Prostate cancer care and what guides treatment

Prostate cancer rarely shows symptoms in the beginning stages and early screening remains the single most powerful way to catch it before it spreads and becomes incurable.

Over 300,000 men in the U.S. will be diagnosed with prostate cancer in 2025, yet many do not understand the numbers that will ultimately guide their care. A positive prostate cancer diagnosis doesn't always mean aggressive disease. Most men diagnosed today live long, full lives; especially when the cancer is found early.

Understanding the key numbers in a diagnosis can empower men to take an active role in their treatment decisions.

A positive prostate cancer diagnosis involves several different numbers, which include:

• prostate-specific antigen or PSA
• prostate health index or PHI
• Gleason score
• cancer stage

Herbert Ruckle, MD, FACS, chair of Loma Linda University Health's Urology Department, explains that while these terms and numbers can be confusing or complex, they serve as an indicator for assessing and treating the cancer.

"The reason why the numbers are important is because it's like a language of the disease, and when understood, it defines the gravity of the situation," Ruckle says.

Prostate cancer is often first detected through a PSA blood test. Men at average risk are encouraged to start talking to their doctors about screening around age 50, but those at higher risk, such as men with a family history or African American men, should begin as early as 40.

The PSA number is one of the most important factors for early detection, Ruckle says, it is the most important number a man should know.

"If possible, it's better to have an early detection and be cured because there are so many options available in terms of treatment," Ruckle says.

A high PSA level doesn't always mean cancer. It may prompt a repeat PSA test or a Prostate Health Index (PHI) test, which can improve accuracy by estimating the likelihood of prostate cancer with a percentage as low as 10% or as high as 50%.

If results suggest a high risk, doctors may recommend a biopsy, in which small tissue samples are taken from the prostate and examined under a microscope. A negative biopsy will mean continued monitoring with PSA tests and follow-up imaging or biopsies if numbers increase. A positive biopsy will mean cancer cells are present and the cancer will be graded and staged.

An important measure to diagnosing prostate cancer is the Gleason score. To determine the Gleason score, a physical examination and imaging will be used to grade and stage the cancer, which will reveal whether the cancer is growing slowly or quickly and how aggressive it is. The combination of grade and stage are foundation to determine treatment options.

Pathologists look at the two most common cell patterns in biopsy, assign each a number from 2 to 5, and add them together for a final score ranging from 6 to 10. Gleason scores of 6 are low-grade cancer, 7 are intermediate and 8 to10 are high-grade and more aggressive. A higher score is not always a death sentence; it is just a piece of information providers use to classify the cancer.

The Gleason score also determines the grade group between 1 and 5, which is then used to help stage the cancer from 1 to 4. Together, the numbers for PSA level, PHI, Gleason score and cancer stage may all be used to guide treatment recommendations.

Treatment for prostate cancer is not one-size-fits-all, Ruckle says. Depending on the stage, grade, and a man's overall health, treatments should be customized and can include:

• active surveillance
• radiation therapy
• nuclear medicine
• surgery
• hormone therapy
• chemotherapy
• high intensity focused ultrasound

Prostate cancer numbers from PSA to Gleason score are more than medical jargon, they are tools that help doctors communicate the disease status and choose the safest, most effective plan for each patient.

Understanding the numbers behind prostate cancer is only the first step in taking an active role in your prostate health. If you or a loved one is due for a screening or want to learn more about your risk, the experts at Loma Linda University Cancer Center are here to help give clarity and peace of mind.

Take charge of your prostate health and make an appointment today.