Treatment Options for Localized or Locally Advanced Prostate Cancer

A man diagnosed with localized or locally advanced prostate cancer has 3 major treatment options: Active Surveillance, surgery, and radiation therapy. Radiation therapy is sometimes combined with hormone therapy, but surgery is almost never combined with hormone therapy.

Choosing the best treatment for localized or locally advanced prostate cancer is generally based on age, the stage and grade of the cancer, the patient’s general health, and an evaluation of the risks and benefits of each therapy option.

Health care providers think about localized or locally advanced prostate cancer is in terms of “risk groups,” which are assigned before the patient undergoes any treatment. There are 3 general risk groups based on the PSA, DRE, and biopsy, which can further be subdivided to better personalize treatment for each patient.


Learn more about “Risk Groups“.


The treatment options for each risk group are very different and you should ask your doctor which risk group you belong to so you can better understand the most appropriate next steps.

Treatment Options for Advanced Prostate Cancer

Disease Stage Treatments to Consider Once This Stage is Reached
Rising PSA but no detectable tumors on imaging Hormone therapy
Radiation to prostate bed if prior surgery
Surveillance
Hormone-naïve metastatic disease Hormone therapy
Hormone therapy + abiraterone
Hormone therapy + docetaxel
Metastatic disease;
resistant to primary hormone therapy
(castration-resistant prostate cancer)
Sipuleucel-T (if minimal symptoms)
Abiraterone or enzalutamide
Radium-223 (for treatment of bone metastases)
Taxane chemotherapy (docetaxel and cabazitaxel)
Patient has exhausted all therapeutic options Platinum chemotherapy
Pembrolizumab (if MMR-deficient or MSI-high)
Clinical trials of targeted therapies matched to tumor
Bone protection Denosumab
Zolendronic acid

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