Factors in deciding treatment for prostate cancer
This page tells you about the factors your doctor will consider when deciding on treatment for prostate cancer. There is information about
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 determine 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.
You can view and print the quick guides for all the pages in the Treating prostate cancer section.
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 your doctor takes a biopsy, a pathologist grades each area of cancer cells on a scale from 1 to 5 according to how the individual cells look. 1 is the lowest grade or most normal looking. 5 is the highest grade or the most abnormal looking.
The pathologist also grades the pattern (arrangement) of the cells in the prostate tissue from 1 to 5. If the arrangement of cells is almost normal it is a grade 1. If the pattern of cells in the tissue looks very abnormal it is a grade 5.
The pathologist adds together the grade of the most abnormal looking cells to the grade of the most common pattern of cells. They add these scores together to make the Gleason score. 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 your doctor will give you 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!"
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