Shenandoah Oncology

Medical Oncology: (540) 662-1108
Radiation Oncology: (540) 536-8912

If you or a loved one was diagnosed with prostate cancer, you deserve expert care that’s close to home. Because prostate cancer is usually slow-growing, most patients have time to carefully consider their treatment options. Immediate surgery is not always necessary, especially in the early stages. The doctors at Shenandoah Oncology will talk with you about whether treatment is needed right away or if watchful waiting is a safe option for your situation.

When the time is right to begin prostate cancer treatment, Shenandoah Oncology offers the most advanced prostate cancer treatments available today, including access to clinical research trials.

When the time is right to begin prostate cancer treatment, Shenandoah Oncology offers the most advanced prostate cancer treatments available today, including access to clinical research trials.

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How is Prostate Cancer Diagnosed?

Prostate Biopsy and Gleason Score

If your doctor suspects cancer, a urologist will perform a biopsy by taking several small samples of tissue from the prostate. A pathologist will then look at the cells under a microscope to see if cancer is present. They will also review the cells to determine how differentiated they are from normal, healthy cells.

The Gleason score is then determined by a pathologist based on the two most common cell patterns found in the samples. These two patterns are each given a score of 1 to 5, with a one being healthy cells and a five being very abnormal cells. The two scores are added together, with the primary cell pattern’s score first in the equation. For example, if the most common pattern is grade 3 and the second most common is 4, the Gleason score is 3 + 4 = 7.

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What does the Gleason Score Mean?

The Gleason score is used along with other factors to determine the extent of the cancer and which therapies will be most effective when treatment needs to begin.

Score 6: or lower: Low-grade cancer, usually grows slowly.

Score 7: Intermediate grade. A score of 3+4=7 tends to be slower growing than 4+3=7. For those with 4+3, the prostatecancer doctor may suggest starting treatment.

Score 8–10: High-grade cancer, more aggressive and likely to spread. Treatment will typically begin right away.

Prostate Biopsy and Gleason Score

If your doctor suspects cancer, a urologist will perform a biopsy by taking several small samples of tissue from the prostate. A pathologist will then look at the cells under a microscope to see if cancer is present. They will also review the cells to determine how differentiated they are from normal, healthy cells.

The Gleason score is then determined by a pathologist based on the two most common cell patterns found in the samples. These two patterns are each given a score of 1 to 5, with a one being healthy cells and a five being very abnormal cells. The two scores are added together, with the primary cell pattern’s score first in the equation. For example, if the most common pattern is grade 3 and the second most common is 4, the Gleason score is 3 + 4 = 7.

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What does the Gleason Score Mean?

The Gleason score is used along with other factors to determine the extent of the cancer and which therapies will be most effective when treatment needs to begin.

Score 6: or lower: Low-grade cancer, usually grows slowly.

Score 7: Intermediate grade. A score of 3+4=7 tends to be slower growing than 4+3=7. For those with 4+3, the prostatecancer doctor may suggest starting treatment.

Score 8–10: High-grade cancer, more aggressive and likely to spread. Treatment will typically begin right away.

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Stages of Prostate Cancer

Prostate cancer staging helps your prostate cancer doctor understand how far the disease has spread. This information guides treatment decisions. The staging system used is called TNM, which looks at:

T (Tumor): Size and extent of the tumor in or around the prostate.

N (Nodes): Whether cancer has spread to nearby lymph nodes.

M (Metastasis): Whether it has spread to distant organs, like the bones.

In addition to TNM, staging also includes two key test results:

PSA level (Prostate-Specic Antigen): A protein found in the blood that may be higher when prostate cancer is present.

Gleason score: A grading system that measures how dierentiated the cancer cells appear under a microscope.

Stage I

Cancer is only in the prostate (T1 or T2, N0, M0)

Gleason score: 6 or less

PSA: Less than 10

Stage II

Cancer is still in the prostate, but is larger than stage I

T1–T2c, N0, M0

Gleason score: Up to 8

PSA: Can be under or over 10 depending on the Gleason score

Prostate cancer staging helps your prostate cancer doctor understand how far the disease has spread. This information guides treatment decisions. The staging system used is called TNM, which looks at:

T (Tumor): Size and extent of the tumor in or around the prostate.

N (Nodes): Whether cancer has spread to nearby lymph nodes.

M (Metastasis): Whether it has spread to distant organs, like the bones.

In addition to TNM, staging also includes two key test results:

PSA level (Prostate-Specic Antigen): A protein found in the blood that may be higher when prostate cancer is present.

Gleason score: A grading system that measures how dierentiated the cancer cells appear under a microscope.

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What Are Prostate Cancer Risk Groups?

Risk groups are used to guide treatment. They are based on the cancer’s stage, PSA level, and Gleason score. Risk groups
help your prostate cancer doctor decide how quickly you need to start treatment.

Low Risk
PSA under 10, Gleason score 6 or less. These cancers tend to grow very slowly, so active surveillance is often recommended.

