Tag Archive for: high PSA

An Overview of Prostate Cancer Treatment Approaches

An Overview of Prostate Cancer Treatment Approaches from Patient Empowerment Network on Vimeo.

How is prostate cancer currently treated? Dr. Andrew Armstrong provides an overview of treatment options for prostate cancer patients across various stages of the disease.

Dr. Andrew J. Armstrong is a medical oncologist and director of clinical research at the Duke Cancer Institute’s Center for Prostate and Urologic Cancers. For more information on Dr. Armstrong here.

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What are the treatment options that are currently available for prostate cancer patients? 

Dr. Armstrong:

It’s a really important question, and I would say it depends. In early disease, when cancer is picked up early, many patients are cured. Prostate cancer is the number one survived cancer in the United States. It’s important to realize that and kind of take a deep breath and realize that most patients beat prostate cancer. Only about one out of six men will suffer a relapse or develop metastatic disease or Stage IV disease that requires more of a lifelong journey of therapy. 

So, most men come into this because they’ve been screened by their primary care doctor. They had a high PSA, they underwent a biopsy, they were found to have cancer.  

And the first decision, particularly for example at our Duke multidisciplinary clinic, the first decision that we always share with the patient, and as part of shared decision-making, is we give information about prognosis and risk using the PSA level, the biopsy information, staging information if imaging is done.  

And then giving a category or a risk group to that patient can help them decide what are the options that are nationally recommended, internationally recommended by evidence-based guidelines. The most important decision is whether that prostate cancer needs treatment right now at all, and the initial observation or active surveillance is a very valuable “first do no harm” approach for men with very low risk or low risk types of prostate cancer. With a low-grade cancer, low PSA, low stage, and that’s about a third of all patients.  

That’s a huge number of men are told they have cancer, but they actually don’t need initial treatment. 

And they need to be explained to, why we’re not going to treat that cancer, why it’s so safe, and why mortality is not high in that patient population when we don’t treat it, and how we do active surveillance. For example, imaging with MRI, repeat biopsies. And a lot of patients do appreciate that because they’re not undergoing surgery or radiation and they’re not being harmed by those treatments. That would be called overtreatment. That’s not for everybody, though. 

So, just like prostate cancer comes in different flavors, treatments come in different flavors. So, there’s things where the Gleason score is higher, the stage may be higher, the PSA is higher, and the risk to the patient is higher. And when we get into that more intermediate- and high-risk situation, treatment is going to be necessary. But then we’ll have a menu of treatment options that is important to talk through. Typically surgery, radiation, sometimes alternatives to that. 

Sometimes combinations with hormonal therapy, which we call systemic therapy. The drugs that work throughout the body. 

Katherine Banwell:

What about for patients who have advanced disease? 

Dr. Armstrong:

The word “advanced” can mean different things to different people. Advanced can mean metastatic disease. It can mean disease that’s not curable. But advanced can also mean that it’s high risk. That the disease is still confined to the prostate, but it’s aggressive, and that if it’s not handled quickly with a multidisciplinary approach, for example, it has a high risk of occurrence.  

So, advanced disease can mean aggressive, in need of treatment. Sometimes it can be cured if it’s confined to the prostate. Sometimes it requires more than just one treatment modality, such as surgery followed by radiation, or radiation plus some of the newer hormonal therapies.  

For men with stage IV disease, that means disease that has left the prostate and gone to distant sites, we have very effective therapies that can still control this type of advanced disease for many, many years, so it is important to realize how far we’ve come with all of our therapies and to reassure the patient and their family about the good prognosis, even in the worst-case scenario, for many patients. 

Are Mobile-Optimized Tools Making an Impact in Prostate Cancer?

Are Mobile-Optimized Tools Making an Impact in Prostate Cancer? from Patient Empowerment Network on Vimeo.

Prostate cancer screening can now be accessed via some mobile methods. Dr. Heather Cheng from Seattle Cancer Care Alliance shares information about mobile-optimized tools and access – and how mobile access is working toward health equity.

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Sherea Cary:

Can you speak to any mobile-optimized tools making a difference in prostate cancer?

Dr. Heather Cheng:

So, I don’t know specifically about…well, I can speak about some efforts I know about, but I think the mobile options are really a great idea. And I think the way I would think about it is, there are maybe…and I know this is the case, for example, mammograms. But I know that there can be traveling clinics where they may offer, for example, the prostate-specific antigen blood tests, which can be used as a screening to determine if somebody might have prostate cancer, and that might be something that somebody otherwise is really busy and doesn’t necessarily have access to. Usually, it’s something that is done by the primary care provider but can be done through mobile access, and I think some of the procedures could be done like blood tests for prostate cancer, I think to get an actual diagnosis to really be confident that there is prostate cancer, not something that’s just causing the PSA, that blood test could be high. Sometimes people can have a high PSA without cancer, and so it’s important to actually get a biopsy to help be more confident and know for sure that there’s cancer. That’s usually done in a clinic, but the screening, meaning the sort of trying to figure out if somebody’s at higher risk or not can be done in a mobile van, and I think there are a number of many excellent programs around the country, not enough, probably, but whose mission it is to try to improve access to cancer screening.

Prostate Cancer Survivor Thrives After Unexpected Diagnosis

Prostate Cancer Survivor Thrives After Unexpected Diagnosis from Patient Empowerment Network on Vimeo.

Prostate cancer patient Theo received a shocking prostate cancer diagnosis six years after a biopsy following a high PSA. Watch as he shares his cancer journey and advice to other prostate cancer patients.

See More From Best Prostate Cancer Care No Matter Where You Live


My name is Theo, and I live in Akron, Ohio. In 2009, I was diagnosed with prostate cancer. At 52 years old, this came as a shock as I took good care of myself and worked out regularly. Prior to that, I had a biopsy in 2003 following a high PSA diagnosed by my primary physician.

After the biopsy, no follow-up with care was recommended. I was not asked to return or contacted again by the urologist’s office. When I met with a urologist in 2009, the biopsy showed cancer with a Gleason score of 7. The doctor showed me a chart that revealed I had eleven years to live. I immediately thought of my oldest grandchild, and wondered if I’d be around to see him grow up. I was in disbelief and stunned.

I opted to have surgery following my diagnosis, and though my PSA was then down below one, it began to climb. I followed up with radiation for seven weeks, but my PSA started to climb after completing radiation. Ever since, I have been seeing my medical oncologist every 3 months since 2010.

Since 2019, my PSA has gone up and down but has gone from 53 in May of 2019 to 57 in December of 2020. My doctor has advised not starting hormone treatments until metastasis is found. Confident in my care, I agreed with that advice. I soon discovered that I was not alone. After speaking with members of my church, I discovered other men faced the same diagnosis and varied experiences.

Soon, time became more precious. I was fortunate to have my family with me every step of the way. Seven grandchildren later, that eleven years has now turned into 12 years.

My advice for other prostate cancer patients:

  • Be aware that your care team members may have biased opinions based on their fields of expertise.
  • Discuss all options with each treatment specialist prior to deciding which course of action to take.
  • Connect with others, it can be comforting to know that you share the same experience.

These actions are key to staying on your path to empowerment.