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Interested in learning more about intermediate-risk prostate cancer? You’re in the right place.
Let’s take a closer look at intermediate-risk prostate cancer. We’ll review how risk is calculated, and how this risk level compares to others. We’ll also discuss potential treatment options based on this prostate cancer risk level.
Understanding Intermediate-Risk Prostate Cancer
Intermediate prostate cancer represents one of five risk-level groupings used by physicians to guide treatment.
Medical professionals can assess the risk level of prostate cancer using the Gleason grading system, commonly called the Gleason Score. As the score increases, the cancer is seen as more aggressive.
Intermediate prostate cancer represents a medium level of risk in this regard. A key defining trait is that intermediate prostate cancer is limited to the prostate itself. Depending on follow-up testing, personal health, age, and more, more aggressive or conservative treatment options may be suggested.
How is Prostate Cancer Risk Level Determined?
Prostate cancer risk level can be determined with many pieces of information such as appearance on imaging, Gleason score, PSA, and genetic mutations. The Gleason score determines the grade of the cancer.
The pathologist determines the Gleason score by looking at the abnormal appearance of the cancer cells under a microscope. He or she will determine the grade of the majority of the abnormal cells as wells as the grade of the minority of abnormal cells. Whichever there are more of comes first. So for example, a G4+3 has mainly Gleason 4 and some Gleason 3, but a G3+4 has mainly Gleason 3 and some Gleason 4.
Prostate cancer ranges from Gleason 6 – 10. Because 6 – 10 can be confusing (6 sounds like a bad number), Gleason Grade Groups ranging from 1 – 5 were invented. A Gleason Score of 7, the score for intermediate prostate cancer, falls into Gleason Grade Group 2 or 3. This indicates intermediate risk.
Understanding your Gleason score is crucial for both your physician and yourself. When you understand your risk level, you can make more informed decisions about treatment.
It’s important to note that different types of biopsy vary in their effectiveness, and therefore can result in a less-accurate Gleason Score. A traditional biopsy, for example, can miss 30% or more of cancers.
Fusion biopsy uses MRI imaging to guide the use of ultrasound, which can offer more accurate results. This is an improvement over traditional biopsies that rely only on ultrasound imaging. The most accurate, but most expensive, approach for hitting a target is having the patient inside a high quality MRI and using real time MRI guidance to place the biopsy needle through the target.
Favorable and Unfavorable Intermediate-Risk Prostate Cancer
Intermediate-risk prostate cancer can, depending on the specific scoring of the biopsy pair, fall into Gleason Group 2 or 3.
Favorable intermediate-risk prostate cancer represents a somewhat lower risk level. Unfavorable intermediate-risk prostate cancer represents more risk to the patient.
What is the Gleason Score for Intermediate-Risk Prostate Cancer?
A Gleason Score of 7 (scoring of either 4+3 or 3+4 for the two biopsies) indicates intermediate-risk prostate cancer. This represents Gleason Grade Group 2.
Scores of 8, 9, and 10 are considered high risk. High-risk prostate cancers tend to recur, even with treatment. However, treatment can still be beneficial.
A score of 6 is the lowest grade we consider to be cancer, and is often low risk. However, about 50% of the time (ranging about 30% – 70% depending on the study), patients who have a G3+3 on a random (non-targeted) TRUS biopsy actually have higher-grade cancer.
Can Other Testing Help Determine Prostate Cancer Risk?
Beyond the Gleason Score, genomic testing can also identify genetic mutations and help to determine prognosis. Decipher and Prolaris are commonly used genomic tests for prostate cancer.
How Do Age and General Health Factor Into Treating Intermediate-Risk Prostate Cancer?
Age and general health can influence the treatment of intermediate-risk prostate cancer. Treatment may not be the best option for someone of very advanced age, for example.
The key is risk stratification and personalizing treatment to the individual patient’s situation.
Risk stratification ideally includes reviewing the size of the lesion in MRI results and projecting its aggressiveness. A high-quality multiparametric MRI (mpMRI) yields the best results. An accurate, targeted biopsy is also crucial.
Genomic testing is often an important follow-up. It can help to determine specific risk levels for individual patients. For example, a low Gleason Score combined with less-positive genomic test results provides crucial context about the risk involved, indicating a higher level of risk. This can help physicians and patients make more informed decisions about treatment.
Treating prostate cancer before it spreads to other areas of the body is crucial. Whether the cancer has spread or not has a major influence on the course of treatment recommended by physicians.
Common Treatment Options for Intermediate-Risk Prostate Cancer
Potential treatment options for intermediate-risk prostate cancer include:
- Surgery
- Radiation
- Laser ablation
- Transurethral ultrasound ablation (TULSA-PRO)
- Cryotherapy
For intermediate-risk prostate cancer, imaging helps in terms of diagnosis to:
- Identify the cancer
- Identify the extent of the cancer
- Help determine if cancer has broken through the capsule and potentially spread to other areas of the body
MRI-guided treatment is also possible for both laser ablation and TULSA-PRO. Using an MRI helps to identify the specific location of the cancerous cells to guide treatment and destroy an effective margin around the cancerous lesion itself.
Utilizing MRI guidance along with TULSA-PRO and laser ablation can also help to avoid destroying other, healthy areas. These two treatment options can be very effective for appropriate patients.
Prostate Laser Center is committed to using MRIs whenever appropriate in both the diagnosis and treatment of clinically significant prostate cancer.
Seeking treatment options for prostate cancer or BPH? Request a consultation today.
NOTE: The information provided on this website is general medical information and does not establish a physician-patient relationship. Please discuss your particular situation with a qualified medical professional.
