Best Treatment for Every Prostate Cancer Risk Group

The choice of prostate cancer treatment is based in part on the likelihood, or risk, that your tumor will grow and spread to other parts of your body. The lower your risk, the lower your chances that the prostate cancer will spread and that you will die of it.

For a disease in which there is no “best” choice, patients play a large role in the decision-making process. Potential complications of the various prostate cancer treatments must be taken into consideration when deciding on a treatment plan (for example, surgery and radiation therapy and the risk for bowel, urinary, or sexual problems).

The National Comprehensive Cancer Network recommends the following treatment strategies for very low-, low-, intermediate-, and high-risk groups:

Very low

• Stage T1c

• Prostate-specific antigen (PSA) less than 10 ng/mL

Gleason score 6 or lower and not more than two cores with cancer

• Less than 50 percent of core involved with cancer

• PSA density less than 0.15

Recommendation:

• Active surveillance when life expectancy is less than 20 years

Low

• Stage T1c or T2a and

• PSA less than 10 ng/mL and

• Gleason score less than 6

Recommendation:

• Active surveillance when life expectancy is less than 10 years

• Active surveillance, surgery, or radiation when life expectancy is more than 10 years

Intermediate

• Stage T2b–T2c or

• PSA 10 to 20 ng/mL or

• Gleason score 7

Recommendation:

• Active surveillance or external radiation with/without hormonal therapy, with/without brachytherapy, or surgery if life expectancy is less than 10 years

• Surgery or external radiation with/ without hormonal therapy, with/without brachytherapy if life expectancy is 10 or more years

High

• Stage T3a or

• PSA 20 ng/mL or higher or

• Gleason score 8 or higher

Recommendation:

• Surgery or radiation plus hormonal therapy

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