Stage 3 Prostate Cancer

What is stage 3 Prostate Cancer?

Stage 3 prostate cancer means that the cancer has spread outside the prostate gland into tubes that carry semen (seminal vesicles), bladder, pelvic wall, and the rectum. The stage of the cancer indicates how far it has spread and its overall size. Stages are used to help doctors come up with an informed choice for treatment.

Stage III prostate cancer is characterized by high levels of PSA with a fast growth rate of tumors. This is an indication that locally advanced cancer is very likely to grow and spread. Additional tests are administered if the PSA levels and Gleason's score are high [¹].

It can be complicated, even for experienced doors, to figure out the stage of prostate cancer. It is believed that 95% of men (or 95 out of every 100 patients) will survive stage 3 prostate cancer for five years or more after the initial diagnosis [²].

What are the subtypes of stage 3 Prostate Cancer?

Stage 3 prostate cancer is further classified into subtypes IIIA, IIB, and IIIC. As a rule, an earlier letter indicates a lower stage. While every person’s prostate cancer experience is unique, most cancers have similar stages with a similar outlook that can receive the same treatment. Here are the stages of prostate cancer:

IIIA: The cancer has not spread to nearby lymph nodes outside the prostate. It can be detected by a digital rectal exam or with imaging tests such as transrectal ultrasound. The grade group is 1 to 4, with a PSA level of at least 20.

IIIB: The tumor has spread outside the prostate and may have also reached the seminal vesicles. It could have spread to nearby tissues such as the rectum, bladder, urethral sphincter, and the wall of the pelvis. However, at this stage, the cancer has not spread to nearby lymph nodes or elsewhere in the body.

IIIC: The cancer may or may not grow outside the prostate and into nearby tissues. It hasn’t spread to nearby lymph nodes or elsewhere in the body. The cancer cells appear to look notably different compared to healthier cells.

Stage 3 Prostate Cancer staging and diagnosis

Prostate Cancer staging

In general, the TNM system is used to describe and classify cancers, including Prostate Cancer, where:

• T (tumor) describes the size and location of the tumor
• N (nodes) indicates whether or not it has spread to nearby lymph nodes
• M (metastasis) describes if and how far the cancer has spread from its origin

The American Joint Committee on Cancer combines PSA levels and Gleason scores to identify the grade of prostate cancer. PSA stands for prostate-specific antigen, a protein produced by the prostate. High levels of PSA are often indicative of prostate cancer and are measured in ng/mL.

A Gleason score helps doctors learn about the aggressiveness of the cancer. Each grade is a number between 1 and 5. Both scores are combined to provide a final score.

How common is stage 3 Prostate Cancer?

Prostate cancer is one of the most common types of cancer in the US, with 288,300 new cases registered in 2023 alone. Nearly 34.700 deaths are attributed to complications from prostate cancer. Prostate cancer is so prevalent that approximately 13 in every 100 American men will be diagnosed with the condition in their lifetime, with 2 in 3 men dying from complications [³].

How is stage 3 Prostate Cancer diagnosed?

Stage 3 prostate cancer is diagnosed by a procedure known as a biopsy. It's when doctors remove a small piece of tissue sample from the prostate and examine it under a microscope to see if there are any cancer cells.

The cancer cells are then given a grading based on their Gleason score. The score indicates how likely the cancer is to spread.

There are a few types of biopsies that may be used to further study prostate cancer, including a transrectal biopsy and a transperineal biopsy. A transrectal biopsy is an ultrasound probe that is inserted into the rectum. It allows doctors to see where to pass the needle to collect tissue samples from the prostate.

A transperineal biopsy is when a needle is passed through the perineal skin and into the prostate instead of passing the needle through the rectum. The biopsy needle may be guided by an ultrasound inserted inside the rectum.

Although biopsies are shown to be reliable, they may still have problems such as:

• Failing to identify the tumor
• Requiring another biopsy if the PSA level continues to rise
• Finding low-risk cancers that do not require treatment

Further tests of stage 3 prostate cancer may be conducted using MRI scans, PET scans, and CT scans to build a detailed picture of the body. Doctors may also conduct an isotope bone scan to see if the cancer has spread to the bones.

Stage 3 Prostate Cancer Symptoms

Stage 3 prostate can cause the following symptoms in patients:

• Erectile dysfunction (due to lower testosterone levels due to treatments)
• Presence of blood in the semen
• Pain or discomfort in the pelvic region
• Pain or discomfort in the bone
• Weak urine stream or difficulty starting urination

Nearly all men with stage 3 cancer may experience erectile dysfunction. However, treatment can result in substantial improvement as long as the nerves are still intact.

Stage 3 Prostate Cancer Treatment

Patients with prostate cancer may undergo several types of treatment, including chemotherapy, immunotherapy, surgery, and biphosphate therapy. Treatments are available for bone pain caused by bone metastasis. New types of treatments are also being studied in clinical trials, such as photodynamic therapy, proton beam radiation therapy, and high-intensity focused ultrasound therapy, among others.

