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.
However, there are some additional good findings since your treatment, especially that your PSA levels are staying low. Only after years can we know for sure about the aggressiveness of your cancer, but from what you are telling me, your prognosis is pretty good. Your urologist has all the information to give you the best estimate, and should give you more information if you tell them you want it.
