prostate cancer, according to results of a study in the Journal of Clinical Oncology.

Men in the study, followed with active surveillance rather than curative treatment, were about 24 times more likely to die from a cause other than prostate cancer over a 15-year period.

The long-term results of the study suggest that men with non-aggressive disease should consider active surveillance-the careful monitoring of their disease by their clinician-over treatments that can cause adverse events.

H. Ballentine Carter, MD, professor of urologic oncology and director of adult urology at Johns Hopkins Medical Center in Baltimore, Maryland, and colleagues followed the outcomes of 1,298 men enrolled in the Johns Hopkins surveillance program over the past 20 years. Two of these men died of prostate cancer-including one who was in the active surveillance program for 16 years. An additional 3 men developed metastatic disease while 47 men died of causes other than prostate cancer, including cardiovascular disease. Nine men received treatment for their prostate cancer.

The median treatment-free survival was 8.5 years and ranged from 0.01 to 18 years.

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Findings May Help Predict Outcomes Of Active Surveillance

Active surveillance is used to monitor slow-growing, low-risk, or localized prostate cancer rather than treating it straight away. It typically involves regular prostate-specific antigen screenings, prostate exams, imaging studies, and repeat biopsies to carefully monitor prostate cancer misclassification, growth, or progression without compromising long-term outcomes. The aim of active surveillance is to avoid or delay unnecessary treatment and its side effects.

Active surveillance is increasingly viewed as the preferred approach for the management of lower-risk prostate cancer. However, there is limited information on how long patients remain on active surveillance before converting to active or definitive treatment, such as surgery or radiation therapy.

Dr. Catalona and colleagues analyzed data on 6,775 patients with prostate cancer managed with active surveillance at 28 medical centers in a National Cancer Institute-sponsored Prostate SPORE project study. Sixty-eight percent of the men were classified as having low-risk disease, based on factors including the Gleason grade, which assesses the aggressiveness of cancer cell behavior tumor stage, which reflects how far cancer has spread and the number of positive biopsy specimens .

Article: Factors Associated with Time to Conversion from Active Surveillance to Treatment for Prostate Cancer in a Multi-Institutional Cohort

Movement Builds To Classify Gleason 6 Prostate Lesions As Nonmalignant

Risk Factors &  Symptoms

In prostate cancer, as in life, you roll the dice.

In craps, 3+3 is called a hard six. Its hard because you can only win if you repeat with a combination of 3+3. Any other sixes you roll 4+2, 5+1 are losers.

Gleason 3+3 is a hard six in prostate cancer. It is the lowest grade cancer in the traditional Gleason scoring system. Still, to the eye of a pathologist, a Gleason 6 looks like a malignancy.

Now, a few experts are questioning whether this hard six is a cancer at all. Some urologists see a Gleason 6 as a noncancerous growth that has the potential to be invasive, but most likely will never spread to other organs or end up killing a man.

To a patient like me, who has been on active surveillance for 10 years, a Gleason 6 can create a big medical fuss lasting years with regular prostate-specific antigen blood tests, digital rectal exams , biopsies, and MRIs. It can cause anxious surveillance that prompts them to drop AS and undergo unnecessary radical prostatectomy, which poses a potential risk of impotence and urinary incontinence.

The Gleason 6 diagnosis can yield polar opposite recommendations from urologists. Ten years ago, I found this to be the case in the matter of a day.

On December 14, 2010, a local urologist recommended I undergo a radical prostatectomy within the week. When asked, he said he didnt support active AS, then a relatively new approach for monitoring low-grade prostate cancer.

The right thing to do

Mixed reactions

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