What are prostate cancer treatment options based on stages?

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The stage of prostate cancer is a critical factor in determining the best treatment approach. Staging involves assessing the cancer's extent using the TNM system (tumor, nodes, metastasis), along with the PSA (prostate-specific antigen) level and Gleason score (or grade group) at diagnosis.

For prostate cancers that have not spread (Stages I to III), risk groups—ranging from very low-risk to very high-risk—help guide treatment. Risk groups consider tumor growth, PSA level, Gleason score, prostate biopsy results, and sometimes special lab tests. Other factors like age, overall health, life expectancy, and personal preferences influence treatment decisions, especially for early-stage cancers.

Risk groups and treatment options

Very low-risk group

These cancers are unlikely to grow or spread, even without treatment. Recommended options:

Active surveillance: Regular monitoring without immediate treatment.

If treatment is preferred:

1. Radiotherapy (external beam radiotherapy or brachytherapy).
2. Surgery: Radical prostatectomy (removal of the prostate).
3. Cryotherapy: Freezing cancerous tissue.
4. High-Intensity Focused Ultrasound (HIFU): Using sound waves to destroy cancer cells.

Low-risk group

Treatment options include:

Active surveillance or observation (for men with other serious health conditions).

If cancer shows signs of growth:

1. Radiotherapy.
2. Surgery (radical prostatectomy).
3. Cryotherapy or HIFU.

Favorable intermediate-risk group

Cancers in this group are slightly more likely to grow or spread. Treatment options:

1. Active surveillance.
2. Surgery (radical prostatectomy (a surgical procedure to remove the entire prostate gland and some surrounding tissue to treat prostate cancer) with possible removal of nearby lymph nodes).
3. Radiotherapy.
4. Cryotherapy or HIFU.
5. Hormonal therapy: Reducing androgen levels or blocking their effect on cancer cells.

Unfavorable intermediate-risk group

Treatment options:

1. Surgery (radical prostatectomy with lymph node removal).
2. Radiotherapy with hormonal therapy.

High- or very high-risk group

Cancers in this group have a higher likelihood of growth and spread. Options include:

1. Radiotherapy combined with hormonal therapy (typically for one to three years), often including Abiraterone acetate (a newer hormone drug).
2. Surgery (radical prostatectomy with lymph node removal).

Stage IV prostate cancer includes stage IVA and stage IVB.

Stage IVA

Cancers have spread to nearby lymph nodes but not distant parts of the body. Options:

1. Radiotherapy combined with hormonal therapy, often including Abiraterone acetate.
2. Hormonal therapy alone (may include abiraterone).
3. Surgery (radical prostatectomy with lymph node removal).

Stage IVB

Cancers have spread to distant organs, such as bones. These cancers are generally not curable but are treatable to control the disease and improve quality of life. Options:

1. Hormonal therapy often includes newer drugs like Abiraterone acetate, Apalutamide, or Enzalutamide.
2. Hormonal therapy combined with chemotherapy (typically Docetaxel), especially for extensive cancer.
3. Surgery (transurethral resection of the prostate or TURP) to alleviate symptoms such as bleeding or urinary obstruction.

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