When making decisions related to the treatment plan, patients are encouraged to consider the option of participating in clinical trials.

A clinical trial is a research study that tests a new approach to treatment. Doctors want to know if the new treatment is safe, effective and possibly better than standard treatment. Clinical trials can test a new drug, a new combination of standard treatments or new doses of standard drugs or other treatments.

The options and treatment recommendations depend on several factors, including the type and stage of the cancer, the possible side effects, as well as the patient’s preferences and general health status. Because most cases of prostate cancer are found in the early stages when the cancer is growing slowly, you usually do not have to hurry to make treatment decisions. During this time, it is important to talk with your doctor about the risks and benefits of all your treatment options, and when to start treatment. This analysis should also address the current status of cancer, such as:

• If PSA levels are rising or stable.
• If the cancer has spread to the bones.
• Your medical history.
• Any other medical condition you have.

Early stage prostate cancer (stages I and II)

In general, early-stage prostate cancer grows very slowly and may take years to cause some symptoms or other health problems, if at all. As a result, active surveillance can be recommended. Radiation therapy (with external beam or brachytherapy) or surgery, as well as clinical trials, can also be suggested. For men who have a higher Gleason score, the cancer may be fast growing; therefore, radical prostatectomy (see “Surgery” below) and radiation therapy are often appropriate. Your doctor will consider your age and general health status before recommending a treatment option.

Locally advanced prostate cancer (stage III)

For some patients with a larger tumor, local treatments alone, such as surgery and radiation therapy, are less likely to eliminate cancer. Often, a type of surgery called radical prostatectomy is done, which includes the removal of the pelvic lymph nodes.

Doctors do not treat locally advanced prostate cancer with systemic therapy before surgery, including neoadjuvant androgen-deprivation therapy (ADT) or neoadjuvant chemotherapy. Neoadjuvant treatment is one that is administered before surgery. However, neoadjuvant and concurrent ADT is the standard of care for men receiving radiation therapy to treat locally advanced prostate cancer.

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