Choosing a Treatment for Intermediate Risk Prostate Cancer | Prostate Cancer Staging Guide

PCRI’s Executive Director, Mark Scholz, MD, compares different treatments for men with Teal stage (intermediate-risk) prostate cancer. He compares these treatments based on side effects, cure rates, and convenience.

0:35 There are three subtypes of teal (intermediate-risk) prostate cancer, Low Teal, Basic Teal, and High Teal. When we are talking about different choices for treatment, we are really only referring to Basic Teal, or “intermediate intermediate-risk” prostate cancer. Men with Low Teal can consider active surveillance, and men with High Teal generally require combination therapy.

1:23 Some of the options for Basic Teal include surgery, radiation therapy (IMRT, proton therapy, SBRT), temporary and permanent seed implants, even hormone therapy alone.

1:57 When you are comparing treatments, it is helpful to look at three factors. The first factor is cure rates. The second factor is convenience and discomfort, if cure rates are equal you can choose the treatment that is the least uncomfortable. The third factor is the incidence of long term side effects.

2:45 Cure rates. The best cure rates come from radioactive seed implants. Outcomes are the same between temporary seeds and permanent seeds. Other forms of radiation should still be considered because Basic Teal is easy to cure so there isn’t a large difference in cure rates between seeds and other forms of radiation. So one can consider another treatment if it is less uncomfortable or more convenient.

3:55 Convenience and discomfort. Radioactive seeds come out on top again, since the procedure can be completed in one day. A close second is SBRT since the treatment course is relatively short as well. IMRT and proton therapy can take up to as much as 5-9 weeks of daily treatment.

4:33 Long term side effects. Since practically every therapy has high cure rates for this stage of the disease it is important to weigh the side effects. Even though it is not curative, primary hormone therapy or TIP (testosterone inactivating pharmaceuticals) wins since its side effects are reversible, and it doesn’t have long term side effects like surgery or radiation. A tier below this is all of the radiation treatment options. There is barely any difference between the side effect profiles of each different type of radiation, assuming of course that your treatment is done at a quality center. At the bottom of the list is surgery, it has higher chances of impotence, and poses a risk of incontinence that the other treatments don’t typically cause.

6:29 Summary. All these treatments should be considered by patients who have Basic Teal. In terms of cure rates and convenience, seed implants seem to score the highest. If you are trying to avoid side effects, hormone therapy can be a good option. It is a good idea to make a list of all the options and cross off the ones that you absolutely don’t want. The key is avoiding bad consequences since cure rates are generally very high.

Don’t know your stage? Take the quiz: Visit http://www.prostatecancerstaging.org

To learn more about prostate cancer visit http://www.pcri.org

To download the free Staging Guide visit http://www.pcri.org/prostate-cancer-staging
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The Prostate Cancer Research Institute (PCRI) is a 501(c)(3) not-for-profit organization that is dedicated to helping you research your treatment options. We understand that you have many questions, and we can help you find the answers that are specific to your case. All of our resources are designed by a multidisciplinary team of advocates and expert physicians, for patients. We believe that by educating yourself about the disease, you will have more productive interactions with your medical professionals and receive better individualized care. Feel free to explore our website or call our free helpline at 1 (800) 641-7274 with any questions that you have. Our Federal Tax ID # is 95-4617875 and qualifies for maximum charitable gift deductions by individual donors.

The information on the Prostate Cancer Research Institute's YouTube channel is provided with the understanding that the Institute is not engaged in rendering medical advice or recommendation. The information provided in these videos should not replace consultations with qualified health care professionals to meet your individual medical needs.

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