Locally advanced prostate cancer is not synonymous with metastasis. It is defined as a cancer that has begun to spread beyond the prostate without going too far. It may have just passed the boundaries of the prostate (the capsule), but it can also affect neighbouring regions of the prostate (vesicles seminal, bladder, rectum, pelvic wall). The best treatment will depend on the extent of your cancer, its risk of progression, your PSA level, your age and general health. It may include:

Radiation therapy – Radiation therapy is often used to treat locally advanced prostate cancer. It is usually administered in combination with hormone therapy

Hormone Therapy – It can be offered before, during, or after radiation therapy. It can be used as the sole treatment if you cannot undergo radiation therapy or surgery.

Surgery – Open or robotic surgery will be an option depending on the extent and risk of progression of your cancer, as well as your life expectancy. Radical prostatectomy with extensive lymph node dissection may be considered as an alternative to hormone therapy.

What you need to know

If the doctor is certain that your cancer has spread outside your prostate, a radical prostatectomy or radiotherapy alone will not be enough to treat the locally advanced prostate cancer.

For example, T3+ (the cancer has spread beyond the prostate capsule) and T4 (the tumour has reached neighbouring tissues, such as the bladder, external sphincter and rectum) stage cancers are no longer limited to your prostate, even if no metastases are detected, as confirmed by bone scan and other diagnostic tests.

In such cases, hormone therapy is often used as a complement to radiotherapy. It should be noted that radiotherapy is generally used for the T3+ and T4 stages because these stages are too advanced for surgery.

• Hormone therapy will be prescribed in combination with radiotherapy for a limited period of time.
• The medical follow-up and regular dosage of your PSA allow you to judge the stabilization of the cancer. Your PSA level may never move again.
• If your PSA levels start to rise again, hormone therapy could be prescribed again.

If your cancer is considered to be at high risk of progression, you may consider participating in a research study. Talk to your doctor about it. He or she will advise you if a clinical trial could be beneficial to you.