There are Three Subtypes of Teal

In the broad spectrum of what we call “prostate cancer, Teal is a transition stage that lies between “harmless” Sky and “consequential” Azure.”  While Sky is benign enough to be simply watched, Azure is dangerous enough to require combination therapy—radioactive seeds, IMRT and hormonal blockade. Within Teal, therefore, the degree of risk covers a broad spectrum, ranging from harmless types like Sky at the low end, to Azure at the other end. An individual’s treatment will therefore vary depending on which of three subtypes, Low-, Basic-, or High-Teal, that he falls into.

Characteristics and Treatments Vary by Subtype

Men with Low-Teal have only one or two biopsy cores with Gleason 3+4 =7. All their other staging factors, however, are similar to Sky.  Studies show that men in Low-Teal can be candidates for active surveillance.

Men with Basic-Teal have a profile that is similar to Low-Teal except up to 50 percent of their biopsy cores can contain Gleason 3+4=7.  However, none of these cores can be more than 50% replaced with cancer.  The list of appropriate treatment options for Basic-Teal is long and includes seed implants, IMRT, SBRT proton radiation, focal cryotherapy, hormonal therapy or surgery.

Men with High-Teal have higher PSA (10-20), a larger (but unilateral) nodule on digital rectal exam and / or more than 50 percent cores positive for Gleason 3+4=7 or 4+3 = 7.  Treatment need to be more thorough, consisting of seed implantation, IMRT plus four months of hormonal therapy.

Challenges Vary According to Subtype

Men with Low-Teal face a “behind-the-times” medical industry still incorrectly assuming that all types of prostate cancer are deadly.  Men with Basic-Teal are forced to listen to and choose between numerous experts, all who sincerely believe that their type of treatment will be best for you. High-Teal requires the selection and coordination of a team of doctors, as well as a need to implement multiple procedures to reduce treatment-related side effects.

The Key to Prostate Cancer has a section solely devoted to making Teal understandable to patients.  In addition, Key provides information about diet, exercise, general men’s health, supplements, biopsies, scans, as well as a chapter about how to shop for doctors.


The TEAL stage of prostate cancer lies in between the harmless SKY stage, and the more dangerous Azure stage. With Teal, therefore, the degree of risk covers a broad spectrum with a wide variety of treatment options. Here are some questions for men to discuss with their doctors, much of which is covered in the Teal section of The Key to Prostate Cancer.

1.  If I have Low-Teal and opt for active surveillance how safe is it considering my stage has a possibility of growing?  

2.  I have so many options. What is a helpful way to weigh them against each other?

3.  I have seen multiple doctors, each of which has a different treatment opinion. How can I decide who to trust?

4.  Are the side effects from the treatment I’ve chosen reversible?

5.  What are the best ways to manage my side effects?

6.  How do I prepare for treatment?

7.  How do I ensure my prostate cancer doesn’t spread?

8.  Why not just have surgery and remove the problem completely?

9.  How should my age factor in to my treatment decision?

10.  Does immediate treatment improve my cure rates?