Prostate cancer is a common yet complex disease affecting men. As a general rule, prostate cancer grows slowly, but there are times when it can develop suddenly and grow aggressively. This variability raises an important question: how does your doctor predict prostate cancer’s growth rate?
Factors Influencing Prostate Cancer Growth
If diagnosed with prostate cancer, your doctor will assess several factors to determine the aggressiveness of the disease. These factors help classify your cancer into low-risk, intermediate-risk, or high-risk categories.
- Gleason score and grade. The Gleason score consists of two numbers, when added together they add up to a maximum of 10. The Gleason score is then translated into a grade indicating the aggressiveness of the cancer. These grades range from 1 to 5, with grade 1 representing slow-growing prostate cancer and grade 5 indicating rapidly growing cancer.
- PSA levels and PSA velocity. Elevated levels of prostate-specific antigen (PSA) in the bloodstream can suggest that the prostate gland is enlarged, infected, or cancerous. A simple blood test measures PSA levels; consistently higher values typically indicate a greater likelihood of prostate cancer. PSA velocity refers to the rate at which PSA levels rise. A sharp increase in PSA levels often suggests aggressive cancer.
- Genetic and biological factors. Certain heredity and non-hereditary genetic mutations can increase the aggressiveness of prostate cancer.
Learn more in our blog: What Does the Gleason Score Mean?
How Prostate Cancer Develops
Prostate cancer develops when abnormal cells in the prostate gland begin to grow uncontrollably, forming a tumor. This process often starts with genetic changes that enable these cells to multiply.
Prostate cancer growth can be divided into three main stages:
- Growth within the prostate gland.
- Growth beyond the prostate gland.
- Spread to lymph nodes, bones, lungs, or other distant organs.
When cancer cells are detected, they receive a grade based on their appearance under a microscope. The more abnormal the cells look, the more likely the cancer will grow and spread quickly. Grade 1 indicates that the cells resemble normal prostate tissue, while grade 5 suggests that the cells are very abnormal. Grades 2, 3, and 4 reflect various features and levels of severity, with most prostate cancers being grade 3 or higher.
Types of Prostate Cancer
The specific type of prostate cancer also influences its growth rate, with some prostate cancer cells developing faster than others. Different types originate in different cell types:
- Acinar adenocarcinoma: The most common type, which is usually slow-growing, develops in the cells lining the prostate.
- Small cell prostate cancer: This begins in neuroendocrine cells and is rare and aggressive.
- Ductal adenocarcinoma: Grows and spreads quickly, starting in the cells lining the prostate ducts.
- Squamous cell cancer: Tends to grow and spread more rapidly than adenocarcinoma, originating in the cells covering the prostate.
- Transitional cell cancer: A rare and aggressive type that begins in the lining of the urethra and typically starts in the bladder before spreading to the prostate.
Once the specific type and grade of prostate cancer are determined, it’s ideal to visit with an oncologist to discuss treatment options and the right time to start therapy.
Monitoring Prostate Cancer Growth Through Active Surveillance
Not all men diagnosed with prostate cancer require immediate treatment. Your doctor may recommend active surveillance if you have early-stage, slow-growing prostate cancer that does not currently pose a risk to your health and well-being.
Active surveillance allows you to avoid the side effects of surgery or radiation therapy until treatment is necessary. Men who delay treatment may have similar outcomes to those who choose to undergo treatment right away.
If active surveillance is a suitable option, you will have regular check-ups with your doctor. During these visits, you will undergo tests to monitor any changes in your cancer. The tests typically include:
- PSA testing every 3 to 6 months
- Prostate ultrasound or digital rectal exam (DRE) every 6 to 12 months
- Prostate biopsy every 1 to 2 years
If the tests indicate that the cancer is growing or becoming more aggressive, your doctor may recommend a treatment plan that could include surgery, radiation therapy, or another approach. However, if there are no changes or the changes are not concerning, your doctor may suggest continuing with active surveillance.
Active Treatment Options Based on Cancer Growth
Understanding the growth rate of prostate cancer is essential for developing a personalized treatment plan. While some individuals can live with little or no intervention for several years, others may experience a more aggressive form of the disease that requires immediate attention. The goal of any treatment is to keep the cancer under control for as long as possible. Your prostate cancer doctor will discuss your risk group and how it will influence your recommended treatment plan.
Low-Risk Prostate Cancer Treatments
For men in the low-risk category, active surveillance is typically recommended. However, if you are uncomfortable with this approach and prefer to start treatment right away, you may undergo surgery (radical prostatectomy) or receive radiation therapy (either external beam or brachytherapy). In some cases, men may require both treatments.
Moderate-Risk Prostate Cancer Treatments
Moderate-risk prostate cancers have a slightly higher likelihood of growth and spread. They can be further categorized as "favorable" or "unfavorable" based on specific factors related to your cancer. Men with favorable moderate-risk levels may be treated with active surveillance, surgery, or radiation therapy. Those with unfavorable prostate cancer are not suitable candidates for active surveillance and will require other types of prostate cancer treatments, such as surgery (including the removal of nearby lymph nodes), radiation therapy, and hormone therapy.
High-Risk, Advanced, and Recurrent Prostate Cancer Treatments
Men classified as high-risk usually receive a combination of radiation therapy and hormone therapy, along with surgery to remove the prostate and surrounding lymph nodes. For stage IV prostate cancers, chemotherapy may also be an option. Participation in clinical trials may be considered as well.
If prostate cancer returns after treatment, options may include immunotherapy, targeted therapy, chemotherapy, or other forms of hormone therapy.
PSA Levels After Treatment
After a radical prostatectomy, PSA levels should be very low or even undetectable within a couple of months. Your prostate cancer specialist will check your levels several weeks after surgery. If your PSA remains detectable, your doctor will continue to monitor it over time to determine the best next steps.
If radiation therapy is part of your treatment plan, your PSA levels will not reach undetectable levels, as healthy prostate cells will still produce PSA. Additionally, PSA levels after radiation tend to decrease slowly and might not reach their lowest levels until two years or more after treatment. Typically, your doctor will test your PSA levels every few months to identify any trends that could indicate the need for further treatment.
Prostate Cancer Treatment in the Atlanta Area
The best way to be proactive about your prostate health is to schedule regular checkups with your doctor, including a PSA blood test starting at age 50. When prostate cancer is detected early, you have more time to explore the best treatment options for your situation.
Our team is here to discuss your biopsy results and recommend the next steps. If you live in the greater Atlanta area, receiving the latest radiation treatment close to home is possible at any of our centers in Blairsville, Conyers, Covington, Decatur, and Snellville, Georgia. We are also available for second opinions on the best prostate cancer treatment plan for you.