Intermediate Risk
PSA of 10–20 or Gleason score of 7. Treatment usually starts within a few months.

High Risk
PSA over 20 or Gleason score 8–10. These cancers are more aggressive and may need prompt treatment.

Risk groups are used to guide treatment. They are based on the cancer’s stage, PSA level, and Gleason score. Risk groups
help your prostate cancer doctor decide how quickly you need to start treatment.

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Treatment Options for Prostate Cancer

Your treatment plan will depend on your stage, risk group, overall health, and personal goals. At Shenandoah Oncology, our oncologists work closely with your urologist to develop a plan that will be most effective while preserving your prostate when possible.

 

Active Surveillance

If you have a Gleason score of 6 or less, and the prostate cancer is slow-growing, your prostate cancer doctor may recommend watchful waiting or active surveillance. These are safe options that involve monitoring your cancer regularly. Treatment starts only if the cancer grows or causes symptoms.

Radiation Therapy for Prostate Cancer

Radiation therapy is often used to treat prostate cancer because it can kill cancer cells without removing the prostate. If you have a prostatectomy, radiation therapy is often used after surgery to be sure all cancer cells are destroyed, reducing the likelihood of the cancer coming back.

Radiation for prostate cancer is given by our radiation oncologists at our cancer center in Winchester, Virginia. The most common radiation treatment for prostate cancer is external beam radiation. Brachytherapy is also an option. This procedure places tiny radioactive seeds into the prostate where they release radiation over time, killing the cancer cells. Your radiation oncologist will discuss which one is right for you. For some patients, both internal and external radiation therapy are most effective.

Radiopharmaceuticals

For metastatic (stage IV) prostate cancer that has spread to other areas of the body, radiopharmaceuticals can be used to deliver radiation directly to those areas through a targeted therapy drug that identifies and attacks only cancer cells.

Prostate Cancer Hormone Therapy

Hormone therapy reduces levels of male hormones that help prostate cancer grow. This treatment may be used alone or combined with radiation, especially for men with intermediate or high-risk cancer.

Targeted Therapy

Targeted therapies attack specific genetic changes in cancer cells. These treatments are often used for advanced prostate cancers that have stopped responding to hormone therapy and for prostate cancers with a BRCA1 or BRCA2 gene mutation.

Immunotherapy

Immunotherapy helps the immune system recognize and attack cancer cells. One type is a therapeutic vaccine designed for certain men with advanced prostate cancer.

Surgery (Prostatectomy)

Some men may choose surgery to remove the prostate. There are lasting side effects of this treatment option that should be discussed with your partner, urologist, and prostate cancer oncologist. For some men, it can be avoided or delayed.

Chemotherapy

Chemotherapy is rarely used for prostate cancer until the most advanced stages.

Your treatment plan will depend on your stage, risk group, overall health, and personal goals. At Shenandoah Oncology, our oncologists work closely with your urologist to develop a plan that will be most effective while preserving your prostate when possible.

 

Active Surveillance

If you have a Gleason score of 6 or less, and the prostate cancer is slow-growing, your prostate cancer doctor may recommend watchful waiting or active surveillance. These are safe options that involve monitoring your cancer regularly. Treatment starts only if the cancer grows or causes symptoms.

Radiation Therapy for Prostate Cancer

Radiation therapy is often used to treat prostate cancer because it can kill cancer cells without removing the prostate. If you have a prostatectomy, radiation therapy is often used after surgery to be sure all cancer cells are destroyed, reducing the likelihood of the cancer coming back.

Radiation for prostate cancer is given by our radiation oncologists at our cancer center in Winchester, Virginia. The most common radiation treatment for prostate cancer is external beam radiation. Brachytherapy is also an option. This procedure places tiny radioactive seeds into the prostate where they release radiation over time, killing the cancer cells. Your radiation oncologist will discuss which one is right for you. For some patients, both internal and external radiation therapy are most effective.

Radiopharmaceuticals

For metastatic (stage IV) prostate cancer that has spread to other areas of the body, radiopharmaceuticals can be used to deliver radiation directly to those areas through a targeted therapy drug that identifies and attacks only cancer cells.

Prostate Cancer Hormone Therapy

Hormone therapy reduces levels of male hormones that help prostate cancer grow. This treatment may be used alone or combined with radiation, especially for men with intermediate or high-risk cancer.

Targeted Therapy

Targeted therapies attack specific genetic changes in cancer cells. These treatments are often used for advanced prostate cancers that have stopped responding to hormone therapy and for prostate cancers with a BRCA1 or BRCA2 gene mutation.

Immunotherapy

Immunotherapy helps the immune system recognize and attack cancer cells. One type is a therapeutic vaccine designed for certain men with advanced prostate cancer.

Surgery (Prostatectomy)

Some men may choose surgery to remove the prostate. There are lasting side effects of this treatment option that should be discussed with your partner, urologist, and prostate cancer oncologist. For some men, it can be avoided or delayed.

Chemotherapy

Chemotherapy is rarely used for prostate cancer until the most advanced stages.

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