Learning more about prostate cancer

A reader who has been successfully treated for prostate cancer wonders how aggressive the cancer is.



April 15, 2022 - 3:00 PM

Photo by Pixabay.com

Dear Dr. Roach: I am 68 and have prostate cancer. I had PSAs, an MRI and a biopsy. My Gleason score was a high 7. No genetic testing as I can recall. My urologist said I had “upper moderate” cancer and that I could remove my prostate or do radiation therapy. I underwent three months of radiation treatment from September to November 2020. I’ve done three PSA tests since the radiation. All have been very low and, per my doc, good. 

I don’t specifically recall my doctor making any reference to my having a rather slow cancer or more aggressive cancer. How can I determine this for my situation? — T.P.

Answer: There are factors that can help predict whether a prostate cancer will be aggressive. The most useful of these are the size of the tumor (and whether any lymph nodes are involved); the PSA level and Gleason score; and the molecular characteristics of the tumor. The last comes from DNA testing of the tumor. Since I don’t know the size and you didn’t have any molecular tests, the best information I can give is that you have a Gleason score of 7 and apparently no positive lymph nodes or distant disease. This would put you, as your urologist said, into an intermediate risk group. Without having the details from the pathology report, I can only give a rough estimate, but the best guess is that between 65% and 83% of men like you would continue to be free from prostate cancer five years after diagnosis.

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