Treatment by stage

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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:

Bicalutamide (Casodex)
Flutamide (Euflex)
Acétate de cyprotérone (Androcur)
Nilutamide (Anandron)

Second line hormone therapy (new generation)

Acétate d’abiratérone (Zytiga)
Apalutamide (Erleada)
Enzalutamide (Xtandi)
Darolutamide (Nubeqa)

Drugs to treat bone metastases symptoms

Denosumab (Xgeva)
Acide zolédronique (Zometa)
Alendronate (Fosamax)
Pamidronate (Aredia)

Newer targetted therapies

Olaparib (Lynparza)
Lutetium (177Lu) (Pluvicto)

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.

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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.

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