What is the Step-by-Step Prostate Cancer Treatment?

Staging the cancer is one of the most important factors in choosing the best alternative for treatment. Staging of prostate cancer is based on the extent of the cancer (using the T, N, and M categories) and the PSA level when first diagnosed, and the Gleason score (Grade Group).

For non-invasive prostate cancers (Stages I to III), patients are divided into risk groups (based on how large the prostate tumor has grown, PSA level, and prostate biopsy results) to help determine treatment options. Risk groups range from very low risk to very high risk; Low-risk group cancers have a lower chance of growth and spread compared to high-risk groups. While looking at treatment options, the stage of the disease, PSA value and risk group should be taken into account, while the medical team has to consider other factors when deciding on treatment options. ;

When deciding on treatment and treatment options, the following are also taken into account:

  • The patient’s age and life expectancy,

  • Whether or not they are currently sexually active,

  • Whether there are other diseases that impair the quality of life,

  • The socio-cultural and economic level of the patient,

  • Depending on the stage of prostate cancer (TNM and Group stage) and the extent of cancer (Gleason score)

  • existing technical infrastructure,

Stage I Prostate Cancer Treatment

This stage prostate cancer mass and tumor burden are relatively small (T1 or T2) and have not protruded or grown outside the prostate. They have low Gleason scores (6 or less) and low PSA levels (less than 10 ng/mL). They usually grow very slowly and never cause any symptoms or other health problems.

Treatment Options:

  • For men who do not have any complaints and/or have other serious health problems that may limit their lifespan, only surveillance (Wait-See) or active surveillance is usually recommended. For patients who insist on starting treatment, radiation therapy (external beam therapy -EBRT or brachytherapy) or radical prostatectomy (Open or Robotic) may be options.

  • In younger, healthy patients, active surveillance, radical prostatectomy (Open or Robotic) or radiation therapy (external beam or brachytherapy) may be considered. In some patients, radiotherapy and/or short-term hormone therapy can be added according to the pathology result after radical prostatectomy.

Stage II Prostate Cancer Treatment

Stage II cancers still have not yet protruded or protruded beyond the prostate, but are larger in volume, have higher Gleason scores and/or higher PSA levels than stage I cancers. Stage II cancers that do not undergo surgery or receive radiation therapy; Compared to stage I, it is more likely to spread outside the prostate and cause prostate complaints.

Treatment Options:

  • As with stage I cancers, only follow-up (Wait-See) or active surveillance is an option for patients whose cancer does not cause any symptoms and who are elderly and/or have other serious health problems. Alternatively, hormone therapy and/or external beam therapy or brachytherapy (internal beam therapy) may be an option.

  • Treatment options for patients who are younger and healthier include:

  • Radical prostatectomy (removal of prostate, seminal vesicle and pathways, pelvic lymph nodes together). If the pathology report obtained after the surgery protrudes beyond the prostate, if the PSA level does not fall to the desired level a few months after the surgery, external beam radiation can be given.

  • Only external beam radiation can be sufficed

  • Brachytherapy only (to select patient groups)

  • Combination of brachytherapy and external beam radiation can be done

  • There may only be patient groups that can be actively monitored.

  • There may be clinical applications of some experimental new treatments that are not yet in routine use.

  • If the cancer is more likely to relapse based on PSA level and/or Gleason score, all radiation options may be combined with hormone therapy, which may take several months to 2 years.

Stage III Prostate Cancer Treatment

Stage III cancers may have grown outside the prostate and spread to the bladder or rectum (T4). however, they have not spread to lymph nodes or distant organs. These cancers are more likely to recur after treatment than early-stage tumors.

Treatment options at this stage include:

  • External beam therapy plus hormone therapy

  • Hormone therapy plus external beam therapy and internal beam brachytherapy

  • Radical prostatectomy plus external irradiation and/or hormone therapy in some selected patients.

  • For older patients or those with other medical conditions, less aggressive treatments such as hormone therapy alone, external beam therapy, or even active monitoring may be chosen.

  • There may be clinical applications of some experimental new treatments that are not yet in routine use.

Stage IV Prostate Cancer Treatment

Stage IV cancers have spread to nearby areas such as regional lymph nodes or distant organs such as bones. Most stage IV cancers are not completely curable. The goal of treatment is to keep the cancer under control for as long as possible and to improve the patient’s quality of life.

Treatment options at this stage include:

  • hormone therapy

  • Chemotherapy plus hormone therapy

  • External beam therapy plus hormone therapy

  • Chemotherapy

  • Surgery to relieve symptoms such as bleeding or urinary obstruction (TUR-P)

  • Treatments targeting bone metastases involving bisphosphonates such as Denosumab (Xgeva), zoledronic acid (Zometa), external radiation to the bones, or injections of radioactive materials such as strontium-89, samarium-153 or radium-223

  • Observation (for those who are older or have other serious health conditions and no major symptoms of cancer)

  • Take part in the clinical trial of newer treatments

  • Treatment of stage IV prostate cancer may also include treatments that help prevent or relieve symptoms such as pain.

The above options are first-line treatment options for different stages of prostate cancer. But if these treatments don’t work, if the cancer continues to grow and spread, or if the cancer recurs, secondary and other treatments come into play.

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