Prostate cancer is a common malignancy affecting many individuals worldwide, often developing slowly over time. Understanding the extent of the cancer’s spread, known as staging, is important for determining the most suitable course of action. This article focuses on locally advanced prostate cancer, a specific stage where the disease has grown beyond its initial confines but remains within the pelvic region.
Defining Locally Advanced Prostate Cancer
Locally advanced prostate cancer refers to cancer that has extended beyond the prostate gland’s outer layer, known as the capsule, but has not yet spread to distant parts of the body. It may have grown into nearby structures such as the seminal vesicles.
Spread can also involve adjacent organs like the bladder or rectum, or even nearby lymph nodes within the pelvic area. This stage is commonly classified as T3 or T4 disease within the TNM staging system, meaning it has grown beyond the prostate capsule or into nearby organs like the bladder or rectum. It is distinct from early-stage, localized prostate cancer, which is entirely contained within the prostate, and metastatic prostate cancer, which has spread to distant body parts like bones or distant lymph nodes.
Treatment Approaches
Treatments for locally advanced prostate cancer often involve a combination of therapies to address the cancer’s spread beyond the prostate capsule. One common approach is radical prostatectomy, which involves the surgical removal of the entire prostate gland. During this procedure, surgeons may also remove nearby pelvic lymph nodes to assess for further spread. Following surgery, radiation therapy or hormone therapy, or both, might be recommended to help eliminate any remaining cancer cells.
Radiation therapy uses high-energy rays or particles to destroy cancer cells and is frequently used for locally advanced prostate cancer, often in conjunction with hormone therapy. External Beam Radiation Therapy (EBRT) delivers radiation from a machine outside the body, precisely targeting the prostate and surrounding areas, including the seminal vesicles and pelvic lymph nodes. Another form, brachytherapy, involves placing radioactive sources directly into or very close to the tumor within the prostate. This internal radiation can be given as permanent seed implants or as high-dose rate brachytherapy.
Hormone therapy, also known as Androgen Deprivation Therapy (ADT), aims to reduce the levels of male hormones, primarily testosterone, which prostate cancer cells often need to grow. This can be achieved through injections or medications. Hormone therapy is often administered before, during, or after radiation therapy to shrink the tumor and enhance the effectiveness of other treatments. While it can control cancer for extended periods, hormone therapy alone does not cure locally advanced prostate cancer.
Prognosis and Monitoring
The prognosis for individuals with locally advanced prostate cancer varies, but outcomes are favorable with appropriate treatment. Factors influencing prognosis include the Gleason score, which assesses the aggressiveness of cancer cells, and Prostate-Specific Antigen (PSA) levels. Men with higher Gleason scores or elevated PSA levels may face a greater risk of recurrence.
Following treatment, ongoing monitoring is important to detect any signs of cancer recurrence. Regular PSA blood tests are a standard part of follow-up care. After a radical prostatectomy, PSA levels should drop to very low or undetectable levels, below 0.2 ng/mL. For those treated with radiation, PSA levels may not reach zero but should stabilize at a low point. Follow-up appointments with healthcare providers allow for timely detection and management of any changes.