Your Tumor

• Has your brother of father had prostate cancer?
• Are you African American?
• What’s your Gleason score?
• Has the tumor metastasized?
• How big is your tumor? What shape is it? Where is it?
• What are your historic PSA levels?

Your Current Symptoms

• Erectile Dysfunction?
• Reduced Ejaculate Volume?
• Urinary Incontinence?
• Urinary Retention?
• Pain urinating?

Your Desired Outcomes

• How old are you?
• What’s your preferred recovery time?
• What’s your risk tolerance for side effects?
• What’s your ideal outcome?

The questions listed about your tumor can help us to determine the severity and progression of the disease. Here are some considerations to get you started.

1. Family History. If your father or brother has had or died from prostate cancer, then you carry a higher risk of serious prostate cancer.
2. Race. African-American men have a higher risk of aggressive cancers &/or metastases.
3. Gleason score. The Gleason score is assessed based on pathology or genomic scoring of biopsy samples. A score of 8 or above on a biopsy or a genomic risk score above “intermediate” suggests more aggressive disease.
4. Metastasis. Prostate cancers that have metastasized to bone or lymph nodes or have spread outside the prostate capsule (extracapsular extension or ECE) or have invaded the seminal vesicles (seminal vesicle invasion or SVI). Because these cancers have spread beyond the confines of the prostate organ, they usually require chemotherapy or hormonal therapy. Minimal SVI or ECE can be treated with surgery or focal therapies; however, the recurrence risk is greater.
5. Tumor size, shape, location. If your tumor is smaller than 2cm, has clean margins, and is not pressing up against other structures, you may be a candidate for innovative therapies.
6. PSA Levels. PSA greater than 10 indicates a more aggressive disease.