At 49, how can I manage my Gleason 7 prostate cancer?

Question

Hi, Doctor

I recently received a prostate cancer diagnosis at the age of 49 after my biopsy revealed a Gleason score of 7. My urologist talked about radiation, surgery, and active monitoring, but the amount of information has grown overwhelming and challenging to comprehend.

I still feel physically normal, which makes deciding on aggressive treatment harder for me.

Does a Gleason score of 7 automatically mean surgery is the best option at my age?
How do doctors determine whether radiation or monitoring could still be reasonable instead?
What are the realistic long term risks of surgery regarding urinary control or sexual function afterward?

Kindly help.

Answer 1

Hello,

Welcome to icliniq.com.

I read your query and can understand your concern.

In cases where we choose active surveillance for prostate cancer, when the prostate-specific antigen (PSA) level is below 10, and the Gleason score is 7, we can go for active monitoring or active surveillance. In this situation, you would usually repeat the PSA test every month and follow up on the Gleason score every three months. This is considered a very important and available option if you do not want to undergo surgery or radiation treatment.

As for the surgical option, I personally do not usually prefer it because its side effects can be significant, including erectile dysfunction, problems with sexual life, and recurrent urinary tract infections. These are issues we generally try to avoid as oncologists.

We usually prefer radiation therapy techniques such as intensity-modulated radiation therapy (IMRT) and CyberKnife because they provide very accurate outcomes and can effectively treat the tumor in both early and late stages, while giving results comparable to surgery.

In addition, hormone therapy is another option that can be offered, especially in more advanced stages or after radiation if the PSA level remains elevated. In that case, hormonal treatment becomes an available option as well.

I hope this information helps you.

Feel free to ask further queries.

Thank you.