Prostate cancer is a prevalent malignancy affecting men globally. Medical professionals classify prostate cancer into low, intermediate, and high-risk groups. This classification guides treatment decisions, aligning with the cancer’s potential aggressiveness and likelihood of progression. Understanding these distinctions helps patients and their families navigate diagnosis and treatment options.
Understanding Intermediate Risk Prostate Cancer
Intermediate risk prostate cancer is defined by a combination of clinical factors that determine the tumor’s likely behavior. A prostate-specific antigen (PSA) level between 10 and 20 ng/mL is one indicator. The Gleason score, which assesses cancer cell aggressiveness, is another factor. A Gleason score of 7 (either 3+4 or 4+3) places a patient in this group.
The clinical T-stage, describing the tumor’s extent within the prostate, also plays a role, including stages T2b or T2c. This classification indicates the cancer is more aggressive than low-risk forms but less aggressive than high-risk cases.
Diagnostic Evaluation and Staging
Diagnosis often begins with an elevated PSA level. A prostate biopsy is then performed to confirm cancer and determine its characteristics, including the Gleason score. This procedure involves taking tissue samples from the prostate for microscopic examination. A digital rectal exam (DRE) is another part of the evaluation, where a doctor manually checks the prostate for abnormalities, contributing to the clinical T-stage assessment. Imaging tests, such as multiparametric MRI (mpMRI), are increasingly used to characterize the tumor’s location and extent within the prostate.
Treatment Options
Treatment for intermediate-risk prostate cancer is individualized, considering factors like the specific sub-category (favorable versus unfavorable intermediate risk), patient age, overall health, and personal preferences. Active surveillance is an option for favorable intermediate-risk cases, involving close monitoring with regular PSA tests, digital rectal exams, and sometimes repeat biopsies. This approach aims to delay or avoid active treatment.
Radiation therapy is a common treatment, delivered either as External Beam Radiation Therapy (EBRT) or Brachytherapy (internal radiation). EBRT uses a machine outside the body to deliver radiation, while brachytherapy involves placing radioactive seeds directly into the prostate. Radical prostatectomy is a surgical option where the entire prostate gland is removed. This procedure can be performed using traditional open surgery or minimally invasive robotic-assisted techniques, which may lead to reduced blood loss and faster recovery.
Post-Treatment Monitoring and Outlook
After treatment, ongoing monitoring is a regular part of follow-up care. This typically involves regular PSA tests and scheduled appointments with the medical team. For patients who had surgery, the PSA level should become undetectable. After radiation, it should drop significantly.
The overall prognosis for intermediate-risk prostate cancer is generally favorable, with high survival rates for localized disease. However, some men may experience a recurrence, indicated by a rising PSA level. In such cases, further tests and potential salvage therapies may be considered.