Based on the pathology report outcomes, there are a range of treatments as follows:
No Cancer
Before scheduling a biopsy, we already know in advance the probability that we will find cancer. There may be an instance for example, that the pre biopsy evaluation suggested a cancer probability of 25%, so we expect that 75% of the time, the biopsy will show no cancer. If no cancer is found, we would recommend routine follow-ups with repeated PSA tests.
Occasionally, we may encounter a situation where the expectation of cancer is very high and no cancer is found on biopsy. We have a variety of strategies if this occurs, including prostate MRI, repeat biopsy and other individualized options.
Low grade Cancer
This is actually a very common biopsy outcome. This form of prostate cancer grows very slowly and depending on life expectancy, may never need treatment, or treatment can be delayed for many years.
There is a standard protocol for carefully monitoring patients with low grade prostate cancer, called Active Surveillance that includes twice yearly PSA tests and eventual repeat biopsy. Some of the patients with low grade cancer, eventually develop a faster growing form of cancer which needs to be detected early, hence the importance of careful monitoring.
Higher Grade Cancer
Treatment is usually recommended . If the cancer is caught at an early stage (before it has spread), treatment options include surgery or radiation to attempt complete cure. If the cancer has already spread, there are a variety of hormonal or chemo treatments available.
