Treatment by stage
Discover our animated video!
Diagnosis and treatment.
Have you recently been diagnosed with prostate cancer? This video is for you! When it comes to cancer, it pays to know the facts. Let’s take a closer look.
Overview
After receiving your diagnosis for prostate cancer, it is natural to imagine the worst and worry about how cancer will affect your life and the lives of your loved ones. It can be difficult and stressful to have to decide on your treatment. You will most certainly have questions regarding your prognosis and may want to know what the chances are for a successful treatment.
Unfortunately, no one can tell you exactly what your outlook will be since many factors come into play: your type of prostate cancer (grade, stage, PSA rate), your age, your health status, and your medical and family history, among others. Here is a summary of the types of prostate cancer.
Localized prostate cancer
- In most cases, this cancer is slow-growing and does not affect your lifespan.
- In many cases, the primary treatment will get rid of the cancer.
- In some cases, the cancer can be aggressive, evolve more quickly and spread elsewhere in the body
- In some cases, the cancer recurs after the primary treatment and other treatments become necessary.
Locally advanced prostate cancer
- In many cases, the primary treatment aims to eliminate the cancer.
- Treatment may involve a combination of therapeutic approaches.
- In some cases, the cancer recurs after the primary treatment and other treatments become necessary.
Metastatic prostate cancer
- This cancer cannot be cured.
- Hormone therapy can be effective in keeping your cancer under control for many years.
- Depending on its spread in the body, dual or triple therapy may be considered (e.g., standard hormone therapy + chemotherapy + next-generation hormone therapy)
- Developing resistance to hormone therapy calls for further treatments, often in combination
- Treatments can also relieve pain and symptoms related to metastases
Stages 1 and 2
Localized prostate cancer
The cancer is localized only within the prostate. The important thing here is to determine the risk of cancer progression (see Prognosis and Survival). When it comes to localized prostate cancer, your treatment options are:
- Active surveillance
- Radical prostatectomy (surgery) with or without pelvic lymph node dissection
- Radiation therapy (external or brachytherapy) with or without short/medium/long-term hormone therapy
Stage 3
Locally advanced prostate cancer
The cancer has begun to break out of the prostate, but not too far. When it comes to locally advanced prostate cancer, your treatment options are:
- Radical surgery and pelvic lymph node dissection
- Radical surgery with adjuvant pelvic radiotherapy (after surgery)
- External radiotherapy combined with long-term hormone therapy (18-36 months)
- External radiotherapy combined with temporary brachytherapy
- Hormone therapy alone
Stage 4
Metastatic prostate cancer
The tumour has spread to neighbouring organs, lymph nodes, or other parts of your body far from your prostate. When it comes to metastatic prostate cancer, your treatment options are:
- Hormone therapy +/-
- Next generation hormone therapy
- Chemotherapy
- External radiotherapy to the prostate
- Other treatment combinations
- Surgery to relieve symptoms
- Treatment of bone metastases
Clinical Trials
Recurrent
With or without metastasis
A recurrent cancer corresponds to a cancer that returns after radical prostatectomy or radiotherapy. Recurrence can be biochemical only (an increase of prostate-specific antigen (PSA) in the blood) or clinical (appearance of metastases on imaging tests). When it comes to a recurrence, your treatment options are:
Without metastasis
- Monitoring only (if the biochemical recurrence is slow)
- Radiation therapy +/- Hormone therapy
- Brachytherapy post-radiation therapy
- Hormone therapy
With metastasis
- Hormone therapy +/-
- Next generation hormone therapy
- Chemotherapy
- External radiotherapy to the prostate
- Other treatment combinations
- Surgery to relieve symptoms
- Treatment of bone metastases
Clinical Trials
Case studies
Drugs used
Treatments can be given to cure cancer or to control or relieve symptoms. You may receive a single treatment or a combination of treatments based on your individual preferences/values and depending on the grade and stage of your cancer (i.e. how far the cancer has spread and how fast it can grow).
This section provides you with information on drugs to treat prostate cancer that are currently approved by Health Canada. As new prostate cancer drugs are approved for use in Canada we will update our information in a timely manner.
Approved by Health Canada
Drugs used in chemotherapy and radiotherapy
- Docetaxel (Taxotere)
- Cabazitaxel (Jevtana)
- Mitoxantrone (Teva)
- Prednisone or Prednisolone
- Dichlorure de radium 223 (Xofigo)
Drugs used in hormone therapy
The most common LHRH agonists are:
- Leuprolide (Lupron, Lupron Depot, Eligard)
- Goséréline (Zoladex)
- Buséréline (Suprefact)
- Triptoréline (Trelstar)
The LHRH antagonist is:
- Dégarélix (Firmagon)
The most common types of anti-androgens are:
Second line hormone therapy (new generation)
Drugs to treat bone metastases symptoms
Newer targetted therapies
Newer nuclear imaging
- TEP-PSMA (68Ga) (Illuccix)
For more information on medications reimbursed in Quebec, please visit the National Institute of Excellence for Health and Social Services (INESSS) website.
