Not all Prostate Cancer is Dangerous. Testing is key.

In the United States, one in eight men will get a prostate cancer diagnosis at some time in their lives1, but this statistic may not be as alarming as it sounds. That’s because there are different types of prostate cancer. Some are very slow growing, unlikely to spread, and may never require treatment. Doctors call these non-aggressive cancers.

Others are aggressive, which means they are more likely to grow quickly and spread – with potentially life-threatening consequences. The key to managing prostate cancer effectively lies in determining whether your cancer is non-aggressive or aggressive.

What is aggressive prostate cancer?

Aggressive prostate cancer grows quickly and is more likely to spread to other parts of your body (metastasize), which may lead to serious health problems or even death if not treated promptly.

How fast does aggressive prostate cancer grow? There’s no simple answer to that, but as a rule of thumb, the quicker the prostate specific antigen (PSA) level doubles, the quicker the cancer is growing².

Men with aggressive prostate cancer may develop symptoms such as difficulty urinating, blood in the urine, pelvic pain, or trouble getting an erection³. In contrast, non-aggressive cancers can remain asymptomatic for a long time, or never cause any symptoms at all⁴.

Some men may be at a higher risk of developing aggressive prostate cancer, including African American men, those with a family history of prostate cancer, and men aged 70 to 80 years⁵.

Because of their potentially life-threatening nature, aggressive prostate cancers usually need more immediate treatment, with a goal of eradicating the cancer or slowing its progression.

The earlier prostate cancer is diagnosed, the greater the chances of survival: In the US, men diagnosed with early-stage prostate cancer have a survival rate of more than 99%6.

That’s why it’s so important to work out whether your prostate cancer is aggressive or non-aggressive as soon as possible.

How to tell if prostate cancer is aggressive

Doctors use several methods to determine whether prostate cancer is aggressive. One is the Gleason Score⁷. This is calculated by looking at samples of prostate tissue taking during a prostate biopsy under a microscope to assess the cancer cells.

The Gleason Score ranges from 6 to 10 and the higher the score, the more likely the cancer cells are to behave aggressively^8.

PSA testing is often used in prostate cancer assessment and while it’s an effective screening test, it does not specifically pick up the aggressive form of prostate cancer. In fact, many things can cause a rise in PSA, including infection, inflammation, and recent ejaculation⁹.

Advanced tests can detect aggressive prostate cancer and help determine if a biopsy is necessary. Unlike invasive biopsies, these tests use a simple blood sample to assess your risk, offering a safer and more convenient option. Using a scientifically validated algorithm, they analyze various data to evaluate your risk. Some tests are 95% sensitive to aggressive cancers, making them highly effective for detection¹⁰. Discover if this test is right for you here.

How long can someone live with non-aggressive prostate cancer?

Non-aggressive cancer grows very slowly and can remain within the prostate gland for years, or even a lifetime, without causing problems. Over a period of 10 to 15 years, less than 3% of men with a Gleason score of 6 or lower and classed as low risk will die as a result of prostate cancer, regardless of whether it is treated or not¹¹.

The chances of surviving prostate cancer also depend on whether it has spread outside the prostate: At five years, the survival rates for localised prostate cancers are 100%, but just 36.6% for cancers that have spread to distant parts of the body¹².

Knowing your risk of aggressive prostate cancer can not only give you greater clarity about your health, it can also help you and your doctor choose the best course of action.

References

1. National Cancer Institute. Cancer Stat Facts. Available at https://seer.cancer.gov/statfacts/html/prost.html. Accessed 21 Aug 2024.
2. David MK, Leslie SW. Prostate Specific Antigen. [Updated 2022 Nov 10]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2024 Jan. Available at  https://www.ncbi.nlm.nih.gov/books/NBK557495/. Accessed 21 Aug 2024.
3. American Cancer Society. Signs and Symptoms of Prostate Cancer. Available at https://www.cancer.org/cancer/types/prostate-cancer/detection-diagnosis-staging/signs-symptoms.html. Accessed 21 Aug 2024.
4. Rosario E, Rosario DJ. Localized Prostate Cancer. [Updated 2022 Sep 26]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2024 Jan-. Available at https://www.ncbi.nlm.nih.gov/books/NBK563248/. Accessed 21 Aug 2024.
5. Shah N, Ioffe V, Chang JC. Increasing aggressive prostate cancer. Can J Urol. 2022;29(6):11384-11390.
6. Prostate Cancer Foundation. Prostate cancer survival rates. Available at https://www.pcf.org/about-prostate-cancer/what-is-prostate-cancer/prostate-cancer-survival-rates/. Accessed 21 Aug 2024.
7. Munjal A, Leslie SW. Gleason Score. [Updated 2023 May 1]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2024 Jan. Available at https://www.ncbi.nlm.nih.gov/books/NBK553178/. Accessed 21 Aug 2024.
8. National Cancer Institute. Gleason Score. Available at https://www.cancer.gov/publications/dictionaries/cancer-terms/def/gleason-score. Accessed 21 Aug 2024.
9. National Cancer Institute. Prostate-Specific Antigen (PSA) Test. Available at https://www.cancer.gov/types/prostate/psa-fact-sheet. Accessed 21 Aug 2024.
10. Shore ND, Pieczonka CM, Henderson RJ, et al. A comparison of prostate health index, total PSA, %free PSA, and proPSA in a contemporary US population-The MiCheck-01 prospective trial. Urol Oncol. 2020;38(8):683.e1-683.e10. doi:10.1016/j.urolonc.2020.03.011H.
11. Ballentine Carter et al., Gleason Score 6 Adenocarcinoma: Should It Be Labeled As Cancer? JCO 30, 4294-4296(2012). doi:10.1200/JCO.2012.44.0586
12. 12. National Cancer Institute. Cancer Stat Facts: Prostate Cancer. Available at https://seer.cancer.gov/statfacts/html/prost.html. Accessed 21 Aug 2024.