What Are the Treatments for Prostate Cancer by Stage?

Prostate cancer will affect about one in every six men in the United States, making it one of the most common types of cancer for men, according to the Mayo Clinic. Doctors subdivide prostate cancer into four stages depending on its severity and potential to spread. Treatments depend not only on the stage of the cancer but also the general health of the patient. Younger patients in the early stages might be able to avoid invasive treatments with cautious monitoring, for example, and older patients in poor health might find that some treatment options shorten rather than elongate their lifespans.

Stage I

• At Stage I, cancers are small and in many cases are causing no symptoms. Immediate treatment is not always required because cancer cells at this stage do not grow or spread quickly. Doctors often suggest vigilant monitoring of the cancer, both in young, healthy patients and in older patients who have other health problems. Radiation therapy can treat cancer if it is causing urinary problems. The therapy comes in two forms: external beam radiation therapy, which zaps cancer cells with X-rays, and brachytherapy, in which doctors use ultrasounds to guide needles that inject grain-sized radioactive seeds into the cancer cells. Less commonly, doctors will remove the prostate in Stage I prostate cancer patients.

Stage II

• At Stage II, the cancer remains confined to the prostate but is more likely to spread to other organs. Older patients with other health problems still might opt for no treatment at this stage. Healthier patients might receive either form of radiation therapy or a combination of both. Doctors also might remove the prostate along with the pelvic lymph nodes. Several months of hormone therapy can accompany both radiation therapy and prostate removal. With hormone therapy, doctors inject drugs to block the production of testosterone, which in turn blocks the hormone from getting into the cancer cells. Removal of the testicles produces the same effect for patients who do not wish to undergo regular injections.

Stage III

• At Stage III, the cancer reaches beyond the prostate on one or both sides or into the seminal vesicles, small glands near the bladder. Treatment options at this stage are similar to Stage II but are less likely to provide a complete cure. Doctors might use hormone therapy by itself or in combination with external beam radiation therapy. Removal of the prostate at this stage generally includes removal of the pelvic lymph nodes as well as the nerve bundles that flank the prostate, which are what allow men to have erections. As with the other stages, older patients who have other health problems might opt for no treatment if surgery or radiation would aggravate those health problems.

Stage IV

• At Stage IV, cancer has spread far beyond the prostate, into the bladder, lymph nodes, rectum or even the bones. Full recovery at this stage is rare, so treatment focuses more on relief of symptoms. Doctors still might suggest hormone therapy, radiation therapy or, for older patients with health problems, no treatment. If the cancer is resistant to hormone therapy, chemotherapy can be an effective treatment. Patients might need surgery to relieve urinary obstructions. If the cancer has spread to the bones, the patient might require radiation therapy or medication to treat the pain.

Treatment Development

• Although early attempts at cryotherapy--a method of destroying cancer cells by freezing them--resulted in long-term damage to the bladder and rectum, advancements have made it a more effective treatment, according to the Mayo Clinic. Prostate removal also is undergoing advancements, with doctors able to complete it using robot-assisted laparoscopy. A few medical centers offer such experimental treatments as immune therapy or gene therapy, which the Mayo Clinic reports might be a more widespread method of treating prostate cancer in the future.