My father has prostate cancer. How often should PSA be monitored?

Question

Hello doctor,

My father is 72 years old and was recently diagnosed with localized prostate cancer. His PSA is 12, and the biopsy report shows a Gleason score of 7 (3+4). The doctor suggested options like active surveillance, radiation, or surgery.

We are confused about which is best, considering his age and general health, and looking for your suggestions on:

Does surgery carry a higher risk of urinary incontinence or erectile dysfunction?
Are newer radiation methods like IMRT safer?
How fast does prostate cancer usually grow at this stage, and how often should PSA be monitored?

Please suggest.

Answer 1

Hello,

Welcome to icliniq.com.

I hope you are well, and I wish your father a speedy recovery. I completely understand the pain and fear you feel just from your father being diagnosed with prostate cancer.

I want to tell you that there are many treatment modalities available. Currently, we aim to reduce the burden on both the patient and their caregivers.

First, if we prefer active surveillance, we usually consider it when the PSA (prostate-specific antigen) is below 10, and the Gleason score is below 7. In such cases, we consider the tumor not aggressive. During active surveillance, we monitor PSA every three months to see if the levels increase.

Considering your son’s age, we generally do not prefer surgical treatment for prostate cancer because its side effects can be severe, including permanent incontinence and permanent erectile dysfunction, and there can be a significant loss of control.

We usually recommend radiation therapy, which nowadays has many precise and accurate modalities that target the tumor cells without affecting surrounding tissues, such as IMRT (intensity-modulated radiation therapy) or CyberKnife (non-invasive, robotic surgery).

These are excellent options for prostate cancer with minimal side effects. As I mentioned, PSA monitoring continues every three months. In your son’s case, we do not prefer surgery at all; radiation therapy is preferred.

Of course, if you still choose to proceed with treatment, it is fine, but we would be very careful. If any symptoms appear, similar to what your father experienced, we would stop radiation therapy immediately.

I hope my explanation is clear and helps you make the right decision.

You can ask me any question at any time; we are here to support you.

Thank you.