Choosing a Treatment for Intermediate Risk Prostate Cancer | Prostate Cancer Staging Guide

PCRI’s Executive Director, Mark Scholz, MD, compares different treatments for men with Teal stage (intermediate-risk) prostate cancer. He compares these treatments based on side effects, cure rates, and convenience.

0:35 There are three subtypes of teal (intermediate-risk) prostate cancer, Low Teal, Basic Teal, and High Teal. When we are talking about different choices for treatment, we are really only referring to Basic Teal, or “intermediate intermediate-risk” prostate cancer. Men with Low Teal can consider active surveillance, and men with High Teal generally require combination therapy.

1:23 Some of the options for Basic Teal include surgery, radiation therapy (IMRT, proton therapy, SBRT), temporary and permanent seed implants, even hormone therapy alone.

1:57 When you are comparing treatments, it is helpful to look at three factors. The first factor is cure rates. The second factor is convenience and discomfort, if cure rates are equal you can choose the treatment that is the least uncomfortable. The third factor is the incidence of long term side effects.

2:45 Cure rates. The best cure rates come from radioactive seed implants. Outcomes are the same between temporary seeds and permanent seeds. Other forms of radiation should still be considered because Basic Teal is easy to cure so there isn’t a large difference in cure rates between seeds and other forms of radiation. So one can consider another treatment if it is less uncomfortable or more convenient.

3:55 Convenience and discomfort. Radioactive seeds come out on top again, since the procedure can be completed in one day. A close second is SBRT since the treatment course is relatively short as well. IMRT and proton therapy can take up to as much as 5-9 weeks of daily treatment.

4:33 Long term side effects. Since practically every therapy has high cure rates for this stage of the disease it is important to weigh the side effects. Even though it is not curative, primary hormone therapy or TIP (testosterone inactivating pharmaceuticals) wins since its side effects are reversible, and it doesn’t have long term side effects like surgery or radiation. A tier below this is all of the radiation treatment options. There is barely any difference between the side effect profiles of each different type of radiation, assuming of course that your treatment is done at a quality center. At the bottom of the list is surgery, it has higher chances of impotence, and poses a risk of incontinence that the other treatments don’t typically cause.

6:29 Summary. All these treatments should be considered by patients who have Basic Teal. In terms of cure rates and convenience, seed implants seem to score the highest. If you are trying to avoid side effects, hormone therapy can be a good option. It is a good idea to make a list of all the options and cross off the ones that you absolutely don’t want. The key is avoiding bad consequences since cure rates are generally very high.

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The Prostate Cancer Research Institute (PCRI) is a 501(c)(3) not-for-profit organization that is dedicated to helping you research your treatment options. We understand that you have many questions, and we can help you find the answers that are specific to your case. All of our resources are designed by a multidisciplinary team of advocates and expert physicians, for patients. We believe that by educating yourself about the disease, you will have more productive interactions with your medical professionals and receive better individualized care. Feel free to explore our website or call our free helpline at 1 [phone] with any questions that you have. Our Federal Tax ID # is 95-4617875 and qualifies for maximum charitable gift deductions by individual donors.

The information on the Prostate Cancer Research Institute's YouTube channel is provided with the understanding that the Institute is not engaged in rendering medical advice or recommendation. The information provided in these videos should not replace consultations with qualified health care professionals to meet your individual medical needs.

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[Dratf]

Thank you Dr Mark, and may the Lord bless you and your family . You are a truly a good physician and also a great blessing to prostate cancer patients.

[ramjet]

Great Video that spells out exactly what the title states. A rare example of a great teacher.

[Allessio]

Sensible advice...of course, the question of where ARE the "Quality Centers", is sometimes difficult to determine if you are not in a major city (and sometimes even if you are in a major city).

[patriciawilliamsn]

Thank you for all of this wonderful information

[cooperjdcox]

One of your best, thanks. I had HDR Brachytherapy and am very happy with the results.

[dmcarden]

my god i have been looking for this !!

[anthonyford]

Gosh this is good information. So Easy to understand and helpful. Thank you.

[steveg]

This was good at identifying treatments, but without some numbers, its really hard to distinguish between options.

[Gajdacsi]

My husband, 60, has basic intermediate risk prostate cancer (Teal). Not mentioned in Dr Scholz's excellent list of options, is NanoKnife therapy (irreversible electroporation). It would be great to hear his thoughts on this to see whether that can be considered to be a valid option. In terms of side effects it is promising. Some studies put IRE effectiveness at comparable levels with surgery.

[wilander]

I wish focul therapy options were addressed and how they compare to radiation in terms of cure rates.

[rakeshgrover]

Got a prostatectomy three weeks ago as Gleason score was 4+4. After histopathology ( 3+4) have been advised to go in for hormone therapy with Bicalutamide 50 mg. Is the line of treatment good and appropriate. I am in my 69th year at present.

[ramjet]

Dr Scholz, Could you please explain how and why some men are not suitable candidates for seed implants? How and why does calcification occur? Is it possible to still have seed implants where a prostate shows calcification?

[Wunderpus-photogenicus]

Dr. Scholz: if I have both bladder cancer (non-muscle invasive) as well as intermediate grade prostate cancer, is it true that for the treatment of the prostate cancer I should not do radiotherapy, because radiotherapy will more likely cause recurrence of bladder cancer? Thanks.

[bojanreljic]

My father 74 age recently been diagnosed Gleason 3+4=7, 2 grade, psa 8, 8, biopsy 4 of 12 positve all left and left centar 1 and 2 (6%-10%), 3 and 4(11%-20%)
Tretman recomnded

[walidsarwary]

I read an article in the internet back in 2008 that people who had hip xray have 2 or 5 times chance to develop prostate cancer, as my father been dignosed at age 68 and i am only 36 and had hip xray a month ago now i am suffering from anxiety adepression how accurate is this risk factor.

[UserName-sjfg]

I have Gleason 7. I didn;t get to choose a treatment. I was told that CyberKnife was available and the only one for my age. I have done two of the five treatments so far. Very unpleasant. Can;t wait to finish. Gotta be done.

[bryanmanderville]

Innovative cancer Institute in Miami Florida a good place for radiation therapy for a 3+4=7 my psa has been 13.7 now is 8.2 has been dropping I found it high after covid 19

[alanaldpal]

I am “not buying” the hormone therapy being a simple on off regarding negative side effects and duration.

[mbs]

Which doctors and treatment centers in California does Dr Scholz recommend for a man with prostate cancer?

[shamrock]

Does your age matter when it comes to seed implants when you have basic teal ?