What are the stages and treatment options for prostate cancer?

From the Guidelines

Prostate cancer treatment should be guided by the cancer's stage, with localized disease (stages I-II) often managed with active surveillance, surgery, or radiation therapy, while locally advanced disease (stage III) typically requires a combination of radiation and hormone therapy, and metastatic disease (stage IV) necessitates systemic treatments including hormone therapy, chemotherapy, and newer hormonal agents. The staging of prostate cancer is crucial in determining the most appropriate treatment approach, with stages ranging from I to IV based on the extent of the disease's spread. For localized prostate cancer, which includes stages I and II, treatment options may include:

• Active surveillance: This approach is often recommended for patients with low-risk disease, involving regular monitoring with PSA tests, digital rectal exams, and periodic biopsies to watch for signs of disease progression.
• Surgery (radical prostatectomy): This involves the removal of the prostate gland and is a common treatment for localized prostate cancer.
• Radiation therapy: This can include external beam radiation therapy or brachytherapy, where radioactive seeds are implanted directly into the prostate gland.

For locally advanced disease, which is stage III, treatment typically involves a combination of:

• Radiation therapy: To target the tumor directly.
• Hormone therapy (androgen deprivation therapy or ADT): Medications like leuprolide (Lupron), goserelin (Zoladex), or bicalutamide (Casodex) are used to reduce testosterone levels, which can help slow the growth of the cancer.

In the case of metastatic prostate cancer, stage IV, systemic treatments are necessary, including:

• Hormone therapy (ADT): To reduce testosterone levels.
• Chemotherapy: With drugs like docetaxel (Taxotere) or cabazitaxel (Jevtana).
• Newer hormonal agents: Such as abiraterone (Zytiga) or enzalutamide (Xtandi).
• Immunotherapy or targeted therapy: In some cases, these may be considered as part of the treatment plan.

Treatment decisions should be made considering the cancer's aggressiveness (Gleason score), PSA levels, patient age, overall health, and personal preferences 1. Side effects of treatments can vary but may include urinary problems, erectile dysfunction, hot flashes, fatigue, and bone density loss. Regular PSA monitoring is essential during and after treatment to track the response and detect potential recurrence.

Key considerations in treatment planning include the patient's quality of life, potential side effects of treatments, and the impact of the disease on the patient's overall health and well-being. As noted in recent guidelines, there is no consensus on the optimum management of localized disease, and patients should be informed of the benefits and harms of different options, with the opportunity to consult with both a urologist and a radiation oncologist 1.

In making treatment decisions, it's crucial to prioritize the patient's morbidity, mortality, and quality of life, considering the most recent and highest quality evidence available, such as the guidelines provided by the European Society for Medical Oncology (ESMO) 1.

From the FDA Drug Label

1.1 Stage B2-C Prostatic Carcinoma 1.2 Prostatic Carcinoma 2.1 Stage B2-C Prostatic Carcinoma 2.2 Prostatic Carcinoma

The treatment for prostate cancer stages includes the use of goserelin (IM) for Stage B2-C Prostatic Carcinoma and Prostatic Carcinoma.

• The specific treatment details are provided in sections 2.1 and 2.2 of the drug label.
• Goserelin (IM) is administered via a specific administration technique outlined in section 2.5.
• Key considerations for treatment include monitoring for tumor flare phenomenon and hypersensitivity as outlined in section 5 2.

From the Research

Prostate Cancer Stages

• Prostate cancer is typically staged after diagnosis to evaluate prognosis and determine the treatment approach 3
• The stages of prostate cancer are not explicitly defined in the provided studies, but the treatment options vary based on the stage and aggressiveness of the cancer

Treatment Options

• Treatment options for prostate cancer include: + Active surveillance: close monitoring with curative intent when there is evidence of disease progression 4, 5, 6 + Watchful waiting: palliative in intent and focuses on delaying treatment until symptoms or complications develop 5, 3 + Surgery (radical prostatectomy) 4, 3, 7 + Radiation therapy (external beam radiation therapy, brachytherapy) 4, 3, 7 + Hormone therapy (androgen deprivation therapy) 4, 3 + Chemotherapy 4 + Combination therapy 3
• The choice of treatment depends on the stage and aggressiveness of the cancer, as well as patient preferences and factors 4, 5, 3

Treatment Outcomes

• Active surveillance appears to be safe and has become the preferred approach for men with less-aggressive prostate cancer 4, 6
• Surgery and radiation continue to be curative treatments for localized disease but have adverse effects such as urinary symptoms and sexual dysfunction that can negatively affect quality of life 4, 7
• Chemotherapy as initial treatment now appears to extend survival compared with androgen deprivation therapy alone for metastatic disease 4
• New vaccines, hormonal therapeutics, and bone-targeting agents have demonstrated efficacy in men with metastatic prostate cancer resistant to traditional hormonal therapy 4
• Patient-reported outcome measures and experience measures after active surveillance, radiation therapy, and radical prostatectomy for prostate cancer show differences in the effects on urinary, bowel, and sexual functions among the treatments, but no difference for mental or physical quality of life 7