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Prostate Cancer: Treatments by Stage

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Stage II

The cancer is much larger, but it hasn’t spread outside your prostate. Your PSA levels and Gleason scores are also higher. Surgery or radiation is often needed to keep it from spreading.

With stage II, you should consider the following treatments:

  • Active surveillance. In this stage, it’s typically used if you're a much older man or you have other serious health problems.
  • Radiation therapy, possibly combined with hormone therapy. Those are drugs that stop testosterone from helping your cancer cells grow.
  • Radical prostatectomy

Stage III

The cancer has spread beyond your prostate, but it hasn't reached your bladder, rectum, lymph nodes, or nearby organs.

With stage III, you should consider the following treatments:

  • External radiation plus hormone therapy
  • External radiation plus brachytherapy and possible hormone therapy
  • Radical prostatectomy, often combined with removal of your pelvic lymph nodes. Your doctor might recommend radiation after surgery.

Stage IV

This happens when your cancer has spread to the bladder, rectum, lymph nodes, organs, or bones. Cases of stage IV are rarely cured. Still, treatments can extend your life and ease your pain.

In this stage, you should consider the following treatments:

  • Hormone therapy, which is often combined with surgery, radiation, or chemotherapy
  • Surgery to relieve symptoms such as bleeding or urinary obstruction and to remove cancerous lymph nodes
  • External radiation with or without hormone therapy
  • Chemotherapy, if standard treatments don’t relieve symptoms and the cancer continues to grow. The drugs will shrink cancer cells and slow their growth.
  • Bisphosphonate drugs, which can help slow the growth of cancer in the bone and help prevent fractures
  • The vaccine sipuleucel-T (Provenge), which boosts your immune system so it will attack the cancer cells. This might be used when hormone therapy doesn’t work.
  • Palliative care, which offers you relief from symptoms like pain and trouble peeing

Clinical trials are testing new treatments. They can give you state-of-the-art cancer treatments or newer ones that aren’t available yet. Ask your doctor if a clinical trial might be right for you.

If Your Prostate Cancer Comes Back

If your cancer goes into remission but later returns, follow-up treatments will depend on where the cancer is located and which treatments you’ve already tried.

  • If the cancer is contained in your prostate, surgery or a second attempt at radiation is suggested. If you've had a radical prostatectomy, radiation therapy is a good option. If you had radiation, radical prostatectomy might be the best approach. Cryosurgery might also be an option.
  • If the cancer has spread to other parts of your body, hormone therapy might be the most effective treatment. External or IV radiation therapy or bisphosphonate drugs can relieve your bone pain.

WebMD Medical Reference

Reviewed by Michael W. Smith, MD on January 26, 2015
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