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.
Two tests are used to look for prostate cancer: a digital rectal exam and a PSA blood test.
The PSA blood test looks for something called prostate-specific antigen in the blood. Who should have a PSA test and when is controversial:
The U.S. Preventive Services Task Force does not recommend regular PSA tests. The task force say the tests may find cancers that are so slow growing that treatment, which can have serious side effects, would offer no benefit.
The American Cancer Society (ACS)...
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:
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 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 be combined with 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.
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, although they are very treatable, and treatment can both prolong life and reduce symptoms for long periods of time.