Factors in deciding treatment for prostate cancer

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.

Your doctor will find out the grade of your cancer by looking at your cancer cells under a microscope. If your cancer cells look very like normal prostate cells, your cancer is low grade. The more abnormal the cells appear (and so less like normal cells), the higher the grade of the cancer.

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).

Your doctor may tell you your Gleason score. This is a way of describing the grade of the cancer. When biopsies are taken, each area showing cancer cells is graded on a scale from 1 to 5 according to how the cells look. 1 is the lowest grade or most normal looking. 5 is the highest grade or the most abnormal looking. 

The pathologist finds the two areas with the highest grade cells and adds their scores together to give the combined Gleason score. So your Gleason score can be as low as 2 or as high as 10. Some doctors write the two scores separately, for example 3 + 4, instead of 7. Nowadays doctors only score tissue biopsies as 3 or higher so you will be given a combined score between 6 and 10.

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 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 like this. 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.

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.

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!"