Ralph A. Highshaw, M.D.

There are several methods of treatment for prostate cancer. Choosing the right treatment for you is based on your PSA, gleason score, clinical stage, and volume of disease. Two of the important issues one should think about when choosing a treatment for prostate cancer are cure rate and quality of life.

After a diagnosis of prostate cancer has been made through a transrectal ultrasound biopsy of the prostate, a man has a wide spectrum of treatment options. These options include radical retropubic prostatectomy, robotic radical prostatectomy, laparoscopic radical prostatectomy, radiation treatment (external beam, proton beam, brachytherapy or radioactive seed therapy, and IMRT), cryoablation (freezing the prostate), androgen deprivation therapy, HIFU ( High Intensity Focused Ultrasound, which is non-FDA approved), clinical trials, and active surveillance.

Localized prostate cancer can be divided into low risk, intermediate risk, and high risk cancer. By risk is meant the likelihood of cancer spreading (metastasizing). Low risk prostate cancer involves PSA value 10 or below, Gleason score 2-6, and clinical T1c-T2a prostate cancer. Gleason is a scoring system for prostate cancer. The higher the score the increase risk of aggressiveness of cancer advancing beyond the prostate. Intermediate risk prostate cancer includes Gleason score 7, or clinical T2b prostate cancer (cancer in more the one- half, unilaterally of the prostate). High risk prostate cancer includes a PSA greater than 20, Gleason score 8-10, or clinical T2c (prostate cancer found in both lobes of the gland).

For localized prostate cancer with low risk of metastasis, all of the above treatments are options. Those patients with low volume disease, PSA under 10 and Gleason score 6 or less may be candidates for active surveillance. Active surveillance involves following the patient with prostate cancer with PSA’s and periodic re-biopsy to rule-out incresed volume of disease or higher Gleason grade. It also includes pursuing treatment if the PSA or re-biopsy of the prostate reveals progression of disease.

Intermediate prostate cancer risk would also include the above treatments. In some cases, this stage of disease may include androgen deprivation therapy either prior to treatment or subsequently.

High risk prostate cancer often denotes metastatic disease, even if clinically not found. Androgen deprivation is used for this stage of disease. Androgen deprivation therapy as a treatment alone does not cure prostate cancer. It will suppress the cancer for a period of time.

For more information concerning diagnosis, treatment or management of prostate cancer contact Dr. Highshaw at (951) 509-9000.

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