Increasing acceptance of different types of “intermediate-risk” prostate cancer


A new review article in the journal Oncology provides us with an overview of the appropriate management of men with “favorable” and “unfavorable” forms of intermediate-risk prostate cancer.

The full text of the paper by Serrano et al. is available on line and will be a useful new resource for support group leaders and other prostate cancer educators, quite apart from its value to anyone who has recently been diagnosed with prostate cancer that meets any one of the following three criteria:

  • A clinical stage of T2b or T2c
  • A Gleason score of 7
  • A PSA level of between 10 and 20 ng/ml

Serrano et al. provide a careful explanation of the new subdivisions of “intermediate” risk prostate cancer into two sub-groups:

  • “Favorable” intermediate-risk disease, meaning a patient who has all three of these characteristics
    • Just one of the three risks factors for intermediate-risk disease specified above
    • A Gleason score of 3 + 4 = 7 (or lower)
    • Fewer than half his biopsy cores positive for cancer
  • “Unfavorable” intermediate-risk disease, meaning a patient who has at least one of these characteristics
    • More than one of the three risk factors for intermediate-risk disease listed above
    • A Gleason score of 4 + 3 = 7
    • More than half his biopsy cores positive for cancer

They discuss the evolution of the new guidelines on management of “favorable” as opposed to “unfavorable” intermediate-risk prostate cancer from the National Comprehensive Cancer Center (NCCN) and place particular emphasis on the ways in which active surveillance and radiation therapy (with or without the use of androgen deprivation therapy (ADT) may be appropriate in the first-line management of intermediate-risk disease.

Because management decisions can be particularly challenging for men with “favorable” and “unfavorable” forms of intermediate-risk prostate cancer, it is also worth bearing in mind that must such patients have some time to come to a good decision about how they want to get treated. That would be less true for the patient who has all or nearly all of the following characteristics:

  • A clinical stage of T2b or T2c
  • A Gleason score of 4 + 3 = 7
  • A PSA level of nearer to 20 ng/ml than 10 ng/ml
  • Most or all of his biopsy cores positive for cancer with a Gleason score of 4 + 3 = 7

While such a patient still meets the formal criteria for intermediate risk, he would certainly be very near to high-risk, and probably needs to come to a conclusion about how to get treated in a relatively prompt manner.

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