When prostate cancer is diagnosed, the first step for your health care team (which may include your primary care doctor, a urologist, an oncologist, and a radiation oncologist) is to examine and determine the extent of its growth. This is known as the stage of the cancer. The stage is an important factor in treatment decisions, and it is often determined through the same tests that led to the cancer diagnosis, including CT scans and PET scans.
Generally, the more the cancer has spread, the higher the stage, and the more treatment you will likely need. There are other important factors that could determine treatment course, such as the type of cancer, how fast it is spreading, if you’ve had cancer before, and your overall health.
In some cases, slow-developing cancer might never cause symptoms or develop into much of a threat so treatment can vary from just monitoring to more aggressive options.
Stages 1 and 2.
In stage 1, the cancer is small and hasn’t grown outside your prostate. It may also mean that laboratory tests show low levels of prostate specific antigens (PSA), a key indicator of prostate cancer. Stage 2 cancers are a little bit larger, but the cancer is still confined to the prostate. Your PSA score will be a little higher, as will the Gleason score, which is a measure of how a tumor looks under a microscope.
Based on a full assessment of your overall health, your health care team may consider the following treatments, alone or in combination with each other:
- Watchful waiting - close monitoring of the size and spread of cancer, along with watching for other symptoms for signs of cancer progression
- Active surveillance - a step beyond watchful waiting, it includes tracking your PSA levels and tests to show tumor size and progress, including rectal exams and ultrasounds
- Radiation therapy or ablation therapy – these are two different ways to kill or slow the growth of cancer cells. Radiation uses a powerful beam to eliminate cancer cells. Ablation uses freezing or ultrasound to kill cancer cells.
- Radical prostatectomy - removal of the prostate and perhaps some surrounding tissue
- Hormone therapy - designed to take away the fuel driving cancer growth
For stage 2 cancer and beyond, you may have the opportunity to participate in clinical trials. Clinical trials are part of the scientific research into the disease and have been the foundation for many advances in cancer care and treatments. For people with prostate cancer, clinical trials may involve new or advanced types of radiation therapy designed to kill cancer cells or new medications for chemotherapy or managing side effects.
When cancer comes back.
Cancer recurrence means that the same type of cancer has returned. Even for patients who have had the prostate removed and aggressive radiation treatment, there is a chance that the cancer may come back. Your health care team will again examine and determine the stage of the cancer—as well as investigate the potential spread to other parts of your body—before recommending treatment.
Your health care team will closely monitor your treatment and conduct follow-up tests to see how the treatment regimen is working. Depending on the size, spread, and type of cancer, treatment can last from a few weeks to a few months.
Most treatments for cancer cause some type of side effect. Surgery to remove the prostate or neighboring cells can cause pain and swelling. Radiation therapy can cause itching, soreness, and peeling skin. Even targeted therapy, which is designed to go after cancer cells while leaving healthy cells alone, can cause side effects, including vomiting, fatigue, and diarrhea. See the article on prostate cancer side effects for more.
Side effects from prostate cancer treatment vary widely from person to person, and many are treatable. Talk to your doctor about ways to lessen or treat side effects.