If you or someone you love has been diagnosed with prostate cancer, understanding what your diagnosis means can be one of the first challenges you face. You may hear terms such as localized, metastatic, high-risk, or hormone-sensitive, but knowing how these categories apply to you can be confusing.
To help patients better understand how prostate cancer is diagnosed and categorized and why treatment can look different from one person to another, we spoke with Dr. Kevin Zarrabi at Jefferson Health. He explains what doctors consider when defining prostate cancer, how factors beyond the cancer itself can influence treatment decisions, and why understanding all of your options can help you take an active role in your care. As Dr. Zarrabi puts it, “No two prostate cancers are the same.”
Prostate cancer can have different levels of risk
When prostate cancer is localized, meaning it hasn’t spread outside the prostate, that doesn’t necessarily mean every patient has the same type of cancer or the same treatment options.
Doctors look at several characteristics to determine how aggressive the cancer may be. These can include your Gleason score, tumor characteristics, PSA level and tumor size, among other factors.
For some people, the cancer may be considered very low risk. In these cases, immediate treatment may not be necessary because the cancer is unlikely to threaten their health in the near term. Instead, their care team may recommend active surveillance, which involves regularly monitoring the cancer with tests such as PSA testing, imaging and, when appropriate, biopsies.
At the other end of the spectrum, a person can have very high-risk prostate cancer even when the cancer is still confined to the prostate. In these cases, treatment may be recommended because the cancer has a greater potential to grow or spread.
Dr. Zarrabi explains, “It’s not just the location of the tumor that matters and whether it’s metastatic or not.” The cancer’s risk category and whether it responds to hormone therapy are other factors to take into consideration. Together, these characteristics help doctors understand what type of prostate cancer a person has and how it may behave.
Treatment decisions consider both the cancer and you
Once your care team understands the characteristics of your prostate cancer, the next question is: What treatment makes sense for you?
Depending on the cancer, treatment options may include active surveillance, surgery, radiation therapy, hormone therapy, androgen receptor pathway inhibitors (ARPIs), chemotherapy, targeted treatments, radioligand therapy, or combinations of these approaches.
The decision is not based on the cancer alone.
Your overall health and other medical conditions can also affect which treatments are appropriate. For example, your doctors may consider conditions such as heart failure or COPD, your ability to undergo surgery, whether you can safely receive medications that lower testosterone, and how a treatment could affect your quality of life.
“There are two factors at play here,” Dr. Zarrabi says. “One is the cancer itself, and one is the individual and their overall health.”
A multidisciplinary team can help you understand your options
Because prostate cancer treatment can involve several different types of specialists, getting coordinated input can be helpful.
At Jefferson Health, Dr. Zarrabi describes a multidisciplinary clinic where patients can meet with a medical oncologist, urologist, and radiation oncologist as part of a coordinated discussion.
Instead of receiving recommendations from different specialists during separate appointments, a multidisciplinary visit can give you the opportunity to hear about different treatment approaches together. This may make it easier to understand how surgery, radiation, and systemic treatments compare and what the potential risks and benefits are for your particular situation.
It can also help put your diagnosis into perspective. “Many patients are confused because they say, ‘My neighbor was told just to watch it for 10 years and prostate cancer is not a big deal,’” Dr. Zarrabi says. “And other patients say, ‘My loved one passed away from the disease within one year.’”
The difference is that prostate cancer isn’t one disease with one predictable course. The biology and characteristics of one person’s tumor can be very different from another person’s.
Think beyond your next treatment
If you have advanced or metastatic prostate cancer, you may be thinking not only about what treatment comes next, but also about what options could be available later.
This is an important part of treatment planning. In some situations, the order in which treatments are given can affect which treatments may be useful in the future. Your care team may therefore consider the potential sequence of treatments rather than looking only at the option immediately in front of you.
“Prostate cancer does not follow a simple recipe book in terms of this is your first drug, that’s your second drug, that’s your third drug in a row,” he says.
Instead, treatment decisions are individualized. Your doctors may consider how likely a treatment is to control your cancer, what side effects it may cause, how those side effects could affect your long-term quality of life, and whether choosing one treatment could limit future options.
That means asking about the bigger picture can be just as important as understanding the treatment being offered today.
Ask about all of your options
It can be tempting to focus on the first treatment your doctor recommends, but Dr. Zarrabi encourages patients to understand the alternatives, too.
“There’s almost always more than one option available,” he says. “And patients ideally should know that they should hear what all the available options are and what are the pros and cons of each.”
When discussing those options with your care team, consider asking:
- What are my treatment options right now?
- Why are you recommending this treatment for me?
- How likely is it to control or shrink my cancer?
- What side effects should I expect, and could any be long-lasting?
- How might this treatment affect my quality of life?
- If I choose this treatment now, could it affect my ability to receive another treatment later?
- Are there other specialists I should meet with before making a decision?
- Are there clinical trials that may be appropriate for me?
You don’t have to understand every treatment decision at once. Asking questions and getting a clear explanation of your options can help you take a more active role in decisions about your care.
Dr. Zarrabi shares, “Ask what are the options, and then working with your doctor or your provider, determine what is the best option for you is at that given day.” “All information is a good thing. The more informed a patient is, the better,” he concludes.
Tune into the full discussion with Dr. Zarrabi, here.
Disclaimer: The information provided in this article is for informational purposes only and is not intended to be a substitute for professional medical advice, diagnosis, or treatment. Outcomes4Me is not acting as your caregiver, and any suggestions or guidance offered should not replace the advice of your healthcare provider or qualified medical professional. Always seek the guidance of your physician or other qualified health provider with any questions you may have regarding a medical condition.
