Frequently Asked Questions

Risk Groups

Q: Are there other factors to look at besides Gleason score, PSA and stage?

A: Yes. We also look at the number of needles with cancer, the amount of cancer in the biopsy and perineural invasion.

Q: My Gleason score says I have a faster growing prostate cancer than most men but my PSA is below average and I have the earliest stage you can have – T1c. How do you put this all together?

A: Based upon a man’s Gleason score, PSA and stage, we classify men into prostate cancer risk groups: low, intermediate and high – which indicates the increasing risk of an aggressive incurable cancer. The three risk groups are listed in the table here which also shows the percent of men in the various risk groups. Based upon your Gleason score of 4+3=7, you would be in the moderate risk group. On the other hand, if you had a Gleason score of 3+3=6, you would be in the low risk group. There also is a subset of the Low risk group called Very Low which will be discussed later. These risk groups combine your particular Gleason, PSA and stage.

Table-6

Q: I don’t understand why I am in the moderate risk group, with a low PSA of 4.4 and stage T1c. Can you explain?

A: To be in the moderate risk group, you only need one factor, his was Gleason 7 (4+3). If he had Gleason 3+3=6 but PSA 14.3, he would also be in the moderate group. On the other hand, if he had Gleason 4+4=8, he would be in the high group.

Q: Why did I get prostate cancer?

A: We don’t know. We can only assume that something in your prostate caused one of your normal prostate cells to change into a cancer cell. Normal cells (prostate, liver, lung, etc.) have a balanced growth: when a new cell is made, an older one dies off so the total cell number stays even. In contrast, cancer cells have uncontrolled growth. So, you have one cancer cell becoming two cancer cells and those two cancer cells multiply to four cancer cells, then eight and so forth. And, since each cancer cell usually makes a lot more PSA than a normal cell, they cause PSA in the bloodstream to elevate such as yours did to 4.4.

Figure 3. Cancer Cell Growth Beginning of Prostate Cancer.

Figure-3--Cancer-Cell-Growth-Beginning-of-Prostate-Cancer

Q: When did my prostate cancer start?

A: We don’t know. It was probably several years ago when your first cell transformed into malignancy.