Dr. Sherita King and Dr. Zachary Klaassen explain how prostate cancer treatment recommendations are based on a patient's cancer risk, with low-risk disease often managed through active surveillance and intermediate- to high-risk disease typically treated with surgery or radiation based on the patient's age, overall health, and individual circumstances.
Sherita A King:
Okay. So now they've had the biopsy, they have the diagnosis. What do you do with those patients? Is there a difference in the grades of the cancer? Will that change your management?
Zachary Klaassen:
Yeah. So if we start at low grade cancer, so this is the Gleason 3+3, low PSA less than 10, most of those men will be a candidate for active surveillance. So active surveillance is not forgetting about the diagnosis, but it's literally active monitoring. So what that means in my practice is typically a PSA check every six months. I typically will repeat an MRI every two years and certainly try to do a confirmatory biopsy within about 12 to 18 months. And then we try to keep them in that window where we're not missing the window to cure if we need it, but also not over treating them and giving them the side effects of treatment, whether it be radiation or radiotherapy.
If we move into the intermediate to high risk disease patients, so these patients typically need a form of treatment, most commonly surgery, so removal of the prostate or radiotherapy, treating it with x-rays to the prostate, not removing the prostate. And those conversations delineating between those two treatments are typically based on age and health. So if a 55-year-old man walks in in great health, generally we will recommend surgery for those men. Whereas somebody who's say 66, a little overweight, maybe has some heart disease, those patients can maybe go both ways, maybe favor radiation a little bit more. So these are the conversations.
Obviously there can be a lot of details and every patient's journey is specific and unique, but generalities in terms of the intermediate and high risk patients, those are the ones that we're having those conversations with about actual treatment at that time.