Memorial Health Care System
Memorial Medical Bldg. East
725 Glenwood Drive, Suite E790
Chattanooga, TN 37404-1163
Why are different recommendations made for different people?
The first thing I want patients and their families to understand about prostate cancer and how decisions are made is the variability of prostate cancer as a disease. Prostate cancer is a highly variable disease. Not all prostate cancers behave the same or present the same threat. So when we are making recommendations for managing prostate cancer, it is very important that we know what kind of prostate cancer we are dealing with. We need to understand the risk presented by the specific prostate cancer that a man has and keep in mind that most prostate cancers grow very slowly. So we evaluate that risk in the context of a man’s life expectancy. We consider when in a man’s life time did this occur and what other health issues may he have that are more of an immediate threat to him. We then make recommendations for managing that risk with one goal in mind. That common goal is that no man suffer the consequences of metastatic disease or die from prostate cancer. We don’t want that for anyone, we just don’t have to do the same thing to every man to achieve our goal.
We learn what kind of prostate cancer a man has by looking at the Gleason score. The Gleason score is a number from 2-10 that is assigned to a particular prostate cancer by the pathologist based on the appearance of the prostate cells under the microscope. The appearance of the cells and the patterns that they form give us a good idea of what kind of behavior we can expect from that particular prostate cancer. We also take into consideration the number of biopsy cores that are involved as well as the PSA. These features of a given prostate cancer help us establish a risk category which is then used along with a patients’ preference, to help determine the best recommendation for management and treatment. Options for management range from active surveillance for very low risk patients to multimodal therapy for high risk patients. For young men in their 40s, 50s, and sixties, who are otherwise in good health and have a clinically important prostate cancer, the best option is often surgical management.
The goals of surgical management are: