The first treatment would be active surveillance. And the indications would be for those who have low risk prostate cancer. So what’s low risk prostate cancer? When we diagnose prostate cancer, we make the diagnosis based on the appearance of the cells versus normal prostate cells. We grade the cells from 1 to 5. A grade 1 cancer cell is a cell that looks very similar to normal prostate cells. And they tend to grow very slowly. They’re not a terribly aggressive form of cancer. At the other end of the spectrum, we give a Gleason grade of 5. That’s a cell that looks nothing like normal prostate cells and tends to behave extremely aggressively. So that’s the Gleason grade. When we arrive at the Gleason score, and the Gleason score is what we use to put you into one of three buckets: low-risk prostate cancer, intermediate risk prostate cancer, and high-risk prostate cancer.
And when we say risk, we’re basically telling you what the risk is for this cancer to spread to other areas of the body in the absence of successful treatment. So Gleason grade 1 to 5, it’s unusual to see only one type of cell. So we identify the two most common cells, assign it a grade, and then come up with a Gleason score. So your Gleason grade is 1 to 5 and your Gleason score will be 2 to 10. So, first bucket: low-risk prostate cancer. Generally speaking, if your Gleason score is between 2 and 6, we consider you to have low risk prostate cancer. And generally, surveillance is definitely a treatment option. Certainly if you’re older age and you have other medical issues, we’ll recommend surveillance. Surveillance basically takes many forms, but it’s just active follow-up. And the active follow-up can be three months, can be six months, and typically includes a rectal exam and a PSA. If the PSA starts to rise or the rectal exam becomes abnormal, we consider re-evaluating your diagnosis, which possibly might include repeating the prostate biopsy or obtaining an MRI if one was not obtained prior. So that’s active surveillance.