Prostate cancer stages and treatments


Prostate cancer is one of the most common diseases to afflict males.  According to the Prostate Cancer Foundation, 1 in 9 men will be diagnosed with prostate cancer in their lifetime.  What are the stages and treatments of prostate cancer? 

Prostate cancer occurs in the prostate – a small, walnut shaped gland in men that produces the fluid that nourishes sperm.  It is one of the most common types of cancer for makes with 1 in 9 expected to be diagnosed with the disease. According to the Prostate Cancer Foundation, the odds increase to 1 in 3 with a family history of prostate cancer and African-American men are 74% more likely to get the disease.  While some forms of prostate cancer are slow growing, other types are more aggressive. Once diagnosed, oncologists will use a variety of methods to determine the stage of prostate cancer and the best treatments.

Symptoms and Diagnosis

Prostate cancer can often be difficult to diagnose as it can mimic other diseases.  Some common symptoms include difficulty with urination, loss of bladder control, blood in the semen or urine or erectile dysfunction.  Typically, if cancer is suspected, a test to measure the level of protein specific antigen in the blood generated by the prostate gland is conducted, along with a digital rectum exam (and sometimes an ultrasound, MRI or CT scan).  A high level of PSA in the blood is often a sign of prostate cancer although it can mean non-cancerous conditions as well. Generally, with a high PSA, a doctor will decide to do a biopsy to look at the prostate cancer cells and will assign a ‘Gleason score’ based on the cells’ appearance.

Prostate Cancer Stages and Treatments 

Once prostate cancer is diagnosed, a doctor then determines how far a cancer has spread through a process called ‘staging’, considering the PSA and Gleason scores.  Often doctors will use the TNM system as well – T for size of tumor, N for whether the cancer has spread to the lymph nodes and M for Metastasis, or how far the cancer has spread and whether it has spread to the bones.  The prostate cancer ‘stage’ describes how much cancer is in the body and how serious it is. Once the prostate cancer stage is determined, doctors can then decide how best to treat it.  

Stage One:

Cancer is growing in the prostate but hasn’t spread

  • Tumor is in one-half or less of only one side of the prostate
  • Cancerous tissues look like other prostate tissues and the prostate gland is small
  • Cancer is slow growing and doctors can’t feel the tumor during a digital rectal exam

Stage One Treatments:

  • Watch and wait and continue to track PSA levels to see if they rise
  • Radiation treatment to kill cancer cells and keep them from growing and dividing
  • In rare cases, a prostatectomy to remove prostate

Stage Two:

  • Prostate gland is larger but still well formed
  • Cancer is growing in the prostate but hasn’t spread beyond it
  • Tumor can be in more than one-half of one side of prostate or in both sides
  • Cancer can be detected during a digital rectal exam and doctors may be able to see and feel the tumor

Stage Two Treatments:

  • Active surveillance to see if anything changes
  • Radiation combined with hormone therapy using drugs that stop testosterone from helping cancer cells grow
  • Prostatectomy

Stage Three:

  • Prostate is still recognizable but cancer cells are darker, have left the glands
  • Cancer has grown outside the prostate and spread to other tissues near the prostate such as the rectum, bladder or wall of pelvis
  • Cancer may have spread to seminal vesicles 
  • Cancer has not spread to the lymph nodes or elsewhere in the body, including bones

Stage Three Treatments:

  • External radiation plus hormone therapy
  • External radiation plus brachytherapy and possible hormone therapy
  • Radical prostatectomy often combined with removal of pelvic lymph nodes and radiation

Stage Four:

  • May be diagnosed years after the initial cancer diagnosis and/or after the primary cancer has been treated or removed.
  • Prostate tissue has few recognizable glands or no recognizable glands as it is surrounded by cancer cells
  • Often there are just sheets of cancer cells throughout the prostate
  •  Cancer has spread to other parts of the body, sometimes even after the prostate has been removed.  It could be just to the lymph nodes (Stage IVA) or to the bones, rectum and/or other organs including the liver and lungs

Stage Four Treatments:

  • Often considered incurable at this stage
  • Treatments are usually to extend life and ease pain and can include:
  • Surgery to relieve symptoms such as bleeding or urinary obstruction or to 
  • remove cancerous lymph nodes
  • Radiation without hormone therapy
  • Chemotherapy to shrink and slow growth of cancer cells
  • Hormone therapy combined with surgery, radiation or chemotherapy
  • Vaccine Provenge to boost immune system if hormone therapy is ineffective 
  • Bisphosphonate drugs to slow growth of the cancer in the bones and prevent fractures
  • If all else fails, palliative care

If you are suffering from the symptoms and suspect may have prostate cancer, it is best to seek the advice of a doctor or other medical professional.  A doctor can run tests to determine your cancer stage and determine the best course of treatment. If you are diagnosed with a later stage, it may be wise to get a second opinion as well.  In addition, check out these resources:

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