Treatment Options For Stage 1 Prostate Cancer

Prostate cancer occurs in the prostate, a gland in the male reproductive system. Read more about prostate cancer here.

Picture of a human holding both his hands together to express pain

How is prostate cancer staged?

Prostate cancer is staged using TNM method of staging cancer, a system generally used to stage cancers that form tumours. Two additional parameters, the PSA levels and the grade (depending on the Gleason score) are used to stage prostate cancer.

Stage I of prostate cancer:

In this stage, the cancer is confined to the prostate only and has PSA levels less than 10. Stage I of prostate cancer cannot be felt in physical examinations because it is microscopic. Microscopic prostate cancers are contained in less than half of the lobe of the prostates. The Gleason score of stage I prostate cancers is less than 6. It is staged as cT1, N0, M0, Grade group 1. In this stage, the cancer has not spread to any lymph nodes or other organs.

When the cancer can be felt in DRE tests and has not metastasized, it is staged as cT2a, N0, M0, Grade group 1.

When the prostate has been removed when the cancer was in stage 1, it is staged as pT2, N0, M0, Grade Group 1.

How is stage I prostate cancer treated?

As the cancer is small and is confined to the prostate gland and the growth and spread may be slow and it may never show symptoms. The course of action depends on the age of the patient and their overall health and if they can withstand the treatment. The following are the treatment methods generally preferred for stage I prostate cancer treatment:

Active surveillance:

Because this cancer type grows very slowly, men may often not require any treatment immediately if not throughout their lifetime. Active surveillance is a method of monitoring the cancer closely regularly. PSA blood test, DRE (digital rectal examination), prostate biopsies may be done once in six months or so. If the results show signs of the cancer spreading, the treatment options are reviewed to eliminate the cancer.

Radiation therapy:

This treatment uses high beams of x-rays to kill the malignant cells. The radiation is aimed at the cancer cells to kill them, restrict their growth and to shrink tumours. The two main types of radiation therapy used in the treatment of prostate cancer:

  • External beam radiation: In external beam radiation therapy, also called EBRT, beams of radiation are focused on the prostate gland from a machine outside the body and it is used to treat the early stages of cancer.
  • Brachytherapy: Also called seed implantation or interstitial radiation therapy, small radioactive pellets of the size of a grain of rice are placed directly inside the prostate gland. This treatment is used alone in patients in the early stages of cancer showing relatively slow growth. Otherwise, this is preferred in combination of other treatment methods.
    Read more about radiation therapy of prostate cancer here.

Radical prostatectomy:

Surgery is the preferred choice of treatment for prostate cancers that show symptoms but is confined to the the prostate gland. The main type of surgery used is called radical prostatectomy, in which in addition to the prostate gland, the tissue around it including the seminal vesicles may be removed. Radical retropubic prostatectomy and radical perineal prostatectomy are the two types of surgeries depending on how the prostate is approached.

Read more about surgery for prostate cancer here.

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