Staging and Treatment Options

Treatment options section provides an overview of possible treatment options. This website is only providing you with information, so that you would be able to discuss your treatment options with the physician. The best treatment option differs in each case, and a medical specialist is trained to select the best treatment option, as it depends on several things such as how far the cancer has spread, the age and overall health of the patient.


Expected treatment Pathways based on your disease stage at the time of diagnosis include:

Stage 1. Localized Stage 2. Locally Advanced Stage 3. Metastatic
No Treatment (watchful waiting) Surgery Radiotherapy
Active surveillance Radiotherapy Hormone therapy (Androgen deprivation therapy)
Surgery Hormone therapy (Androgen deprivation therapy) Chemotherapy
Hormone therapy (Androgen deprivation therapy)

All treatment options have known side effects that varies by patient receiving medications. Take the time to discuss available treatment options to you and the related side effects in more details with your physician.


Management Options:

If you have low-risk prostate cancer (i.e. localized prostate cancer and a low biopsy Gleason score), you might be offered the following management options and will not need to start active treatment immediately after your diagnosis.



A- Watchful waiting (No Treatment)

Watchful waiting refers to conservative disease management. It is usually considered as an option for low-risk patients, as well as older patients with less than 10 years of life expectancy. No treatment is prescribed, and the patients will be regularly monitored (schedule specific to each individual patient case), if symptoms develop (e.g. bone pain), treatment will be offered to manage these symptoms.


B- Active surveillance:

For men who have low-risk prostate cancer, active surveillance is an option. Men are regularly monitored by the Prostate Specific Antigen (PSA) test, digital rectal examination (DRE) and occasional further biopsies. The results from these tests and procedures will show if the cancer has changed.

If the disease progresses, they are offered treatment with the intent to cure, usually by surgery or radiotherapy. The thinking behind this strategy is that because treatments have side effects that affect quality of life, it can be better to delay treatment as long as possible. Men on active surveillance might never need treatment.




C- Hormone Therapy (Androgen Deprivation Therapy)

Since testosterone serves as the main fuel for prostate cancer cell growth, it’s a common target for treatment. Hormone therapy, also known as androgen-deprivation therapy or ADT, is designed to stop testosterone from being released or to prevent it from acting on the prostate cells.

Although ADT has always played an important role in men with advanced metastatic prostate cancer, it is also increasingly being used in combination with radiation therapy because studies have shown that this combination increases long term survival.

Many plant-based and complementary medicines can have estrogen-like properties and can interfere with the effectiveness of your hormone therapy, so be sure that your doctor has a complete list of all drugs—including the “non-traditional” ones— that you are taking, so that he or she can better monitor the effects of your therapy on the progression of your disease.


D- Chemotherapy

Chemotherapy uses anti-cancer drugs to destroy cancer cells in advanced prostate cancer when the cancer has spread to other parts of the body. It cannot eradicate prostate cancer, but it can shrink it and slow its growth. Chemotherapy may help some men with advanced prostate cancer to live longer. Chemotherapy can also help relieve some of your symptoms.

Because the side effects of chemotherapy can be severe and may limit what you can do, your doctor may assess whether you are fit enough to go through a course of chemotherapy. You may also be prescribed steroid tablets along with your chemotherapy to prevent or reduce side effects such as poor appetite, weight loss, fatigue and low energy.

Chemotherapy is commonly given intravenously –as a liquid through a fine tube into a vein in your arm. This way, the medicine goes into your bloodstream and moves through the whole body to attack any cancer cells that are there. Chemotherapy is usually given in a hospital setting but as an outpatient, which means you don’t have to stay overnight. The number of times you have to go, and the length of time you are there, depend on the chemotherapy treatment you have been prescribed by your doctor. Some chemotherapy drugs can be expensive. It is important to find out as much as you can about the treatment, procedure, possible side effects and outcomes so you are prepared. This can relieve the stress that some people experience when they are on chemotherapy.

A- Surgery:

To treat the cancer, the prostate is removed through surgery. This is called a radical prostatectomy and can successfully stop the cancer in many cases if it has not yet spread beyond the prostate gland. It involves the removal of the entire prostate gland as well as some of the tissues surrounding it. Surgery is generally offered to healthy men whose cancer has not spread to other parts of the body.


B- Radiotherapy:

Radiotherapy is a form of prostate cancer treatment that has a curative intent and involves the killing of cancer cells with ionizing radiation or photons. Radiation damages the cancer cells’ DNA (the genetic material of the cancer cell), leaving them unable to survive, grow, or spread; subsequently, the cancer cells die. Radiation therapy, like surgery, is very effective at killing localized or locally advanced prostate cancer and has the same cure rate as surgery.

If the disease progresses, a combination of treatments is likely to be given to the patient. Hormone therapy is often given together with radiation therapy for localized disease (note: it is also used alone or in combination with other treatments for men with metastatic prostate cancer).

There is also a risk that prostate cancer might spread after surgery and the PSA levels will continue to rise, in such case it is likely for the radiotherapy to be prescribed as a combination treatment.