We are here for you
You have questions or concerns? Don’t hesitate. Contact us at 1-855-899-2873 to discuss with one of our nurses specialized in uro-oncology. They are there to listen, support and answer your questions, and those of your family or your loved ones. It’s simple and free, like all of our other services.
Also take the time to visit each of our pages on this website, as well as our YouTube channel, in order to get familiar with the disease, our expert lectures, our section on available resources, the support that is offered to you, our events and ways to get involved to advance the cause.
Staying Informed
Pages that might interest you
Want to know more? Just click on one of the links below.
The latest PROCURE news that might interest you
Every week we publish a blog article. Here are some we have chosen for you.
- Did you say prostate cancer?
- I want to postpone my treatment… Is that wise?
- I have several treatment options… Which one to choose?
The medical content and editorial team at PROCURE
Our team is composed of urologists, and nurses certified in uro-oncology with a deep knowledge of prostate cancer and other diseases related to the genitourinary system. Meet our staff by clicking here.
Sources and references
- Prostate Cancer – Understand the disease and its treatments; Fred Saad, MD, FRCSC and Michael McCormack, MD, FRCSC, 4th et 5th editions
- Canadian Cancer Society
- Prostate Cancer Foundation-PCF.org
- National Cancer Institute-USA
- American Cancer Society
- Memorial Sloan Kettering Cancer Center
- Prostate Cancer UK
Last medical and editorial review: April 2023
Written by PROCURE. © All rights reserved
Treatment by stage
Treatment by stage
After receiving your diagnosis for prostate cancer, it is natural to imagine the worst and worry about how cancer will affect your life and the lives of your loved ones. It can be difficult and stressful to have to decide on your treatment. You will most certainly have questions regarding your prognosis and may want to know what the chances are for a successful treatment.
Unfortunately, no one can tell you exactly what your outlook will be since many factors come into play: your type of prostate cancer (grade, stage, PSA rate), your age, your health status, and your medical and family history, among others.
Localized prostate cancer
- In most cases, this cancer is slow-growing and does not affect your lifespan.
- In many cases, the primary treatment will get rid of the cancer.
- In some cases, the cancer can be aggressive, evolve more quickly and spread elsewhere in the body
- In some cases, the cancer recurs after the primary treatment and other treatments become necessary.
Locally advanced prostate cancer
- In many cases, the primary treatment aims to eliminate the cancer.
- Treatment may involve a combination of therapeutic approaches.
- In some cases, the cancer recurs after the primary treatment and other treatments become necessary.
Metastatic prostate cancer
- This cancer cannot be cured.
- Hormone therapy can be effective in keeping your cancer under control for many years.
- Depending on its spread in the body, dual or triple therapy may be considered (e.g., standard hormone therapy + chemotherapy + next-generation hormone therapy)
- Developing resistance to hormone therapy calls for further treatments, often in combination
- Treatments can also relieve pain and symptoms related to metastases
Stages 1 and 2
Localized prostate cancer
The cancer is confined to the prostate only. The important thing here is to determine the risk of cancer progression (see Prognosis and survival). When it comes to localized prostate cancer, your treatment options are:
- Active surveillance
- Radical prostatectomy (surgery) with or without pelvic lymph node dissection
- Radiotherapy (external or brachytherapy) with or without short/medium/long-term hormone therapy
Stage 3
Locally advanced prostate cancer
The cancer has started to spread beyond the prostate but has not gone too far. When it comes to locally advanced prostate cancer, your treatment options are:
- Radical prostatectomy and pelvic lymph node dissection
- Radical prostatectomy with adjuvant pelvic radiotherapy (after surgery)
- External beam radiotherapy combined with hormone therapy
- External beam radiotherapy combined with brachytherapy
- Hormone therapy alone
Stage 4
Metastatic prostate cancer
The tumor has invaded neighboring organs, lymph nodes, or more distant parts of the body. When it comes to metastatic prostate cancer, your treatment options are:
- Hormone therapy +/-
- Next-generation hormone therapy
- Chemotherapy
- External beam radiotherapy to the prostate
- Other treatment combinations
- Surgery to relieve symptoms
- Treatment of bone metastases
- Clinical trials
Recurrent
With or without metastases
Recurrent cancer refers to cancer that returns after radical prostatectomy or radiotherapy. Recurrence can be biochemical only (increase in blood prostate-specific antigen (PSA) levels) or clinical (appearance of metastases on imaging). When it comes to recurrence, your treatment options are:
Without metastasis
- Surveillance only (if biochemical recurrence is slow-growing)
- Radiotherapy +/- Hormone therapy
- Post-radiotherapy brachytherapy
- Hormone therapy
With metastasis
- Hormone therapy +/-
- Next-generation hormone therapy
- Chemotherapy
- External beam radiotherapy to the prostate
- Other treatment combinations
- Surgery to relieve symptoms
- Treatment of bone metastases
- Clinical trials
Treatments can aim to cure cancer or to halt or alleviate symptoms. You may receive a single treatment or a combination of treatments according to your preferences or personal values and depending on the stage and grade of the cancer you have (in other words, according to the degree and rate of cancer spread).
