Approximately three-quarters of all newly diagnosed prostate cancers are clinically localized ( Stage I or Stage II). About 15% are Stage III and 11% are Stage IV.

If you cancer is Stage III it is a regionalized tumor that has spread beyond the prostate – through the capsule that encloses the prostate and perhaps into the seminal vesicles. However, it has not reached the lymph nodes or any more distant sites in the body.

The long term prospects for men with Stage III prostate cancer depend on the extent of the disease. Once the cancer has broken through the prostate capsule, chances that the disease will progress in the next 10 years are 50-50.

If your prostate cancer has spread to the nearby lymph nodes or to distant parts of the body, it is called metastatic prostate cancer. Hormonal therapy will generally improve the symptoms and delay the progress of the disease for another 2 to 3 years. If just the lymph nodes are involved, a man may use hormonal therapy to delay the progress of the prostate cancer even longer. However, the vast majority of those with positive lymph nodes at the time of getting hormonal therapy will remain at risk of developing additional metastatic disease within 10 years of treatment. Bone metastases tend to be less responsive to hormonal therapy.

Over time, metastatic prostate cancer often stops responding to hormonal therapy. Advancing disease may be accompanied by painful symptoms, usually involving the urinary tract or bones, along with weakness, fatigue and weight loss. Radiation may ease pain caused by bone metastases and it may also delay the progress of the disease. Surgery can be helpful in opening a blocked urinary track. Beneficial drugs include steroids and other “second-line” hormonal therapies, as well as pain killers. While pain cannot be entirely eliminated, it can be effectively relieved in the majority of patients.

An important consideration to factor into your treatment decisions is that success is not guaranteed. As many as half of the apparently localized cancers turn out, at surgery, to have already spread. And up to one-fourth, despite apparently successful surgery, will produce a recurrence over the next several years. 

In coming to a decision, you may find it helpful to thoroughly discuss your treatment options, including benefits and side effects, with your wife/partner. You may also consider contacting a local prostate cancer support group after consulting with your physician. Getting a second opinion and different perspectives can be very helpful.

You may want to take part in a clinical trial evaluating new approaches. Visit www.clinicaltrials.gov for comprehensive information regarding current clinical trials.

Reference: Understanding Treatment Choices for Prostate Cancer by Us TOO International and the National Cancer Institute