Treatment Options for Stage 3 Prostate Cancer
For stage 3 prostate cancer, the combination of radiotherapy and long-term hormone therapy is the primary recommended treatment option, particularly for patients with T3 disease and/or Gleason score of at least 8. 1
Primary Treatment Options
Radiation Therapy + Hormone Therapy
- The combination of radiotherapy and long-term hormone therapy is recommended for locally advanced prostatic cancer (stage T2b, T3) and/or Gleason score of at least 8 1
- Short-term hormone therapy can be prescribed for patients with a good prognosis 1
- This combination has shown improved survival outcomes compared to either treatment alone 2
Radical Prostatectomy
- Prostatectomy can be considered for stage T3 cancers, though it should ideally be undertaken in the setting of a clinical trial assessing its efficacy alone or in combination with other treatments 1
- Not recommended for stage pN1 high-grade tumors (Gleason score >7) 1
- PSA relapse occurs in approximately 39% of surgical cases without adjuvant treatment 2
Hormone Therapy Alone
- Can be considered in patients with nonmetastatic disease if curative treatment is not planned 1
- Appropriate for patients who are not candidates for surgery or radiation 1
- Overall survival rate is lower (67%) compared to operation (91%) or radiation therapy (88%) groups 2
Watch and Wait Policy
- Can be considered in select cases, particularly for patients with limited life expectancy 1
- Less commonly used for stage 3 disease compared to earlier stages 1
Adjuvant and Combination Therapies
After Prostatectomy
- Adjuvant hormonal therapy can be prescribed after radical prostatectomy for patients with node involvement 1
- Adjuvant radiotherapy may be considered in patients with widespread stage pT3a cancer or with positive surgical margins 1
- One advantage of adjuvant radiotherapy is that the dose is lower than when treatment is deferred until PSA rise 1
Brachytherapy Options
- The combination of external-beam radiotherapy and brachytherapy can be considered in patients with intermediate prognosis 1
- The combination of brachytherapy, external-beam radiotherapy, and hormonal therapy for poor prognosis patients should only be considered in clinical trials 1
Neoadjuvant Hormone Therapy
- Neoadjuvant hormonal therapy should not be considered for stage T3 cancers outside clinical trials 1
- Has not shown significant benefit for local stage cancers (T1-T2) 1
Special Considerations
Drug Treatment
- For locally confined Stage T2b-T4 (Stage B2-C) carcinoma of the prostate, goserelin (Zoladex) is indicated in combination with flutamide 3
- Treatment should start 8 weeks prior to initiating radiation therapy and continue during radiation therapy 3
Chemotherapy
- The use of chemotherapy in nonmetastatic prostate cancer is not recommended 1
- May be considered in later stages if the disease becomes hormone-refractory 4
Follow-up Recommendations
After Prostatectomy
- Total serum PSA should be measured between 1-3 months after radical prostatectomy 1
- PSA levels should be measured every 3 months during the first year and every 6 months for the following 7 years if concentration is below detection limit 1
- Digital rectal examination is optional in patients with PSA levels below detection limit 1
After Radiotherapy
- Follow-up should include PSA determination and digital rectal examination for an indefinite period 1
- PSA determination and digital rectal examination should be undertaken every 6 months 1
Prognostic Factors
- Clinical tumor stage, Gleason score, and pretreatment PSA concentration are key prognostic factors 1
- Other useful prognostic factors include Gleason grades, number of affected biopsies, extent of tumor tissue in core biopsy, and perineural invasion 1
- Partin tables can help evaluate the risk of extraprostatic spread and pelvic node invasion 1
Treatment Efficacy
- Approximately 75% of patients present with cancer localized to the prostate, with a 5-year survival rate approaching 100% 5
- For stage 3 disease specifically, aggressive treatment with short-term androgen deprivation could be beneficial when suitable candidates are selected 2
- Delayed androgen deprivation has shown effectiveness for patients without adjuvant therapy after PSA relapse 2