A step-by-step overview of staging, treatment options, likely outcomes, and where to get care.
Prostate Cancer Treatment Guide
Quick overview
Treatment is tailored to your stage (how far the cancer has grown), grade (Gleason/Grade Group, how aggressive the cells look), PSA level, age and general health. Decisions are made together with a multidisciplinary cancer team.
Staging — what it means and how it guides treatment
Staging combines clinical exam (DRE), PSA, biopsy (Gleason/Grade Group) and imaging (mpMRI, CT, bone scan or advanced PET where available).
| Stage (clinical) | Typical findings | Risk group | Common treatment approach |
|---|---|---|---|
| Stage I | T1–T2a; low PSA; Gleason ≤6 (Grade Group 1) | Low risk | Active surveillance; selective focal therapies |
| Stage II | T2b–T2c; PSA moderately elevated; Gleason 7 (Grade Group 2–3) | Intermediate risk | Radical prostatectomy OR radiation therapy ± short-term hormone therapy; brachytherapy in select cases |
| Stage III | T3: extracapsular extension; higher PSA/Gleason | High risk | Radiation + long-term hormone therapy OR surgery with possible adjuvant radiation |
| Stage IV | N1 and/or M1 (node-positive or metastatic disease) | Advanced / metastatic | Systemic therapy (ADT ± novel anti-androgens ± chemo); palliative radiation for symptoms; clinical trials |
Use this table as a starting point — final decisions depend on your full reports, general health and personal goals.
Treatment options — detailed
A. Active surveillance
Regular monitoring with PSA tests, mpMRI and periodic biopsies. Best for men with low-risk, localized disease who want to avoid immediate side effects of curative treatments.
B. Surgery — Radical prostatectomy
Removal of the prostate (open, laparoscopic, or robotic). Often recommended for localized disease in men fit for surgery. Nerve-sparing techniques may reduce erectile dysfunction risk.
C. Radiation therapy
External Beam Radiation (EBRT): Daily outpatient treatments over several weeks with modern techniques (IMRT, IGRT).
Brachytherapy: Radioactive seeds placed in the prostate for selected low–intermediate risk cases.
D. Hormone therapy (Androgen-Deprivation Therapy — ADT)
Drugs or procedures that lower testosterone. Used with radiation for high-risk disease, or as primary/systemic therapy for metastatic disease. Side effects are manageable with supportive care.
E. Chemotherapy
Typically docetaxel for metastatic or castration-resistant cases. Sometimes combined early with ADT in high-volume metastatic disease.
F. Targeted & newer options
PARP inhibitors for select genetic profiles, radiopharmaceuticals for bone mets (e.g., radium-223), and immunotherapy or clinical-trial agents — usually for advanced disease.
What test results mean for treatment
Below are typical patterns and what they commonly lead to — your doctor will interpret your results in context.
- Low PSA + low Grade Group + organ-confined: Often eligible for active surveillance.
- Higher PSA and/or Grade Group 2–3: Curative options like surgery or radiation are considered.
- Extracapsular extension or positive nodes: Radiation with long-term ADT or surgery + adjuvant therapy is often recommended.
- Metastatic disease: Systemic therapy (ADT ± novel agents ± chemo), symptom-directed radiation and supportive care.
Where to get consultation & treatment in Pakistan
Major tertiary centres with urology and oncology services include (confirm services and appointment procedures when contacting):
- Pakistan Kidney and Liver Institute & Research Centre (PKLI) — Lahore. Multidisciplinary urology and oncology services; availability of robotic-assisted surgery, the first of its kind in the entire city.
- Shaukat Khanum Memorial Cancer Hospital & Research Centre (SKMCH) — Lahore (and Peshawar). Comprehensive cancer services with oncology, surgery, radiation therapy and support programs.
- Institute of Nuclear Medicine & Oncology Lahore (INMOL) — Lahore. Oncology, radiation therapy and nuclear medicine services for staging and treatment.
- Sindh Institute of Urology and Transplantation (SIUT) — Karachi. A leading public hospital offering robotic-assisted urological surgery (including prostate-procedures) via its Versius system.
Other government and private hospitals also provide urology and oncology care around the country. Ask your GP or local hospital for referrals to tertiary centres with modern imaging and multidisciplinary teams.
Practical checklist — next steps after diagnosis
- Get a clear written summary of your stage, Gleason/Grade Group and latest PSA.
- Request a multidisciplinary (tumour board) review if available.
- Discuss treatment options, side effects and likely outcomes with specialists.
- Consider a second opinion before radical treatment.
- Plan support: family involvement, physiotherapy, sexual health counseling and mental health support.
- Keep organised records of all reports, scans and treatments.
A diagnosis is not the end — it’s the start of getting the right care and living well
Prostate cancer care has advanced significantly. With early diagnosis, the right team, and family support, many men return to active, fulfilling lives. Take things one step at a time and ask for help when you need it.