Here are the medications approved by Health Canada to treat prostate cancer. We will update the information as quickly as possible when new prostate cancer medications are approved in Canada.
Medications used in hormone therapy
The most common LH-RH analogues are:
- Leuprolide (Lupron, Lupron Depot, Eligard)
- Goserelin (Zoladex)
- Buserelin (Suprefact)
- Triptorelin (Trelstar)
The LH-RH antagonists are:
- Degarelix (Firmagon)
- Relugolix (Orgovyx)
The most common anti-androgens are:
- Bicalutamide (Casodex)
- Flutamide (Euflex)
- Cyproterone acetate (Androcur)
- Nilutamide (Anandron)
New generation hormone therapy:
- Abiraterone acetate (Zytiga)
- Apalutamide (Erleada)
- Enzalutamide (Xtandi)
- Darolutamide (Nubeqa)
Medications used in chemotherapy
- Docetaxel (Taxotere)
- Cabazitaxel (Jevtana)
- Mitoxantrone (Teva)
- Prednisone or Prednisolone
Medications used to treat symptoms related to bone metastases
- Denosumab (Xgeva)
- Zoledronic acid (Zometa)
- Alendronate (Fosamax)
- Pamidronate (Aredia)
Targeted medications
- Olaparib (Lynparza)
- Niraparib/ Abiraterone acetate (Akeega)
- Radium dichloride 223 (Xofigo)
- Lutetium (177Lu) (Pluvicto)
Nuclear imaging
- 68Ga PSMA PET scan (Illuccix)
Additional Information - Treatment options
How I coped with prostate cancer
A man with prostate cancer shares the challenges of his cancer experience.
Urologist’s advice: Treatments and information on prostate cancer
Learn more about the role of the urologist and the importance for a patient to gather adequate information after receiving a prostate cancer diagnosis.
Prostate cancer: Tests, imaging and biomarkers
Discussion about the variety of approaches available to monitor this disease before, during, or after treatment.
Is prostate cancer hereditary?
Understanding the hereditary and genetic aspects of this disease can provide valuable information to both individuals affected and their families.
Symptoms, risk and screening
Are you over 50 or experiencing urinary problems? Discover why early screening for prostate diseases is important.
Diagnosis and treatment
Recently diagnosed with cancer? Educate yourself to fully understand your situation.
The role of hormone therapy
Has your doctor recommended hormone therapy? This video is for you!
States of prostate cancer following treatment
Do your recent tests show an increase in PSA levels? It could indicate a recurrence.
External radiation or Brachytherapy?
Explore the benefits and considerations of each treatment option for prostate cancer to determine which might be right for you.
Q-A – New therapies for advance prostate cancer
In this interview, we answer patients’ questions about new therapies for advanced prostate cancer.
Genetic predisposition to prostate cancer
Although rare, some hereditary genetic mutations can increase your risk of prostate cancer.
All about hormone therapy
Hormone therapy can reduce tumor size, control cancer, and prolong life. Is it the right treatment for your cancer?
Sexuality and intimacy in 5 points
Sexuality and intimacy in 5 points addresses specific challenges and opportunities that may arise after treatment for prostate cancer.
Orchiectomy? Never heard of that word!
Orchiectomy, a form of hormone therapy, involves surgically removing the testicles, depriving the cancer of testosterone.
Do you have a curved penis?
Is your penis curved? Does it curve to the left, right, upward, or downward? You have a curved penis and you or your partner want to know why?
Orgasm without erection?
It is entirely possible for a man to achieve orgasm without an erection or penetration and there are several ways to achieve this.
Sources and references
Last medical and editorial review: April 2024. See our web page validation committee and our collaborators by clicking here.
Discover our animated video!
Symptoms, risk and screening
Are you over 50 years old, or have you been having urinary problems for some time now? This video is for you! Several diseases can affect your prostate, and it’s important to detect them early. Let’s take a closer look.
Anatomy
What is the prostate
The prostate is a gland:
- Located between the bladder and the penis, just in front of the rectum;
- Formed of 2 lobes which surround the urethra, a canal that runs through the center of the prostate, from the bladder to the penis, letting urine and sperm flow out of the body;
- The size of a walnut, which grows larger in size in your forties;
- That has a soft, spongy texture to the touch like a small, ripe plum.
