Hi, I’m Dr. Scholz.  Let’s talk about prostate cancer.

In this video we’re going to cover a brief overview of the stage we call Teal.  Teal is a transition stage between harmless prostate cancer, which we call Sky, and consequential prostate cancer which we call Azure.  We break Teal into three sub-types: Low, Basic, and High. Low-Teal is almost as harmless as Sky, and High-Teal is almost as dangerous as Azure. So as you look at Teal in the context of the broader staging system it's going to encompass a much bigger spectrum of disease behavior and treatment options than any of the other stages. Use the PCRI staging guide to determine which subtype you belong in.

The subtypes are constituted by PSA, Gleason score, and the digital rectal exam (DRE).  Let’s start with low-teal. Low-Teal patients have PSAs under 10, minimal or no palpable findings on DRE, and a Gleason score 3+4=7, and at most two cores, and the percentage of grade 4 in their biopsy is 5-15% and no more. Patients who have Basic-Teal are very similar to those with Low-Teal although they’re allowed to have any amount of Gleason 3+4 percentage wise, and up to half of the cores can have 3+4.  Men with High-Teal are still in Teal but don’t fit the criteria for either Low-Teal or Basic-Teal.  Appropriate treatment has been determined through scientific studies indicating which treatments match well with each of these different stages of disease.  These different subtypes are like distinct illnesses, and the best available treatment is already determined, but you must of course know your subtype.

For example, men who are identified as having Low-Teal can pursue active-surveillance just like men who are in Sky.  Active-surveillance has many advantages, especially the ability to avoid side-effects of treatment.  Those of you that are categorized in Low-Teal should look at all of the information we’ve provided about how men in Sky should be managed because management for Low-Teal is the same as Sky.  

Men with Basic-Teal have a relatively favorable situation, and therefore do not require very intense therapy.  Men can appropriately be treated with simply one therapy: Seed implants, proton therapy, IMRT, cyber-knife, hormone therapy alone, and surgery. These options are all reasonable.  People who are considering treatment for their Basic-Teal need to become very education about the pros and cons about these different monotherapies—as we call them.  Single treatment is enough.

Now let’s move onto High-Teal.  Studies clearly show that the optimal treatment for these individuals is combination therapy with a short course of hormone blockade, external beam radiation of some sort, and a seed implant of which there are two types, either type is fine, permanent seeds or temporary seeds.  

In Summary, Teal has the best outlook of all the stages except for Sky.  Men are going to live many years regardless of whether they have treatment at all.  Therefore the side-effects of treatment are the big danger in this category. Men need to look at all the potential long-term side-effects before making a decision about which type of treatment to undergo.

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