Risk stratification
Risk stratification
Risk stratification is performed taking into account all of the above factors. This allows for you and your doctor to plan your treatment and assess possible outcomes with long-term prognosis.
- Clinical stage is T1c
- Gleason score is 2-6
- PSA is less than 10 ng/ml
- Fewer than 3 biopsy cores positive, less than 50% of cancer in each core
- PSA density <0.15ng/mL/g
- T1 – T2a
- Gleason score 2-6
- PSA is less than 10 ng/ml
- Clinical stage is T2b – T2c or
- Gleason score is 7
- or
- PSA is 10-20 ng/ml
- Clinical stage is T3a
- or
- Gleason score is 8 -10
- or
- PSA is 20 ng/ml or above
- T3b-T4
- Primary Gleason pattern 5
- or
- More than 4 cores with Gleason
Metastatic disease: Any T, Any N, M1
Once disease becomes M1 (metastatic) it progresses, despite therapy. The goals of treatment focus on slowing disease progression, improving quality of life and increasing survival time. Due to advances in research and development there are now newer therapies being made available, that have been shown to slow the progression of the metastatic prostate cancer, including Castration-Resistant Prostate Cancer (CRPC), and extend patient survival.
What is Castration-Resistant Prostate Cancer (CRPC)?
Testosterone, an androgen responsible for male secondary sexual characteristics, is produced primarily in the testes (95%) and also in small amounts by the adrenal glands (5%). Testosterone is also the fundamental hormone in the regulation of prostate cancer growth.
Castration, defined as, “to deprive (a male animal or person) of the testes,” was originally performed by surgical means (orchiectomy). Today, what we term, “castration,” can be performed either surgically or chemically. Blood testosterone levels vary depending on the method of castration.
- Surgical castration usually involves the removal of the testes, which leads to a decrease in testosterone production.
- Chemical castration is achieved for men undergoing luteinizing hormone-releasing hormone (LHRH) agonist therapy
Castration is therefore one of the treatment methods to control high risk, advanced or metastatic prostate cancer.
Prostate cancer however, may contain cells that are initially insensitive or develop resistance to castration. With time these cells predominate and the cancer continues its growth despite the absence of testosterone. This stage of cancer growth is called castrate resistant.
The term actually describes the fact that the prostate cancer is continuing to grow despite castrate levels of testosterone.
Due to advances in research and development, there are now newer therapies being made available, that have been shown to slow the progression of the CRPC and extend patient survival.
References
- American Cancer Society. Initial Treatment of Prostate Cancer, by Stage and Risk Group. https://www.cancer.org/cancer/prostate-cancer/treating/by-stage.html. Accessed on 22 October 2021.
- American Cancer Society. Prostate Cancer Stages. https://www.cancer.org/cancer/prostate-cancer/detection-diagnosis-staging/staging.html. Accessed on 22 October 2021.
- Prostate Conditions Education Council. Gleason Score. https://www.prostateconditions.org/about-prostate-conditions/prostate-cancer/newly-diagnosed/gleason-score. Accessed on 22 October 2021.
- Urology Care Foundation. Advance Prostate Cancer. https://www.urologyhealth.org/urology-a-z/a_/advanced-prostate-cancer. Accessed on 25 October 2021.
- NCBI. How do we define "castration" in men on androgen deprivation therapy? https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7523606/. Accessed on 20 January 2022.
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