Teal splits into three subtypes: Low-Teal, Basic-Teal, and High-Teal. Treatment is different for each subtype. Low-Teal has only one intermediate risk factor, with all the remaining factors being like those of Sky. Low-Teal is very similar to Sky and...

Many treatments have irreversible consequences, so it is worth doing it right the first time. It is commonly understood in medical circles that long-term survival is improved by receiving optimal treatment up front...

PSA plays a variety of roles, the most familiar being screening to detect prostate cancer at an early stage. PSA also helps to define the Stages of Blue. Another role of PSA is to detect cancer relapse after surgery or radiation. Lastly, rises or declines in PSA after hormone therapy or chemotherapy help determine whether a treatment is working...

The two major components of the pathology report from a random 12-core biopsy are the Gleason score, which measures how aggressive the tumor appears, and the quantity of cancer in the 12-core specimen...

Multiparametric MRI (MP-MRI) provides a three-dimensional image of the prostate, giving important information about the cancer’s location, size, and how “aggressive” it appears. MP-MRI also greatly increases the confidence that higher-grade cancers are not being overlooked in men on active surveillance. MP-MRI is usually performed without an endorectal coil...

This article will discuss an alternative type of imaging, called color Doppler ultrasound (CDU). Unfortunately, CDU followed by targeted biopsy is available in only a few centers around the United States. Even so, this article will expound the many advantages of CDU for the diagnosis and staging of prostate cancer...

While multiparametric MRI and color Doppler ultrasound are excellent tools for monitoring disease inside the prostate, scanning the rest of the body for cancer that may have spread to the lymph nodes or bones is also critical. Body scans are necessary for every Stage of Blue except Sky...

Once the proper Stage of Blue is assigned, the different treatments appropriate for that Stage can be considered. Overall, there are four broad categories of treatment available for prostate cancer: observation, local treatments, systemic treatments, and combination therapy...

Permanent seed implantation, also known as brachytherapy, involves the insertion of small, carefully spaced, radioactive pellets into the prostate. After implantation, the seeds emit a low but continuous energy over a period of...

High dose rate brachytherapy (HDR) is done in 4 steps. The first step is placement of catheters into and around the prostate. Once the catheters are in position, the two next steps are called “simulation” and “dosimetry.” Simulation involves taking...

Intensity modulated radiation therapy (IMRT) is a specialized form of external beam radiotherapy. A device called a linear accelerator is used to administer high-energy photon beams to the prostate. IMRT is delivered in small, daily doses over...

The treatment we recommend at Sloan Kettering is dependent upon which subtype of Intermediate-Risk a patient’s cancer falls into (see Appendices I and II). For example, in patients with favorable Intermediate-Risk prostate cancer who are...

Proton therapy is simply using a beam of protons to deliver precision radiation therapy. In a fashion identical to intensity modulated radiation therapy (IMRT), patients are treated daily on an outpatient basis. A typical treatment session lasts...

Stereotactic Body Radiation Therapy (SBRT) delivers a much larger dose of radiation per patient visit than IMRT. SBRT technology is relatively new. Thus, there are fewer clinical trials comparing it with other therapies. Despite this, SBRT has...

Prostate cancer cells are dependent on testosterone for their survival, so when testosterone is removed, they shrivel and die. Radiation and surgery can’t cure cancer that has already spread outside the prostate. Only hormone therapy, otherwise known...

Many patients operate under the mistaken belief that doctors are generally similar. However, I claim that medical oncologists like myself are quite different. This is because oncologists have no innate preference for surgery over radiation. They perform...

Patients in Sky are still frequently advised to have treatment. It behooves them, therefore, to learn about its side effects. Unlike the other Stages of Blue, men in Sky have a choice—the option of postponing treatment by pursuing active surveillance. Therefore...

Erectile dysfunction (ED) is a risk with every type of treatment for prostate cancer, but the exact risk is very specific to each patient. The better a man’s erections are before prostate cancer treatment, the better chance he has of preserving function...

Loss of bladder control (urinary incontinence) after surgery can be a devastating complication with a very negative impact on quality of life. The good news is that, with appropriate evaluation and treatment, incontinence is usually treatable. Bladder control problems for...