Prostate Cancer: Treatments by Stage
Understanding the size of the cancer, its location, and how much it has spread (metastasis) is necessary in considering treatment for prostate cancer. These factors are evaluated and given a staging letter, number, or grouping. That staging is one of the most important factors in deciding the best way to treat it.
Your medical team will consider other factors, too, such as age, life expectancy, and risk of recurrence after treatment based on Gleason scores and PSA levels.
Stage I prostate cancers are small and have low Gleason scores. They usually grow very slowly and may never cause any symptoms or other health problems.
For men without any prostate cancer symptoms who are elderly and/or have other serious health problems, watchful waiting and radiation therapy (external beam or brachytherapy) are reasonable options.
Men who are younger and healthy may consider one of the following:
- Watchful waiting
Surgery to remove the prostate (radical prostatectomy)
- Radiation therapy (external beam or brachytherapy)
Compared with stage I prostate cancers, stage II cancers that are not treated with surgery or radiation are more likely to spread beyond the prostate and cause symptoms.
As with stage I cancers, watchful waiting by following PSA levels is often a good option for men whose cancer is not causing any symptoms and who are elderly and/or have other serious health problems. Radical prostatectomy and radiation therapy (external beam or brachytherapy) may also be appropriate options.
Treatment options for men who are younger and otherwise healthy include:
- Radical prostatectomy, often with removal of the pelvic lymph nodes and sometimes preceded by hormone therapy
- External beam radiation only*
- Brachytherapy only*
- Brachytherapy and external beam radiation combined*
- Cryosurgery (surgery that freezes diseased tissue)
Compared with surgery or radiation therapy, much less is known about the long-term effectiveness of cryosurgery.
* All radiation options may also have three to six months of hormone therapy.
Stage III cancers have spread beyond the prostate gland but have not reached the bladder, rectum, lymph nodes, or distant organs. Surgery and radiation therapy may be less likely to work but may still be options.
Possible treatment options at this stage include:
- External beam radiation plus hormone therapy
- Hormone therapy only
- Radical prostatectomy in selected cases.
- Watchful waiting for older men whose cancer is causing no symptoms or for those who have another more serious illness
Radical prostatectomy at this stage is not nerve sparing and is often done with removal of the pelvic lymph nodes. Sometimes it is also preceded by hormone therapy.