What are the 4 stages of prostate cancer: Understand the disease progression

Learn what are the 4 stages of prostate cancer and understand the disease progression. Once you’ve heard you have prostate cancer and you’re trying to understand what it may mean, the next step is to determine the stage of the cancer. Staging of prostate cancer tells doctors the extent of the cancer and allows your doctor to measure the disease spread within or beyond the prostate.

Staging of prostate cancer is based on 3 factors:

• Tumor size
• If the tumor has spread or not
• What are the odds of the cancer returning

Finding the best treatment for prostate cancer is not that simple. There could be several methods recommended to beat it back. Your doctor and you will work together to decide how to treat it best. 

Here is a look at the 4 stages of prostate cancer, what each stage means, its characteristics, and which treatment options are recommended.

What are the 4 stages of prostate cancer

Stage 1 prostate cancer

At this stage, the cancerous tumor is small, contained within the prostate gland and has not spread. If the tumor is considered less aggressive or slow-growing, you may have few if any early signs of prostate cancer.

Your PSA level and Gleason scores are low. However, over time, both of these levels can begin to rise, and if they do, it’s likely your cancer has become more aggressive or is more likely to return and need more intensive treatment.

The treatment options for Stage I prostate cancer may include the following:

• Active surveillance/Watchful waiting – This treatment option is exactly what it says: careful follow-up exams that involve a DRE and PSA test every three to six months and a prostate biopsy every one to two years. If your cancer is slow-growing and unlikely to spread this is a viable option. However, it will be important you are compliant with regular checkups and testing and can manage the stress of living with cancer in your body. You are still an active participant in helping regulate your prostate cancer. If your cancer changes, you will have to decide to consider surgery or radiation with your doctor. 

Stage 2 prostate cancer

The cancer is still localized and has not spread beyond the prostate gland. But it is more advanced than stage I and may grow more rapidly. There are two types of stage II that exist: stage II A, found in only one side of the prostate, and stage II B, found in both sides of the prostate. 

The treatment options for stage II may include the following:

• Active surveillance/watchful waiting if the cancer is not changing as rapidly and is still confined within the prostate. This treatment if often used for men who are older and have other serious health problems.
• Radiation therapy that is combined with hormone therapy is an option. Hormone therapy helps stop the hormone testosterone fueling the growth of cancer cells. 
• Radical prostatectomy or the removal of the prostate gland. 

Stage 3 prostate cancer

This stage is when the prostate cancer is referred to as locally advanced cancer, which means it has spread outside the prostate into local tissue such as that of the seminal vesicles. However, stage III prostate cancer has not spread into more distant tissue such as the bladder, rectum, lymph nodes, or bones. 

The treatment options for stage III may include the following:

• External radiation plus hormone therapy
• External radiation plus brachytherapy and possible hormone therapy
• Radical prostatectomy.  There is a possibility this may also include removing the pelvic lymph nodes. 
• Surgically removing the prostate gland and possible radiation afterwards

Stage 4 prostate cancer

This stage is when the cancer has spread to distant parts of the body that can include the rectum, bladder, lymph nodes, bones, or liver. The goal at this stage is to improve the symptoms and to prolong a man’s life since, in most cases, stage IV prostate cancer is not curable.

The treatment options for stage IV may include the following:

• Hormone therapy – These medication stop testosterone from encouraging cancer cell growth.
• A surgery called orchiectomy, that removes a man’s testicles. This may help lower testosterone levels more quickly, helping relieve pain or other symptoms.
• Radiation therapy – Radiation involves the use of powerful beams of energy that kills cancer cells.
• Radical prostatectomy – Removes the entire prostate gland and any metastasized cancer near the prostate.
• Lymph node removal – If prostate cancer has spread to lymph nodes, the lymph nodes can be removed.
• Chemotherapy – Uses strong drugs to kill all cancer cells, helps relieve pain, and may help slow cancer cell growth. 
• Targeted drug therapy – Uses medications used to attack and destroy cancer cells.
• Immunotherapy – This treatment works with the body’s immune system to kill cancer cells. 
• Radioactive medicines targeting cancer in the bones – This delivers radiation directly to bones in men where the prostate cancer has spread to their bones. 
• Bone-building medications – If a man has cancer in his bones that has spread from his prostate cancer, he may also have thinning bones. Bone-building medications help strengthen bones which reduces the risk of a man breaking a bone. 
• Clinical trials – Men can consider involvement in a clinical trial that is searching for participants to help find better treatments for prostate cancer.

Dr. David Samadi is the Director of Men’s Health and Urologic Oncology at St. Francis Hospital in Long Island. He’s a renowned and highly successful board certified Urologic Oncologist Expert and Robotic Surgeon in New York City, regarded as one of the leading prostate surgeons in the U.S., with a vast expertise in prostate cancer treatment and Robotic-Assisted Laparoscopic Prostatectomy.  Dr. Samadi is a medical contributor to NewsMax TV and is also the author of The Ultimate MANual, Dr. Samadi’s Guide to Men’s Health and Wellness, available online both on Amazon and Barnes & Noble. Visit Dr. Samadi’s websites at robotic oncology and prostate cancer 911.