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From surgery to beam radiation: How prostate cancer is treated by stage

A doctor will take into account factors such as age, overall health, and life expectancy before choosing which course of action to take

Stage IV prostate cancers may need surgery.
Stage IV prostate cancers may need surgery. REUTERS

The specific stage of your prostate cancer plays a very large role in determining the best course of action for treating the disease. Other factors that are taken into account when considering all of your options include: your age, overall health, and life expectancy. A doctor will generally make the determination of a patient’s potential treatment options based on the patient’s risk of recurrence, in addition to their specific stage of the prostate cancer. Speak with your doctor about the factors they are taking into consideration when discussing your treatment options. Their recommendations may differ from the options listed below.

Stage I

A Stage I prostate cancer tumor is small (T1a or T2a), localised to the prostate gland, is slow growing and may never show any discernible sign or symptoms. Patients at this stage will also have a low Gleason score of six or under as well as having a low PSA level. Active Surveillance is the recommended course of action at this stage to carefully monitor the disease.

Stage II

Stage II prostate cancer is localized to the prostate gland but tumors are relatively larger at this stage. Patients will also have higher Gleason scores and have higher PSA levels than Stage I tumors. Stage II cancers that are not treated with surgery or radiation are more likely to eventually spread beyond the prostate and cause symptoms.

As with Stage I cancers, active surveillance is often a good option for men whose cancer is not showing any symptoms or causing any significant problems. Treatment options for men with Stage II prostate cancer include:

  • Radical prostatectomy
  • External beam radiation
  • Brachytherapy
  • Combined treatment of both Brachytherapy and External Beam Radiation
  • Taking part in a clinical trial of newer treatments

Stage III

At Stage III prostate cancer has spread beyond the prostate gland but has not reached the bladder or rectum (T3). It has not spread to lymph nodes or distant organs. Prostate cancer at this stage has a higher chance of recurrence following treatment than in earlier stages of the disease. Treatment options at this stage include:

  • External beam radiation in combination with hormone therapy.
  • External beam radiation in combination with brachytherapy, possibly with a short course of hormone therapy.
  • Radical prostatectomy and in certain cases often accompanied with removal of the pelvic lymph nodes.

Stage IV

Stage IV cancers have metastasized into nearby areas of the body such as the bladder, rectum, (T4) nearby lymph nodes, or to distant organs such as the bones. A small percentage of T4 cancers may be curable utilizing some of the same treatments used for stage III cancers. However most stage IV cancers can’t be cured with standard treatment. Treatment options at this stage include:

  • Hormone therapy.
  • In some cases external beam radiation combined with hormone therapy.
  • Surgery such as transurethral resection of the prostate (TURP) to relieve symptoms such as bleeding or urinary obstruction.
  • Treatments aimed at bone metastases, such as denosumab (Xgeva), a bisphosphonate like zoledronic acid (Zometa) or external radiation aimed at bones.

Dr. Samadi is a board-certified urologic oncologist trained in open and traditional and laparoscopic surgery and is an expert in robotic prostate surgery. He is chairman of urology, chief of robotic surgery at Lenox Hill Hospital. He is a medical contributor for the Fox News Channel's Medical A-Team. Follow Dr. Samadi on Twitter, Instagram, Pinterest,, davidsamadiwiki, davidsamadibio and Facebook.