There are three important aspects to aggressive cancer, 1) PSA, 2) Velocity and 3) Gleason score. But remember there are exceptions to every thing we discuss here.
The PSA is usually an indicator of the tumor volume. Numbers below 4 or 5 suggest that the volume is fairly low and that is is mostly confined in the prostate. And a tumor contained in one lobe of the capsule is better than one that is in both lobes. A number higher than 10 or 20 or suggests that the tumor may be out of the prostate. Numbers over 50 or 100 indicate that the tumor is probably definitely out of the prostate.
Velocity relates to how fast the PSA is increasing. A PSA that doubles every year is a very aggressive cancer. Velocity is one of the most important numbers we look at following curative treatment. If velocity doubles in three or six months it is even more dangerous.
Gleason score relates to how differentiated the tumor cells are from normal prostate cells. A G5 or G6 tumor is barely differentiated from normal cells, whereas a G9 or G10 is highly differentiated. The importance of this is that a highly differentiated cell can divide and reproduce much easier outside of the prostate than one that is more like normal cells. This is why with G8, G9 and G10 PCa there is always a risk of micro mets in the body that won't show up even with the most sophisticated kind of testing.
All of these factors are important in determining what type of curative treatment one chooses. My urologist recommended a RP, but after studying the literature of nomograms and prostate calculators I determined that a RP was a very poor choice for me as there was such a high probability that the tumor was already out of the capsule. If that is the case a RP is a waste of time and of your life energy because the probability is that it will not get all of the PCa and you will then have to have salvage radiation and/or HT.
The problem with all of this is that the correlation between Gleason score and the ability of the tumor to survive outside of the prostate is not absolute. For some reason many G6 and G7 cancers find a hospitable environment outside of the capsule while a very few G8, G9 and G10s remain in the prostate. But you really never know with any PCa because there is always the danger of micro mets which can result in a return of the cancer, even many years out from treatment.
Another very important consideration for life expectancy in the event the PCa has escaped the prostate capsule and become systemic is how it reacts to androgen deprivation therapy (Hormone Therapy) over the long term. Most PCa is quite responsive to ADT at first, but after about
three straight years on it about
50% of men will become refractory. Some men, on the other hand, have PCa which responds to ADT far longer, up to 10-15 years and perhaps even longer.
Age 66, PC diagnosed 7/2009 at age 65
Stage: T2c, Gleason: 9 (4 + 5), 6 of 6 cores positive
Bone, CAT and MIR scans negative
Treatment: brachytherapy (103 palladium), 100 gy, 11/2009 + ADT3 (Lupron + Casodex+Avodart) + IMRT on Novalis, 45 gy, 3/2010.
PSA: 7/2009, At time of diagnosis -- 11.9
10/2009 -- 5.0
12/2009 -- 0.56
5/2010 -- 0.15
8/9/2010 -- 0.06
11/2010 -- 0.013
Post Edited (Sancarlos) : 11/24/2010 7:24:49 AM (GMT-7)