Prostate Cancer – No Big Deal or Deadly?

As a leader in the evolution of diagnosis and classification of prostate cancer over the past few decades, Dr. Engel has seen and participated in changes regarding how we view prostate cancer and how it is ultimately treated. Elsewhere on this website and in his webinars, Dr. Engel has discussed PSA or Prostate Specific Antigen and how it revolutionized the diagnosis of prostate cancer…however, early on it was poorly understood, used improperly and ultimately led to over-treatment in many men.

Urologist in white coat holds blue ribbon for prostate cancer awareness at Urologic Surgeons of Washington in DC.

This is where the discussion of the severity of prostate cancer can begin. Prostate cancer, unlike many other cancers, is not a linear “existence=treatment” proposition. In fact, prostate cancer, we now know, manifests itself either as high grade, and thus more severe, or low-grade. As a result, different men will be treated quite differently depending on the severity of their case.

Prostate cancer is a disease that tends to affect older individuals. Just a few decades ago, we were treating both high- and low-grade prostate cancer aggressively with surgery, chemo and radiation. However, today, we know that many cases of low-grade prostate cancer will not spread fast enough to require treatment. Indeed, some patients will be able to live long, full lives even with cancer. The secret to understanding whether prostate cancer needs to be treated or not lies in how PSA testing is used. Dr. Engel believes that PSA needs to be viewed as a trend and not as a single test. Based on subsequent PSA rises, if any, treatment can either commence or we can continue to carefully watch the prostate, but ultimately leave treatment for later, if at all.

So, to answer the question of whether prostate cancer is a significant problem or no big deal, the truth is that it can be both. Some cases should not be treated, to avoid some of the common side effects of cancer treatment. These patients can be followed, and if the situation changes at any time in the future, treatment can begin. Other cases of prostate cancer can be very severe and very aggressive. Unfortunately, prostate cancer does not give us many outward symptoms until it is quite advanced. In these cases, the treatment must be swift and aggressive to minimize the spread of cancer.

The bottom line

Prostate cancer is one of those very interesting diseases that can manifest either very mildly or very aggressively. Typically, we think of cancer as urgent and deadly, but this is certainly not the case with all prostate cancers. As such, it is important to have an experienced and knowledgeable urologic team, such as those here at Urologic Surgeons of Washington, by your side. We believe in a stepwise approach to treating prostate cancer, only employing invasive treatments when absolutely necessary. For more information or to schedule a consultation to learn more about prostate cancer treatment options we encourage you to contact us.


Urologic Surgeons of Washington is a proud member of Privia Medical Group. The best doctors in our community have joined together to form Privia Medical Group (PMG), a multi-specialty, high-performance medical group that puts patients first. Our physicians are united by the mission of providing better, more coordinated care for their patients.

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