Treatment Options for Stage 3 Prostate Cancer

Primary Treatment Options

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, according to the British Journal of Cancer guidelines 1
Short-term hormone therapy can be prescribed for patients with a good prognosis, as suggested by the British Journal of Cancer 1
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, as recommended by the British Journal of Cancer 2
Prostatectomy is not recommended for stage pN1 high-grade tumors (Gleason score >7), according to the British Journal of Cancer guidelines 2
Hormone therapy alone can be considered in patients with nonmetastatic disease if curative treatment is not planned, as suggested by the British Journal of Cancer 3
Hormone therapy alone is appropriate for patients who are not candidates for surgery or radiation, according to the British Journal of Cancer guidelines 4

Adjuvant hormonal therapy can be prescribed after radical prostatectomy for patients with node involvement, as recommended by the British Journal of Cancer 1
Adjuvant radiotherapy may be considered in patients with widespread stage pT3a cancer or with positive surgical margins, according to the British Journal of Cancer guidelines 1
The combination of external-beam radiotherapy and brachytherapy can be considered in patients with intermediate prognosis, as suggested by the British Journal of Cancer 5
The combination of brachytherapy, external-beam radiotherapy, and hormonal therapy for poor prognosis patients should only be considered in clinical trials, according to the British Journal of Cancer guidelines 5

The use of chemotherapy in nonmetastatic prostate cancer is not recommended, as stated by the British Journal of Cancer 6

Total serum PSA should be measured between 1-3 months after radical prostatectomy, as recommended by the British Journal of Cancer 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, according to the British Journal of Cancer guidelines 1
Digital rectal examination is optional in patients with PSA levels below detection limit, as suggested by the British Journal of Cancer 1
Follow-up should include PSA determination and digital rectal examination for an indefinite period, according to the British Journal of Cancer guidelines 1
PSA determination and digital rectal examination should be undertaken every 6 months, as recommended by the British Journal of Cancer 1

Clinical tumor stage, Gleason score, and pretreatment PSA concentration are key prognostic factors, as stated by the British Journal of Cancer 2
Other useful prognostic factors include Gleason grades, number of affected biopsies, extent of tumor tissue in core biopsy, and perineural invasion, according to the British Journal of Cancer guidelines 2
Partin tables can help evaluate the risk of extraprostatic spread and pelvic node invasion, as suggested by the British Journal of Cancer 2