Prostate Cancer: Treatments by Stage

Understanding the size, location, and amount of spreading of the prostate cancer (metastasis) is important. These factors are evaluated and given a staging letter, number, or grouping. Staging is one of the most important factors in deciding the best way to treat prostate cancer.

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. These 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 watchful waiting, surgery to remove the prostate (radical prostatectomy), or radiation therapy (external beam or brachytherapy).

Stage II. 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; 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. 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:

• External beam radiation plus hormone therapy
• Hormone therapy only
• Radical prostatectomy in selected cases. This is not nerve sparing (often with removal of the pelvic lymph nodes; sometimes preceded by hormone therapy)
• Watchful waiting for older men whose cancer is causing no symptoms or for those who have another more serious illness

Stage IV. Stage IV cancers have already spread to the bladder, rectum, lymph nodes, or distant organs such as the bones. Doctors don't usually consider these cancers to be curable.

Treatment options may include:

• Hormone therapy
• External beam radiation plus hormone therapy (in selected cases)
• Surgery (TURP) to relieve symptoms such as bleeding or urinary obstruction
• Watchful waiting for older men whose cancer is causing no symptoms or for those who have another serious illness