Prostate Cancer

Locally-advanced Prostate Cancer

Locally-advanced Prostate Cancer

If you are diagnosed with locally-advanced prostate cancer, your doctor can recommend treating the cancer with watchful waiting, radical prostatectomy, or a combination of radiation therapy and hormonal therapy. Each treatment has its own advantages and disadvantages. The choice depends on your individual situation.

This section describes the different treatment options which you should discuss with your doctor. This is general information, which is not specified to your individual needs. Keep in mind that individual recommendations may depend on your country and health care system.

What is locally-advanced prostate cancer?

Locally-advanced prostate cancer refers to a tumour which has spread outside of the prostate. It may be a T3 or T4 tumour, depending on where and how far outside of the prostate it has grown.

T3 means that the tumour has grown just outside the prostate or to the seminal vesicles. A T4 tumour means that prostate cancer has invaded the bladder neck, the urinary sphincter, the rectum, or the pelvic floor (Fig 1 and 2).

Treatment options

The most common treatment options for locally-advanced prostate cancer are watchful waiting, radical prostatectomy, and a combination of radiation therapy and hormonal therapy. Which treatment pathway is best for you depends on:

  • The tumour characteristics
  • Your medical history
  • Your age
  • The kind of treatment available at your hospital
  • Your personal preferences and values
  • The support network available to you

In watchful waiting the doctor schedules regular visits to monitor your health and recommends further treatment when symptoms appear. This treatment is generally indicated when you are unfit for radical prostatectomy, radiation therapy or hormonal therapy. This may be related to your age or any medical conditions which make those treatments dangerous for you.

Radical prostatectomy is the surgical treatment in which the entire prostate and the seminal vesicles are removed. It can be performed by open or laparoscopic surgery. If you have locally-advanced prostate cancer you generally need additional treatment after surgery. This can be radiation therapy, hormonal therapy or a combination of these.

As an alternative to surgery, your doctor may recommend radiation therapy to cure your cancer. This therapy damages and kills cancer cells. It is a common treatment option for locally-advanced tumours. In locally-advanced prostate cancer, radiation therapy is always combined with hormonal therapy.

Hormonal therapy affects the production of testosterone in the body. The aim is to stop the growth of the tumour. Another name for hormonal therapy is androgen deprivation therapy (ADT).

Fig. 3: A T3 prostate tumour which has spread to the seminal vesicles.
Fig. 1: A T3 prostate tumour which has spread to the seminal vesicles.
Fig. 4: A T4 prostate tumour which has spread to the bladder neck, urinary sphincter, and rectum.
Fig. 2: A T4 prostate tumour which has spread to the bladder neck, urinary sphincter, and rectum.