The "How is prostate cancer staged?" section of this document explains how the T, N, and M classifications are used to stage your cancer. The stage of your cancer is one of the most important factors in choosing the best way to treat it.

What follows is a description of the treatments that may be options for men with prostate cancer diagnosed at a specific stage. But keep in mind that other factors, such as age, life expectancy, and risk of cancer recurrence after treatment (based on factors like Gleason score and PSA level) must also be taken into account when looking at treatment options.

Stage I: T1a, N0, M0, with a low Gleason score (2 to 4)

These prostate cancers are small (T1a) and have low Gleason scores (Gleason 2 to 4). They usually grow very slowly and may never cause any symptoms or other health problems.

For men without any prostate cancer symptoms who are elderly and/or have other serious health problems, active surveillance is often recommended. For men who wish to start treatment, radiation therapy (external beam or brachytherapy) or androgen deprivation may options.

Men who are younger and healthy may consider active surveillance, radical prostatectomy, or radiation therapy (external beam or brachytherapy).

Stage II: T1a, N0, M0, Gleason score of 5 to 10; OR
T1b-T2, N0, M0, any Gleason score

Stage II cancers have not yet grown outside of the prostate gland, but are larger (T1b - T2) or have higher Gleason scores (from 5 to 10) than stage I tumors. Compared with stage I prostate cancers, 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, watchful waiting by following PSA levels is often a good option for men whose cancer is not causing any symptoms and who are elderly and/or have other serious health problems. Radical prostatectomy and radiation therapy (external beam or brachytherapy) may also be appropriate options.

Treatment options for men who are younger and otherwise healthy may include:

• radical prostatectomy (often with removal of the pelvic lymph nodes). This may be followed by external beam radiation if your cancer is found to have spread beyond the prostate at the time of surgery, or if the PSA level is still detectable several weeks after surgery.
• external beam radiation only*
• brachytherapy only*
• brachytherapy and external beam radiation combined*
• taking part in a clinical trial of newer treatments

*All the radiation options may be combined with several months of hormone therapy if there is a greater chance of recurrence based on PSA level and/or Gleason score.

Stage III: T3, N0, M0

Stage III cancers have spread beyond the prostate gland but have not reached the bladder, rectum, lymph nodes, or distant organs. These cancers are more likely to come back (recur) after treatment than earlier stage tumors.

Treatment options at this stage may include:

• external beam radiation plus hormone therapy
• hormone therapy only
• radical prostatectomy in selected cases (often with removal of the pelvic lymph nodes). This may be followed by radiation therapy.
• active surveillance for those who have another more serious illness
• taking part in a clinical trial of newer treatments

Stage IV

Stage IV cancers have already spread to the bladder or rectum (T4), lymph nodes (N1), or distant organs such as the bones (M1). These cancers are generally not considered to be curable.

Treatment options may include:

• hormone therapy
• external beam radiation plus hormone therapy (in selected cases)
• surgery (TURP) to relieve symptoms such as bleeding or urinary obstruction
• active surveillance for those who have another serious illness
• taking part in a clinical trial of newer treatments

If symptoms are not relieved by standard treatments and the cancer continues to grow and spread, chemotherapy may be an option. You may also want to think about taking part in a clinical trial. Treatment of stage IV prostate cancer may also include treatments for relief of symptoms such as bone pain.

Last Medical Review: 07/30/2009
Last Revised: 07/30/2009