Localised prostate cancer is where the tumour is confined to the prostate gland without having spread to other parts of the body. This is also known as “organ confined” prostate cancer. If treatment is required, many localised prostate cancers are potentially curable with surgery or radiotherapy.
How do I know my prostate cancer is localised?
The results of your PSA test, prostate biopsyand Multiparametric Prostate MRIshould indicate whether or not the tumour is localised to the prostate. If your biopsy shows aggressive disease, you will also have a nuclear medicine bone scan to check there is no cancer spread to your bones.
It is sometimes difficult to know with full certainty that a prostate cancer is truly localised. It is possible for a few cells to have spread which are too small to detect on scanning, which may grow into distant tumours with time. The chance of this is very low with less aggressive prostate cancer, but increase in likelihood with more aggressive cancers. This explains why cure rates with surgery or radiotherapy are a little lower with aggressive cancers, even if they appear localised on your initial scans.
What is a Gleason Score?
The Gleason score is a number between 6 and 10 given to denote the aggressiveness of the prostate cancer. After your biopsy, the pathologist will examine the pattern of cancer cells in the specimens and will give them a grade of 3 to 5.
- Grade 3 – cancer cells are arranged in glands, similar to normal prostate glands
- Grade 4 – cancer cells are in abnormal glands which are fused together
- Grade 5 – cancer cells are seen but glands cannot be recognised
The pathologist may see more than one grade of prostate cancer in the sample. The grades of the most common and second most common are added together to give a Gleason score.
For example, if a biopsy shows:
- most of the cancer is grade 3
- there is also some grade 4 cancer
- the Gleason score is 3+4 = 7
What does the Gleason score mean?
The Gleason score is a measure of how aggressive the cancer is and how likely it is to grow and spread.
- Gleason 6 is generally slow growing and sometimes considered benign in smaller volumes
- Gleason 7 suggests the cancer may grow at a moderate rate
- Gleason 8+ suggests the cancer will grow more quickly and is likely to spread
What are my treatment options?
In general, there are three treatment options for localised prostate cancer:
Do I need treatment for localised prostate cancer?
Not all men need treatment for localised prostate cancer. Many low volume Gleason 6 cancers do not progress and can be safely watched with Active Surveillance. Some do progress and radical treatment will be advised if progression is observed at a later date. Men with a life expectancy
Which treatment is right for me?
Everyone is different and treatment is tailored to the individual. The decision about treatment is based on the PSA test, MRI result and Gleason score as well as the patients age, body shape and medical history.
If I have radical treatment, how do I know it was successful?
After surgery or radiotherapy we will monitor your PSA test. If surgery was undertaken, the PSA should remain undetectable. If radiotherapy or brachytherapy was undertaken, the PSA should slowly decline to a low level.