“When we see men with Gleason eight, nine, or 10 prostate cancer, we know that this cancer, by definition, is aggressive,” Dr. Phillip Pierorazio of Penn Presbyterian Medical Center tells SurvivorNet.

“It has the ability to leave the prostate, and so it’s incredibly important to do a full staging evaluation at this time.”

A 2025 case report in Cureus by Dr. Kosuke Uchida and colleagues underscores the challenge of diagnosing cancers like Tesh’s: “High-grade prostate cancer with low PSA is difficult to diagnose… diagnosis often depends on clinical symptoms and DRE.”

Although Tesh’s cancer first appeared at stage 3, it later progressed to stage 4.

“I’ve been fighting cancer successfully, still fighting it. It’s still under treatment, on and off,” he told PageSix.

Over his career, Tesh has earned six Emmy awards, four gold albums, an AP award for investigative journalism, and authored multiple books.

Tesh’s experience highlights the importance of comprehensive screening. Without that DRE in 2015, his cancer — and the initial prognosis of just 18 months to live — might not have been caught in time.

“Men typically don’t want to do that part of the exam, but it is necessary,” he told Patient Resource. “And, for me, it was lifesaving.”

Tesh’s treatment sequence included a radical prostatectomy, which is a prostate cancer surgery procedure that removes the prostate. He then received multiple rounds of chemotherapy and androgen deprivation therapy (ADT), a type of hormone therapy.

WATCH: Androgen Deprivation Therapy: Rethinking Long-Term Impacts and Evolving Patient-Centered Care

“The hormone therapy gave me night sweats, and I couldn’t sleep,” he said of ADT’s side effects.

“Long-term side effects of androgen deprivation therapy (ADT) are somewhat of a mixed blessing,” Dr. William Tester of Thomas Jefferson University’s Sidney Kimmel Cancer Center tells SurvivorNet.

“Men are living much longer and bearing the consequences of long-term ADT.”

He notes that while ADT was once given indefinitely, treatment plans today increasingly consider patient goals.

For men with low-volume disease who respond well, long-term therapy may not be necessary.

“I don’t treat them forever,” he says. “I assess… PSA level and imaging, and make a conscious decision to interrupt therapy when they are in a good remission.”

What Factors Go Into Treatment Choices?

For many patients, the differences between treatment options — such as surgery, radiation, or hormone therapy — can be subtle. But those nuances matter, especially when side effects impact daily life.

Dr. James Ryan Mark, a urologic oncologist at Fox Chase, urges patients to weigh the benefits and trade-offs of each treatment option carefully.

“In certain cases, the differences in treatment options can be relatively minor,” Dr. Mark explains.

WATCH: Balancing Treatment and Quality of Life: What Men Should Know About Prostate Cancer Care

One common combination for aggressive prostate cancer is radiation therapy paired with androgen deprivation therapy (ADT), also called hormone therapy, which suppresses testosterone to slow cancer growth. While this approach can significantly improve recurrence rates and survival, it’s not without cost — especially for older patients.

“Adding those treatments to radiation has a big improvement on the recurrence rate of survival,” Dr. Mark says. “But not all men sustain that big of an improvement, and particularly if you’re older, taking out your testosterone can really affect your muscle strength and vitality.”

For some, preserving strength and energy may outweigh a modest increase in cancer control.

“As patients are getting elderly, to some, that is more important than maybe a 10% [increase] in their case of prostate cancer control,” he adds.

Dr. Mark also cautions against rigid treatment protocols that don’t account for individual needs. He encourages patients to ask their care team questions and explore different types of treatments, specifically inquiring about possible treatment outcomes and the side effects they bring.

“Sometimes, it almost seems dogmatic in the way the treatments are delivered,” he says. “It’s always good to ask what the benefit of each aspect of the treatment is and what can be given in a different way.”

Dr. Vivek Narayan, a medical oncologist at the University of Pennsylvania, is part of a growing movement in oncology that embraces combination therapy as the backbone of metastatic prostate cancer treatment. This approach pairs traditional hormone therapy (also called androgen deprivation therapy or ADT) with FDA-approved oral agents like abiraterone, enzalutamide, apalutamide, and darolutamide — each designed to disrupt the testosterone-driven growth of cancer cells further.

WATCH: A Message Of Hope For Men Fighting Advanced Prostate Cancer

These therapies not only slow disease progression but also offer patients a chance at living longer, fuller lives — even with an advanced diagnosis.

Dr. Narayan highlights the progress in advanced prostate cancer care, noting that the disease is increasingly manageable and patients now have greater potential for improved quality of life. Still, patients must be carefully monitored.

“Even with metastatic prostate cancer, it’s not always the cancer that causes the biggest problems. We’ve got to keep an eye on overall health, because that matters just as much.” Dr. Narayan notes.

This shift in perspective is critical — not just for patients, but for caregivers and clinicians alike. It reframes the diagnosis from a terminal sentence to a chronic condition that can be managed with precision and care.

The outlook for prostate cancer care is promising, driven by breakthroughs in treatment and the rise of personalized medicine. Dr. Narayan’s work at Penn Medicine, among other cancer research centers across the country, continues to push the boundaries of what’s possible, offering patients not just treatment but a renewed sense of continued hope.

Prostate Cancer Screening and Warning Signs

When you do get screened for prostate cancer, your doctor will run a few tests.

One of the tests is the PSA test, a simple blood test that screens for prostate cancer. It looks for higher levels of prostate-specific antigen (PSA) in the blood. An elevated PSA test does not always mean you have prostate cancer. It could also reflect that your prostate is enlarged, which is common, or it could signal an infection or inflammation.

Your doctor may also conduct a digital rectal exam (DRE) to check your prostate for lumps.

Depending on the results of these tests, imaging scans and a biopsy may be ordered.

WATCH: How Gleason Grade Determines Treatment

Prostate cancer does not always behave the same in every man it impacts. The cancer can be considered “low-risk” and can be slow-growing, and treatment might not be necessary. In other men, the cancer may grow faster or more aggressively, requiring more immediate treatment. Because of this, there is some debate about screening.

The United States Preventive Services Task Force recommends that men at average risk between the ages of 55 and 69 years talk with their doctor about the pros and cons of prostate cancer screening.

The American Cancer Society recommends that men at age 50 who are at average risk should begin screening. Men who are at high risk of prostate cancer should begin screening at age 40. Men with a close relative diagnosed with prostate cancer should consider annual screenings in their 30s.

SurvivorNet experts suggested that men consider factors like their family history, genes, and age when deciding whether and when to screen.

Symptoms of prostate cancer may include:

• Urinating more often
• Waking up in the middle of the night to pee
• Blood in your urine
• Trouble getting an erection
• Pain or burning when you urinate
• Pain in your back, hips, thighs, or other bones
• Unexplained weight loss
• Fatigue

Questions for Your Doctor

If you have experienced symptoms associated with prostate cancer or have a screening coming up, here are some questions you may ask your doctor:

• If I have elevated PSA levels, what could be causing that besides cancer?
• How long will it take to learn if my PSA levels warrant further testing?
• What are the treatment options that are best suited for me based on my risk level?
• What financial resources exist to help me with the costs associated with treatment?
• How long will my potential treatment prevent me from working or continuing normal activities?

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