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• Highlights
• Introduction
• Prognosis
• Risk Factors
• Symptoms
• Conditions with Similar Symptoms
• Screening and Diagnosis
• Tests to Determine Severity of Cancer
• Staging and Grading
• Treatment Options by Staging and Grading
• Treatment for Localized Prostate Cancer
• Surgery
• Radiation Treatments
• Options if Treatments Fail
• Other Treatments
• Resources
• References

Prostate cancer

Description

An in-depth report on the causes, diagnosis, treatment, and prevention of prostate cancer.

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.

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.

Stage III

Tumors: T3, N0, M0, Any G (Stage C) Treatment Options. External-beam irradiation using a linear accelerator is a commonly used treatment for most of these patients. Hormonal treatment (orchiectomy or androgen-suppressing drugs) following radiation may improve survival rates from prostate cancer. Hormonal treatments alone. Clinical trials using other therapies. Careful observation in selected patients. Radical prostatectomy usually with pelvic lymphadenectomy is considered in highly selected patients but, in general, surgery has inferior results compared to radiation.

Treatments for Urinary Tract Symptoms. External beam radiation therapy. Hormonal manipulation. Transurethral resection of the prostate (TURP). Investigative radiation therapy using protons or neutron radiation. Investigative cryosurgery.

Stage IV

Tumors: T4, N0, M0, Any G; or Any T, N1 Through 3, M0, Any G; (stage D1 or D2) Treatment Options. Hormonal therapy, which may be one of the following: orchiectomy alone or with an antiandrogen; LHRH agonists, such as leuprolide; leuprolide plus an antiandrogen; estrogens. External-beam radiation possibly used with on-going androgen suppression treatment for attempted cure in highly selected M0 patients. Radical prostatectomy with immediate orchiectomy under investigation. Systemic chemotherapy under investigation. Clinical trials using other therapies. Cure is rare in these patients but striking subjective or objective responses to treatment occur in many patients. In May 2004, the FDA approved docetaxel (Taxotere) injection in combination with prednisone for treatment of patients with advanced metastatic prostate cancer. Other docetaxel-based chemotherapy regimens are also being investigated.

• Treatments for Urinary Tract Symptoms. External beam radiation therapy. Hormonal manipulation. Transurethral resection of the prostate (TURP). Investigative radiation therapy using protons or neutron radiation. Investigative cryosurgery.
• Pain Relief. Low dose prednisone (a corticosteroid) alone or with mitoxantrone (a chemotherapy drug) reduces inflammation and may help relieve pain.

Tumors: Any T, Any N, M1, Any G (stage D2) Treatment Options. Hormonal therapy, which may be one of the following: orchiectomy alone or with an antiandrogen; LHRH agonists, such as leuprolide; leuprolide plus an antiandrogen; estrogens. Cure is rare in these patients but striking subjective or objective responses to treatment occur in most patients.

• Treatments for Urinary Tract Symptoms. External beam radiation therapy. Hormonal manipulation. Transurethral resection of the prostate (TURP).
• Treatments for Symptoms of Bone Metastasis. R adiation therapy (external beam radiation or strontium-89 radioisotopes) or hormonal manipulation (orchiectomy or LHRH agonist drugs or both).

Pain Relief. Low-dose prednisone (a corticosteroid) alone or with mitoxantrone reduces inflammation and may help relieve pain.

Recurrent Prostate Cancer

Treatment Options. Dependent on various factors: prior treatment, site of recurrence, coexistent illnesses, and individual patient considerations.

• Patients whose cancer recurs locally after prostatectomy: radiation therapy, hormonal therapy
• Patients whose cancer recurs locally after radiation therapy: hormonal therapy, prostatectomy (very select patients)
• Patients whose recurrent cancer has spread: See treatment options for stage IV

• Review Date: 7/9/2006
• Reviewed By: Harvey Simon, M.D., Editor-in-Chief, Associate Professor of Medicine, Harvard Medical School; Physician, Massachusetts General Hospital.

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