Prostate cancer is a complex disease. It is not easy to predict how any particular prostate tumor will grow, or how rapidly it will spread to areas outside the prostate. After a prostate cancer diagnosis, your urologist will assess various factors to determine the level of risk associated with the disease. Understanding the risk level—low, intermediate or high—will help you and your doctor make decisions to achieve the best survival rate and quality of life.

Types of prostate cancer

While there are many types of prostate cancers, urologists first divide them into two categories—aggressive and indolent—to begin determining the best treatment.

1. Aggressive prostate cancer

Dr. Scott Sellinger of Tallahassee, FLAggressive prostate cancer is the type that grows rapidly, spreads fairly early, quickly and widely, and causes massive body damage. Since it spreads swiftly via secondary deposits, it quickly becomes advanced stage cancer and is very difficult to treat, particularly during the later stages.

For aggressive high-risk prostate cancer, treatment is most effective when it begins while the tumor is still in its early stages. Without early treatment, the cells of the tumor remain highly active, multiplying rapidly. The tumor grows swiftly, spreads rapidly and causes widespread damage.

2. Indolent prostate cancer

Indolent prostate cancer is the type that grows very slowly and is unlikely to spread to areas outside the prostate. Therefore, it is a low-risk, low-volume tumor that can exist in the prostate for several years without causing significant problems. Even if left untreated, it is unlikely to spread outside the prostate; and if it spreads, it only does so slowly and locally.

How are high-risk and low-risk prostate tumors identified?

If you are diagnosed with prostate cancer, your doctor will monitor the disease periodically to see if it is growing and spreading. The primary way for monitoring the growth and spread of the tumor is the prostate-specific antigen (PSA) level in blood. PSA is produced by the prostate and reaches the bloodstream; but larger amounts of PSA in the bloodstream are usually a signal that the prostate is enlarged, infected or malignant.

For instance, the PSA doubling time—the time it takes for a patient’s PSA level to double—predicts how aggressive the cancer is. The faster the PSA level doubles, the more aggressive is the cancer. Likewise, the PSA velocity helps to predict the aggressiveness of a tumor. If the PSA level increases sharply, then the cancer is likely aggressive.

Urologists also use the Gleason score to detect how fast the cancer is growing and spreading. This score is obtained by grading cells in the tumor on the basis of how abnormal or normal the cells look under the microscope. The two most abnormal areas of the tumor are evaluated, each given a score from 1-5, and then the two numbers are added. The higher the score (typically 6 or more), the more aggressive the tumor.

While immediate treatment is called for with aggressive, high-risk tumors, a patient can live with an indolent, low-risk tumor for 20-30 years without the cancer causing any serious effects. For the slow growing tumor, we may recommend observation or a watchful waiting called active surveillance, where we monitor the growth and spread of the tumor without medical intervention.

At Advanced Urology Institute, we offer a wide range of treatment options for prostate cancer, including chemotherapy, hormone therapy, radiotherapy, and surgery. But before we can recommend any treatment, we try to determine the risk of advanced disease. For more information on the diagnosis and treatment of prostate cancer, visit the Advanced Urology Institute website.

Types of Prostate Cancer: What You Need to Know

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