Choosing a Treatment Option

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 (No previous hormone therapy or adjuvant radiotherapy after surgery) The standard of care is the use of salvage radiotherapy with or without hormone therapy
An alternative option for patients with a slow PSA doubling time and/or limited life expectancy is surveillance
Clinical trials
Hormone-sensitive metastatic disease (Cancer has spread outside the prostate and is responsive to hormone therapy) Hormone therapy
Hormone therapy + radiation to prostate bed (newly diagnosed and with low-volume metastatic disease)
Hormone therapy + 2nd-generation hormone therapy*
Hormone therapy + docetaxel
Clinical trials
Non-metastatic castration-resistant prostate cancer
(Rising PSA but no detectable tumors on imaging in patients who had previous hormone therapy)
Hormone therapy + 2nd-generation hormone therapy*
Clinical trials
Metastatic disease; resistant to hormone therapy Sipuleucel-T (if minimal symptoms)
Abiraterone or enzalutamide
Radium-223 (for treatment of symptomatic bone metastases)
Taxane chemotherapy (docetaxel or cabazitaxel)
Clinical trials
Patient has exhausted all therapeutic options Platinum chemotherapy
Pembrolizumab (if MMR-deficient or MSI-high)
Clinical trials
Bone protection Denosumab
Zolendronic acid
Clinical trials

*Discuss the options in this medication class with your doctor.

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