Treatment Options by Staging and Grading

Treatment Options by Staging and Grading

Stages indicate the extent of the cancer:

• Stage I and stage II cancer are considered early stage. The cancer is localized and has not spread outside the prostate gland.
• Stage III, locally advanced cancer, means that the cancer has spread into the seminal vesicles (glands at the base of the bladder, which are connected to the prostate gland and help produce semen.)
• Stage IV is advanced cancer. The cancer has spread to the lymph nodes and other tissues or organs.

Experts have devised treatments based on classification systems, including staging and tumor grade.

Stage I

Tumors: T1, N0, M0, G1, Stage A. Treatment Options. Watchful waiting, with hormone treatment if symptoms develop. Surgery (radical prostatectomy or cryosurgery). Radiation treatment (either external-beam irradiation or interstitial implantation in selected patients). For reducing mortality rates, no strong evidence supports one treatment choice over another; survival rates appear to be equivalent and close to normal. Treatment may be considered in men under age 60, particularly those with tumors classified as T1b, in which cancer cells are found in more biopsy samples than in T1a. Postoperative radiation treatment may be considered if surgery reveals high risk for recurrence. Radiation with hormone therapy is under investigation for intermediate and high-risk groups.

Click the icon to see an illustrated series detailing prostatectomy surgery.

Stage II

Tumors: T1, N0, M0, G2, 3, or 4 Treatment Options. Watchful waiting in selected patients (such as those with low-grade tumors). Surgery (radical prostatectomy usually with pelvic lymphadenectomy) or radiation therapy (external-beam irradiation or interstitial implantation in selected patients). Radiation treatment after prostatectomy may be considered to reduce local recurrence.

Tumors: T2, N0, M0, Any G, Stage A2, B1, or B2 Treatment Options. Careful watchful waiting in selected patients (such as those with low-grade tumors) followed by hormone treatment when symptoms occur. Radical prostatectomy or radiation treatment (external-beam irradiation or interstitial implantation in selected patients). Treatments have similar results for up to 10 years. Possible use of hormone therapy with radiation treatment. Cryosurgery under investigation. Neoadjuvant hormonal therapy followed by radical prostatectomy under investigation.