Prostate Cancer: Treatments by Stage

Written by WebMD Editorial Contributors
Medically Reviewed by Laura J. Martin, MD on March 30, 2025
5 min read

Once your doctor determines the stage of your prostate cancer, They can start mapping out a treatment plan. Stage is based on:

  • The size of your tumor
  • How far it has spread
  • PSA (prostate-specific antigen) level
  • Gleason score - indicates how likely the cancer is to grow and spread rapidly

Matching the right treatment with your stage isn’t always cut and dry. You might benefit from a combo of a few different approaches. Together, you and your doctor will decide on the best treatment.

There are three different doctors who might be involved in your care:

  • A medical oncologist, who treats cancer
  • A radiation oncologist, who also treats cancer
  • A urologist, who specializes in problems with the urinary tract and male reproductive organs

Here are the stages of prostate cancer along with common treatment options.

The cancer is small, and it hasn't grown outside your prostate. Slow-growing cancers might never cause symptoms or other health problems.

In this stage, your PSA levels and Gleason scores are low, and that's good. When they're higher, your cancer is more aggressive. It’s also more likely to come back and require more intensive treatment.

The PSA (prostate-specific antigen) test measures levels of this protein in your blood. Your doctor then determines your Gleason score by looking at prostate tissue cells under a microscope.

With stage I, you should consider the following treatment approaches:

  • Active surveillance. Your doctor tracks your PSA levels. If those levels rise, it might mean your cancer is growing or spreading. Your doctor can then change your treatment. They might also do tests like rectal exams and ultrasounds.
  • Watchful waiting. This involves fewer tests than active surveillance. Your doctor keeps a close watch on your symptoms. If you're an older man, or you have other serious health problems, your doctor might opt for this method.
  • Radiation therapy. This kills prostate cancer cells or keeps them from growing and dividing. There are two types of this treatment. The "external" kind uses a machine to aim a beam of radiation at your tumor. With "internal radiation," a doctor places radioactive pellets or seeds in or next to the tumor -- this procedure is also known as brachytherapy.
  • Radical prostatectomy. This is a surgery to remove your prostate and some of the surrounding tissue.
  • Ablation therapy. This treatment uses freezing or high-intensity ultrasound to kill cancer cells.

The cancer is much larger, but it hasn’t spread outside your prostate. Your PSA levels and Gleason scores are also higher. Surgery or radiation is often needed to keep it from spreading.

With stage II, you should consider the following treatments:

  • Active surveillance. In this stage, it’s typically used if you're a much older man or you have other serious health problems.
  • Radiation therapy, possibly combined with hormone therapy. Those are drugs that stop testosterone from helping your cancer cells grow.
  • Radical prostatectomy

 

The cancer may have grown outside the prostate and into nearby tissues such as the rectum and bladder.  It has not spread to the lymph nodes.

With stage III, you should consider the following treatments:

  • External radiation plus hormone therapy
  • External radiation plus brachytherapy and possible hormone therapy
  • Radical prostatectomy, often combined with removal of your pelvic lymph nodes. Your doctor might recommend radiation after surgery.

This happens when your cancer has spread to nearby lymph nodes and/or distant parts of the body. Cases of stage IV are rarely cured. Still, treatments can extend your life and ease your pain.

In this stage, you should consider the following treatments:

  • Hormone therapy, which is often combined with surgery, radiation, or chemotherapy
  • Surgery to relieve symptoms such as bleeding or urinary obstruction and to remove cancerous lymph nodes
  • External radiation with or without hormone therapy
  • Chemotherapy, if standard treatments don’t relieve symptoms and the cancer continues to grow. The drugs will shrink cancer cells and slow their growth.
  • Bisphosphonate drugs, which can help slow the growth of cancer in the bone and help prevent fractures
  • Denosumab (Xgeva, Prolia) is a monoclonal antibody that helps increase bone mass and strengthen bones.  It is given to men treated with hormone therapy and when cancer has spread to the bones.
  • Radiopharmaceuticals, or medicinal radiocompounds, are a group of pharmaceutical drugs containing radioactive isotopes which are used to help control the spread of the disease. 
  • PSMA-targeted therapy called lutetium Lu 177 vipivotide tetraxetan (Pluvicto) is a type of radiation treatment that targets a protein called PSMA found on the outside of prostate cancer cells. It can reduce symptoms related to prostate cancer, reduce the size of tumors and slow the growth of the cancer.
  • The vaccine sipuleucel-T (Provenge), which boosts your immune system so it will attack the cancer cells. This might be used when hormone therapy doesn’t work.
  • Palliative care, which offers you relief from symptoms like pain and trouble peeing
  • Checkpoint inhibitors such as pembrolizumab (Keytruda) and dostarlimab (Jemperli) stimulate the immune system by targeting a protein called PD-1 on T cells.  This type of immunotherapy helps the immune system find and attack cancer cells.
  • PARP inhibitors are used to treat certain prostate cancers that have an abnormal DNA repair gene.  These targeted therapy drugs may help shrink tumors by blocking PARP proteins that repair damaged DNA in tumors.

Clinical trials are testing new treatments. They can give you state-of-the-art cancer treatments or newer ones that aren’t available yet. Ask your doctor if a clinical trial might be right for you.

If your cancer goes into remission but later returns, follow-up treatments will depend on where the cancer is located and which treatments you’ve already tried.

  • If the cancer is contained in your prostate, surgery or a second attempt at radiation is suggested. If you've had a radical prostatectomy, radiation therapy is a good option. If you had radiation, radical prostatectomy might be the best approach. Cryosurgery might also be an option.
  • If the cancer has spread to other parts of your body, hormone therapy might be the most effective treatment. External or IV radiation therapy or bisphosphonate drugs can relieve your bone pain.