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Factors in deciding treatment for prostate cancer

Men and women discussing prostate cancer

This page tells you about the factors your doctor will consider when deciding on treatment for prostate cancer. There is information about

 

A quick guide to what's on this page

Factors in deciding treatment for prostate cancer

Your doctor will consider a number of factors when deciding on treatment for prostate cancer. These include

  • How far your cancer has grown and spread (the stage)
  • How the cells look under the microscope (the grade) and the pattern of the cells in the prostate tissue (your Gleason score)
  • Your prostate specific antigen PSA blood test
  • Your age and general health

The stage tells your doctor the size of the tumour and how far it has grown. The treatment choices for a cancer that is small and completely inside the prostate gland will be different to those for a cancer that has grown outside the prostate.

Your doctor will find your cancer's grade by looking at your cancer cells under a microscope. Generally speaking, low grade cancers tend to grow more slowly and are less likely to spread than high grade cancers.

It is important for you and your doctor to talk through which would be the best treatment for you and your individual circumstances.

 

CR PDF Icon You can view and print the quick guides for all the pages in the Treating prostate cancer section.

 

 

How far your prostate cancer has grown and spread

The stage tells your doctor the size of the tumour in your prostate and how far it has grown. The treatment choices for a cancer that is small and completely inside the prostate gland will be different to those for a cancer that has spread outside the prostate. The diagram below shows a cancer contained within the prostate. There is detailed information about staging prostate cancer in this section.

Diagram showing prostate cancer pressing on the urethra

 

Cancer cells under a microscope (Gleason score)

Your doctor will find out the grade of your cancer by looking at your cancer cells under a microscope. Cancer cells are graded depending on how alike they are to normal cells. So, if your cancer cells look very like normal prostate cells, your cancer is low grade. If they are very unlike them your cancer is a high grade.

Generally speaking, low grade cancers tend to grow more slowly and are less likely to spread than high grade cancers. Some doctors refer to these different types of prostate cancer as grumbling (low grade) and galloping (high grade).

The most common grading system doctor’s use is called the Gleason system, or Gleason score.

A  pathologist looks at the pattern (arrangement) of the cancer cells and grades them from 3 to 5. Grade 1 and 2 are thought of as normal prostate cells. Grades 3 – 5 are thought of as cancer cells, with grade 5 being the most abnormal.

The doctor will take more than one sample when you have a  biopsy. This is because there may be more than one grade of cancer in the tumour.  The pathologist works out an overall Gleason score by adding together the two most common Gleason grades.

For example, if the most common grade of the samples is grade 3 and the second most common is grade 4 then the overall Gleason score is 7.  Some doctors write the two scores separately, for example 3 + 4, instead of 7.

The grade can only ever give a doctor an idea of how a cancer might behave. It cannot definitely predict what will happen. Most cancers will behave as expected, but not all.

 

Your age and general health

Your doctor takes your age into account because some prostate cancers grow very slowly. If you are older and your prostate cancer is not causing you any symptoms, you may live just as long without having any active treatment. So you might be offered regular check ups instead of treatment. 

You may find it hard to wait and see if you are offered regular check ups. But it could be the right choice for you if the side effects from the treatment might be worse than the effects of the cancer. This is particularly so if you have other health problems. If your cancer starts to cause symptoms you and your doctor can then consider which treatment is best for you.

 

The PSA blood test

More and more prostate cancers are being diagnosed early from a PSA blood test. The PSA is a very reliable test for checking whether your cancer is growing quickly or slowly. So it can be very useful in monitoring your cancer. There is detailed information about PSA testing in the screening for prostate cancer section.

 

Decisions about treatment

It is important for you and your doctor to talk through which would be the best treatment for you in your individual circumstances. You will need to talk through the benefits and possible side effects of treatments. For some men, an option may be to have no treatment but to monitor the cancer closely. Doctors call this active surveillance or watchful waiting.

Peter, a prostate cancer survivor from Southampton, explains that deciding on treatment for prostate  cancer can be a tricky time:

"Prostate cancer treatment is very complicated. It may take more than one visit to understand all the various options. I think it's really important to take your wife or another close relative or friend with you each time. Don't try to handle it on your own!"

 

More information about prostate cancer treatments

We have detailed information about the treatments for prostate cancer and their possible side effects. You can also phone the Cancer Research UK nurses on freephone 0808 800 4040, from 9am to 5pm, Monday to Friday. They will be happy to answer any questions. 

Our prostate cancer organisations page gives details of other people who can give information about prostate cancer treatments. Some organisations can put you in touch with a cancer support group.

Our prostate cancer reading list has information about books, leaflets and other resources discussing prostate cancer treatments.

If you want to find people to share experiences with online, you could use Cancer Chat, our online forum.

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Updated: 20 February 2014