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Prostate Cancer: Treatments by Stage

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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 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

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.

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

One drug, Xofigo, is approved for use in men who have advanced prostate cancer that has spread only to the bones. Candidates should have also received therapy designed to lower testosterone. Xofigo, given by injection once a month, works by binding to minerals within bones to deliver radiation directly to bone tumors. A study of 809 men showed that those taking Xofigo lived an average of 3 months longer than those taking a placebo.     

If symptoms are not relieved by standard treatments and the cancer continues to grow and spread, chemotherapy may be an option. Treatment of stage IV prostate cancer may also include treatments for relief (palliation) of symptoms such as bone pain. Finally, you can consider taking part in a clinical trial.


Recurrent Prostate Cancer

If the PSA level indicates the prostate cancer has not been cured or has come back (recurred) after initial treatment, follow-up therapy will depend on where your medical team thinks the cancer is and which treatment(s) you have already had.

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