Is my Gleason 7 prostate cancer aggressive at age 63?

Question

Hello doctor,

I am a 63-year-old man recently diagnosed with prostate cancer. My PSA was high, and the biopsy confirmed localized disease with a Gleason score of 7. My doctor has given me treatment options: surgery or radiation, but I am confused about which one is safer for me.

I am especially worried about side effects like urinary leakage or sexual dysfunction. I have also read that some prostate cancers grow very slowly and can be monitored with active surveillance instead of immediate treatment. How can I know whether my cancer is aggressive or something that can be watched?

My father also had prostate cancer, so it feels like this runs in my family, and I want to understand what that means for my risk and my treatment decisions.

Please help.

Thank you.

Answer 1

Hi,

Welcome to icliniq.com.

I read your query and can understand your concern.

It is completely understandable to feel worried, especially since your father also had prostate cancer. Having it run in the family can make the whole experience feel even more overwhelming.

Let us go through your situation step by step so you feel clearer and more supported.

To begin with, your Gleason score is 7, which doctors classify as intermediate risk. This score tells us how aggressive the cancer looks under the microscope. In simple words, it means your tumour is moderately aggressive, not the slowest-growing, but not extremely fast either. Knowing this helps us decide the right treatment.

You also mentioned watchful waiting or active surveillance. These are approaches where doctors closely monitor the cancer without starting treatment. However, these options are usually safe only when the Gleason score is low (generally 6 or below). Because your score is 7 and you have a family history, we cannot rely on surveillance alone. So the next step is to look at the treatment options available to you.

Between surgery and radiation therapy, many doctors lean toward radiation for Gleason 7 cases. Let me explain why, so it feels less confusing.

Radiation therapy today is extremely precise. Over the years, the technology has improved so much that we can directly target the tumour with minimal damage to surrounding tissues. This means:

It provides the same cure rates as surgery.
It has fewer long-term side effects.
Most radiation-related urinary or bowel symptoms are temporary, improving soon after treatment ends.

Now let us connect this to the alternative:

Although surgery can completely remove the tumour, it carries higher risks. The prostate is located in a delicate area, so surgery may lead to:

Permanent urinary incontinence (difficulty controlling urine).
Permanent sexual dysfunction (problems with erections).

Because these issues can significantly affect quality of life, we usually recommend radiation first in cases like yours.

Moving forward, it is also important to understand what happens after radiation.

We will keep monitoring your PSA (prostate-specific antigen) levels, which help us see how the prostate is responding. If PSA remains high even after radiation, we may add hormonal therapy. This treatment reduces male hormones that help the cancer grow. Some side effects include:

Lower sex drive.
Some weight gain.
Occasional hot flashes.

But the reassuring part is that these effects usually improve once the hormonal therapy ends.

I want you to remember that although this journey feels heavy, you are not alone, and your condition is very treatable. There is a clear, effective path ahead, and we will walk through it together.

I hope this helps.

Kindly revert so I can assist you further.

Thank you.