The prostate is made of:
- Gland cells that secrete liquids for ejaculation;
- Muscle cells that participate in the evacuation of your sperm during ejaculation;
- Fiber cells that maintain the structure of the gland.
Around the prostate, we find:
- The seminal vesicles, glands that produce sperm and that are located on either side of the prostate;
- The vas deferens, the tube that carries sperm from the testicle to the seminal vesicles;
- The nerve bundles that control your bladder and erectile function and that are located on either side of your prostate.
Structure
Three main zones of the prostate
Peripheral zone
- The peripheral zone is the largest area of the prostate. It can easily be felt by the doctor during a digital rectal exam (DRE).
- Most prostate cancers start in the peripheral zone.
Transition zone
- This is the area located in the middle of the prostate, between the peripheral and central areas. It surrounds your urethra that runs through the prostate.
- With age, the transitional area increases in size until it becomes the largest portion of your prostate. This is called benign prostatic hyperplasia (BPH) or enlarged prostate.
Central zone
- It is the part of the prostate that is farthest from the rectum. This is why prostate tumors located in this area can not be felt by the doctor during a digital rectal examination.
- If the doctor is in doubt, the following information will help decide if additional investigation is necessary:
- Your PSA level
- Your age and family history
- Your ethnic origin
Fonction
In short
Your fertility and natural fertilization
- It produces … a prostatic fluid rich in enzymes, proteins and minerals that nourishes and protects your spermatozoa.
- It makes … a protein (APS) that is used to liquefy your sperm to facilitate the mobility of your spermatozoa.
- It allows … ejaculation by contracting.
- It promotes … fertility through its enzymes facilitating the penetration of sperm through the cervix.
- It is not related to the mechanism of erection. Therefore, the origin of erectile dysfunction lies elsewhere.
Additional details
Exocrine Function
The prostate is made up of thousands of tiny fluid-producing glands. Specifically, the prostate is an exocrine gland. Exocrine glands are so-called because they secrete through ducts to the outside of the body (or into a cavity that communicates with the outside). Sweat glands are another example of an exocrine gland.
The fluid that the prostate gland produces forms part of semen, the fluid that carries sperm during orgasm. This fluid, produced in the prostate, is stored with sperm in the seminal vesicles. When the male climaxes, muscular contractions cause the prostate to secrete this fluid into the urethra, where it is expelled from the body through the penis.
Urine Flow
The prostate wraps itself around the urethra as it passes from the bladder to the penis. Prostatic changes can affect urine flow. Increasing the size of the prostate or muscle tone may impede the flow of urine due to the close anatomical relationship between the urethra and the prostate.
Prostate Specific Antigen (PSA)
The prostate also produces a protein called prostate-specific antigen (PSA). PSA is released with the ejaculatory fluid and can also be traced in the bloodstream. The testing of PSA levels in the blood is used to detect prostate cancer. The level of PSA in the blood is usually measured in nanograms of PSA per milliliter of blood (ng/mL).
A raised PSA level
Usually, a PSA rate of less than 4 nanograms per milliliter of blood is normal, but age should also be taken into consideration as PSA levels gradually increase with age. A rise in PSA concentration may indicate the presence of:
- An enlarged prostate (benign prostatic hyperplasia)
- An inflammation or infection of the prostate (prostatitis)
- A prostate cancer
Your doctor will have you undergo other tests to determine the exact cause of the increase in your PSA.
We are here for you
You have questions or concerns? Don’t hesitate. Contact us at 1-855-899-2873 to discuss with one of our nurses specialized in uro-oncology. They are there to listen, support and answer your questions, and those of your family or your loved ones. It’s simple and free, like all of our other services.
Also take the time to visit each of our pages on this website, as well as our YouTube channel, in order to get familiar with the disease, our expert lectures, our section on available resources, the support that is offered to you, our events and ways to get involved to advance the cause..
Staying Informed
Pages that might interest you
Want to know more? Just click on one of the links below.
The latest PROCURE news that might interest you
Every week we publish a blog article. Here are some for you.
The medical content and editorial team at PROCURE
Our team is composed of urologists, and nurses certified in uro-oncology with a deep knowledge of prostate cancer and other diseases related to the genitourinary system. Meet our staff by clicking here.
Sources and references
- Prostate Cancer – Understand the disease and its treatments; Fred Saad, MD, FRCSC and Michael McCormack, MD, FRCSC, 4th et 5th editions
- Canadian Cancer Society
- Prostate Cancer Foundation-PCF.org
- National Cancer Institute-USA
- American Cancer Society
- Memorial Sloan Kettering Cancer Center
- Prostate Cancer UK
Last medical and editorial review: September 2023
Written by PROCURE. © All rights reserved
