Among cancer diagnoses, prostate cancer is relatively common, especially for those who are older than 65. Fortunately, it is often manageable with minimal interventions necessary for a substantial portion of patients. However, many prostate cancer cases can be categorized as “aggressive,” meaning it will require more extensive treatment to address or avoid metastasis (spread of the cancer).
“With proper diagnosis and management, people live with prostate cancer for years and sometimes for decades, even after it moves out of the prostate,” says Mark Pomerantz, MD, an oncologist in Dana-Farber’s Lank Center for Genitourinary Oncology. “It’s crucial to be aware of your risk for the disease and discuss any concerning symptoms with your team.”
There are many treatment options available for aggressive prostate cancer.
As opposed to low-risk, slow-growing prostate cancers, where the goal is to preserve quality of life with minimal intervention, the goal of advanced prostate cancer treatment is to shrink or control tumor growth and control symptoms.
There are many treatment options for advanced prostate cancer, including hormone therapies, surgery, chemotherapy, immunotherapy, radiation, bone-targeted therapy, and precision medicine. Almost all prostate cancer diagnoses should also include an active surveillance regimen to monitor the cancer’s growth.
“Our arsenal against prostate cancer is growing,” says Pomerantz. “No matter your diagnosis, there is hope.”
Unlike other forms of prostate cancer, aggressive prostate cancer often requires intervention and multidisciplinary treatment.
Prostate cancer forms in the prostate, a gland that is located below the bladder and directly in front of the rectum. Many prostate cancers are relatively slow growing, so-called “low grade,” cancers that require little to no intervention if detected early.
Aggressive prostate cancers (also called high-risk prostate cancer), on the other hand, grow and spread more rapidly. Because of this, aggressive prostate cancers may present with more concerning symptoms, such as trouble urinating, and may have a greater effect on quality of life and health. They often require more comprehensive intervention and multidisciplinary treatment.
The higher the Gleason score, the more aggressive the cancer is thought to be.
During diagnosis, prostate cancers are assigned a grade, known as a Gleason score, based on what the cancer cells look like under a microscope. The score, which ranges from six to ten, is a measure of aggressiveness and helps determine how likely cancer cells will be able to grow and spread to other tissues.
Risk factors for aggressive prostate cancer include age, family history, and race and ethnicity.
Your risk for prostate cancer is affected by age, family history, race and ethnicity, and the presence of inherited mutations.
- Age: Prostate cancer risk increases with age. About 6 in 10 cases of prostate cancer are found in individuals older than 65. Prostate cancer is rare in those under the age of 40.
- Race/Ethnicity: African Americans face a higher risk for being diagnosed with prostate cancer. They are also more likely to be diagnosed with prostate cancer at younger ages. It is not clear why prostate cancer affects African Americans more than other racial/ethnic groups.
- Genetic Factors: The risk of prostate cancer more than doubles in those with a family history of prostate cancer in their direct relatives. Having family members with breast and ovarian cancer also raises the risk for prostate cancer. That is because some genes mutations, including BRCA1 and BRCA2 mutations, increase the risk of multiple cancers such as breast, ovarian and prostate cancers. If a person has a mutation in any of these genes, they should be screened earlier and/or more often for prostate cancer.
Gene testing results can help determine whether a treatment may be effective. Your health care team may suggest gene testing because of family history or because you have aggressive prostate cancer. Counseling is offered at Dana-Farber through the Cancer Genetics and Prevention Clinic whose physicians specialize in cancer-related genetics, can offer comprehensive risk assessments and recommendations, and conduct research to better understand how mutations affect cancer risk.
Outlook is dependent on diagnosis and individual factors.
With proper management, many patients live with aggressive prostate cancer for years. An individual’s outlook will depend on many factors, from the specific diagnosis and staging of the cancer to the patient’s age, diet, and lifestyle.
Dana-Farber prioritizes treating individuals comprehensively and offers a host of supportive services to ensure the best outcome for the patient, including social work and nutrition and exercise programs through the Leonard P. Zakim Center for Integrative Therapies.
Research into prostate cancer and progress driven by clinical trials continues to improve treatments and outcomes.
About the Medical Reviewer
Dr. Mark Pomerantz is a medical oncologist at the Dana-Farber Cancer Institute. Dr. Pomerantz received his undergraduate degree from Yale University and his medical degree from Stanford University. He trained in Internal Medicine at Brigham and Women's Hospital in Boston, Massachusetts. He then pursued a fellowship in Medical Oncology at the Dana-Farber Cancer Institute in Boston. Dr. Pomerantz received his post-doctoral training in cancer genetics with Dr. Matthew Freedman at the Dana-Farber Cancer Institute and the Broad Institute of Harvard and MIT. He is on faculty at the Dana-Farber Cancer Institute in the Lank Center for Genitourinary Oncology.
Thank you so much to the Dana Farber team who work day and nigh t to ensure that all is well to humanity,, congratulations .
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What age is prostate screening recommended for a son whose mother has had ovarian cancer and father who has had prostate cancer?
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Not only does Dr. Pomerantz have the highest level credentials as a medical oncologist with post doc degrees who treats Dana-Farber patients with prostate cancer – but he is caring and kind.
I was diagnosed with prostate cancer, and I am blessed to have Dr. Paul Nguyen and the excellent team at Dana Faber.