Stage I prostate cancer means that cancerous cells were found in the prostate only. A tumor cannot be felt during a digital rectal exam (DRE) and is not visible by imaging equipment. Most of the time, stage I prostate cancer is found during another procedure, often by accident. Stage II cancer still remains only within the prostate, but a tumor may be felt during a digital rectal examination or it may be seen on ultrasound. Stage I and Stage II are considered early-stage prostate cancer.

Stage III prostate cancer has spread beyond the prostate into some of the nearby tissues, typically the seminal vesicles and glands located near the prostate. Stage IV cancer has spread to the lymph nodes or other parts of the body, typically the bladder, rectum or liver. Very often, in this stage, the cancer has also spread to the bones.

The Gleason score is a commonly used scale to assess the aggressiveness of the cancer. After reviewing the prostate cells removed during biopsy, pathologists determine how closely the cancerous cells resemble normal prostate cells on scale from 2 to 10. More aggressive tumors tend to have higher Gleason scores, meaning that the cells look less like normal prostate cells.

The behavior of the cancer can also be monitored by the rate at which prostate-specific antigen (PSA) is released into the blood. When cancer is present in the prostate, the PSA that is normally produced increases, as does the amount of PSA released into the bloodstream. PSA levels that increase quickly over time tend to suggest a more aggressive form of cancer.

• Watchful waiting
• Surgery
• Radiation therapy
• Cryotherapy
• Hormonal therapy
• Chemotherapy

Surgery
Many men with early-stage prostate cancer choose to undergo surgery to remove the entire prostate, a procedure known as a radical prostatectomy. With this treatment, there is a high likelihood that the entire tumor will be removed from the body. If the cancer is more advanced, removal of the entire prostate or of parts of the prostate may help to alleviate symptoms such as urinary frequency or urinary difficulty, but follow-up treatment with radiation therapy, hormonal therapy and/or chemotherapy will likely be needed. Side effects of prostate surgery include urinary incontinence and erectile dysfunction. Nerve-sparing surgical techniques can minimize these problems.

Radiation Therapy
External beam radiation therapy (EBRT) kills cancer cells with high-energy radiation aimed directly at the prostate gland. It can be used as an alternative to prostatectomy in patients with early-stage cancer, who typically undergo treatments five days a week for up to two months. EBRT is often seen as a good option for older patients or for those not considered good candidates for surgery. In those with metastatic disease, EBRT may be used to relieve certain types of pain. Side effects include bladder irritation, incontinence and rectal bleeding. Use of more focused types of radiation therapy, such as intensity-modulated radiation therapy (IMRT), can minimize some of these problems.

Brachytherapy, the surgical implantation of permanent or temporary radioactive seeds, is an even more focused form of radiation therapy, and is used as an alternative to EBRT in patients with localized prostate cancer. The side effects of this treatment are similar to those seen with EBRT, but tend to be less severe.

Cryotherapy
Cryotherapy is a fairly new procedure, in which the early-stage tumor and surrounding tissues are frozen in an attempt to kill the cells. It tends to has a brief recovery time, and the procedure may be repeated if unsuccessful the first time. The long-term impact of this procedure is still unknown. Similar to prostatectomy and radiation therapy, cryotherapy may result in incontinence or erectile dysfunction.

Hormonal Therapy
Since prostate tissue needs male hormones such as testosterone to grow, one way to treat prostate cancer is to remove the source of these hormones. This can be achieved by surgically removing the testicles, or though drugs that block the release or action of testosterone. Hormonal therapy is mostly used in advanced cancers or in combination with radiation therapy. Side effects include erectile dysfunction and loss of sexual desire, muscle wasting, bone loss and hot flashes.

Chemotherapy
Chemotherapy is used in advanced-stage disease, after the cancer has spread beyond the prostate, to slow tumor growth and relieve symptoms. Side effects may include nausea, hair loss, fatigue, infection and mouth sores.