Stage 3 Prostate Cancer primary/first-line treatment

The most common treatment options include external beam radiation therapy (EBRET) in combination with surgical removal of cancer, active surveillance without immediate treatment, and hormone therapy. In most cases, surgery on its own is not enough to treat prostate cancer. First-line treatment for stage 3 prostate cancer consists of EBRT with long-term androgen deprivation therapy.

This treatment has been shown to improve the outcomes of many stage III patients [⁴].

Other types of treatment for stage 3 Prostate Cancer

This section explores other types of treatment for stage 3 prostate cancer, including:

• Combined Modality Therapy: Multimodality treatment uses a combination of surgery, radiation, hormone therapy, and chemotherapy to improve survival rates.
• Androgen Deprivation Therapy (ADT): Hormone therapy deprives men’s bodies of the necessary hormones needed for the prostate cancer to grow. It is designed to stop the release of testosterone to prevent the growth of cancer.
• Active surveillance: Treatment with radiation and surgery can have devastating side effects; therefore, it is important to choose a strategy of delaying any treatment until the symptoms of cancer reappear. This is known as watchful watching and is based on the premise that the patient may not benefit from first-line treatment of stage 3 prostate cancer. Individuals with a lower risk of cancer may be candidates for this type of treatment.
• Whole pelvic radiation therapy: Some patients may be at a high risk of cancers involving the pelvic lymph node. This is why radiation therapy may include the pelvic lymph nodes. Researchers in the US are conducting a clinical study that compares the efficacy of WPRT to prostate-only radiation [⁵].

Can stage 3 Prostate Cancer be cured?

Stage 3 prostate cancer is curable because treatment can slow the growth of tumors. Moreover, there are several treatments that can extend the patient’s lifespan and reduce the signs and symptoms of prostate cancer. In some cases, if the cancer has spread, the aim is no longer to cure it but to improve the patient's quality of life and manage their symptoms.

It is important to detect and treat stage 3 prostate cancer at an early stage. The vast majority of prostate cancer cases can be treated because tumors in the early stages are more likely to respond to treatment [⁶].

Prognosis: Stage 3 Prostate Cancer survival rate

Stage 3 Prostate Cancer survival rate

The survival rate for stage 3 prostate cancer is predicated on how early it is detected and treated. Around 95% of men (or 95 out of 100) will survive the cancer for five years or more after diagnosis [⁷].

Moreover, the discovery of new treatment methods from clinical trials is showing promising results for patients with stage 3 prostate cancer. There is an 80 percent survival rate for cT3 diagnosis at 20 years compared to 099% for cT2 [⁸].

Stage 3 Prostate Cancer Recurrence Rate

Although stage 3 prostate cancer can be cured, there is a high likelihood of recurrence. Studies show that about 20 to 30 percent of men will have a relapse after five years of initial therapy. The likelihood of recurrence depends on the aggressiveness of the cancer. Many online tools have been used to predict the likelihood of recurrence [⁹].

You can enter your values of PSA, Gleason score, and clinical stage in various online calculators to learn about your cancer recurrence rate. The Han Tables by Hopkins Medicine is a good online tool that gives you a good idea [¹⁰].

Stage 3 Prostate Cancer growth rate

Although not all prostate cancers are alike, most instances of stage 3 prostate cancer are characterized by a slow growth rate. Prostate cancers use androgens as fuel for growth. This is why most prostate cancer treatments are involved around hormonal therapy to lower the patient’s androgen levels.

Lifestyle changes for preventing and managing Prostate Cancer

Although there is no definitive protocol that patients can use to prevent prostate cancer, there are several lifestyle changes that can be made to reduce the risk of developing stage 3 prostate cancer and managing its symptoms.

• Making dietary changes: Patients should eat less trans and saturated fats and instead focus on omega-3 fatty acids from seeds, fish, and nuts. They should eat more fruits and vegetables, including tomatoes and leafy greens. Cruciferous vegetables, in particular, have been shown to protect against prostate cancer because of the presence of sulforaphane.
• Maintaining a healthy weight: Obesity is a major risk factor for stage 3 prostate cancer. Losing weight has been shown to reduce the risk of cancer and improve the patient's quality of life.
• Staying active: In addition to maintaining a healthy weight, staying active can also improve the immune system and fight the negative aspect of a sedentary lifestyle, all of which can contribute to prostate cancer.
• Avoid smoking and drinking: Smoking and alcohol can increase a man’s risk of developing stage 3 prostate cancer. And if you do decide to smoke and drink alcohol, try to do so in moderation. Note that some studies have found that the antioxidant properties of red wine may be beneficial to one’s health.
• Being sexually active: Studies have shown that being sexually active (with or without a sexual partner can decrease the diagnosis of prostate cancer. Although studies are still inconclusive, studies have shown that frequent ejaculation can clear the body of toxins and other substances that may cause inflammation.

Conclusion

Takeaway

Stage 3 prostate cancer means that the cancer has spread from the prostate gland into tubes that carry semen. The survival rate for stage 3 prostate cancer is about 95%, and the patient's quality of life can be significantly improved by early treatment and making certain lifestyle changes, such as avoiding smoking and drinking, as well as being sexually active.