Prostate Cancer Treatment by Stage
Conditions · Prostate cancer · Treatment by stage
Prostate cancer treatment by stage: the newest options explained in plain language, and what the scans you are sent for actually show
A man with a new prostate cancer diagnosis is handed a vocabulary before he is handed a plan: Grade Group, PI-RADS, PSMA PET, active surveillance, SBRT, abiraterone, lutetium. This page translates it. It sets out how doctors decide which stage a cancer is in, what the multiparametric MRI and the PET scan are for, which treatment is standard at each stage in 2026, which newer treatments have genuinely earned their place, which are still experimental, and what each one costs in side effects. We are a clinic devoted to chronic prostatitis and we do not perform cancer surgery or radiotherapy; we wrote this because our patients keep asking, and because a clear map makes the conversation with the oncology team a better one.
Prostate cancer treatment at a glance
First, the map: how a prostate cancer gets its stage
Every treatment decision in prostate cancer starts from three numbers, and it is worth knowing them by heart. The first is the Grade Group, 1 to 5, which the pathologist assigns from the biopsy. It is the modern translation of the older Gleason score: Grade Group 1 is Gleason 3+3, the slow-growing pattern that rarely spreads; Grade Group 2 is 3+4; Grade Group 3 is 4+3; Grade Groups 4 and 5 are Gleason 8, 9 and 10, the aggressive patterns. The second number is the PSA at diagnosis, with 10 and 20 ng/ml as the dividing lines. The third is the stage, which describes extent: T1 and T2 cancers are still inside the gland, T3 has pushed through the prostatic capsule or into the seminal vesicles, T4 has reached neighbouring organs; N1 means cancer in the pelvic lymph nodes, M1 that it has travelled further, usually to bone.
Put together, the three numbers place a man in a risk group, and the risk group is what the guidelines, and your doctors, actually use. For cancer that has not spread there are four: low risk, favourable intermediate, unfavourable intermediate and high risk. Locally advanced cancer (T3, T4 or N1) is treated with the high-risk group. Cancer that has already spread is called metastatic, and is further divided by whether it still responds to hormone therapy and by how much of it there is.
The sentence to ask your doctor for, and to write down, is this one: “My cancer is Grade Group …, my PSA was …, the stage is …, which makes it … risk.” Everything on this page follows from it.
The four risk groups of cancer that has not spread
Low risk: Grade Group 1, PSA under 10, confined to one side of the gland or less (T1 to T2a).
Favourable intermediate: Grade Group 2 with only a little pattern 4, PSA under 10, few positive biopsy cores.
Unfavourable intermediate: Grade Group 3, or Grade Group 2 with several adverse features (PSA 10 to 20, many positive cores, both lobes involved).
High risk: Grade Group 4 or 5, or PSA over 20, or cancer through the capsule (T3), or any pelvic lymph node (N1). This is the group where the biggest advances of the last five years have landed.
The scans everyone is sent for, explained: multiparametric MRI, PSMA PET, biopsy
Ten years ago a man with a raised PSA went straight to a biopsy, and a man with a confirmed cancer went for a bone scan and a CT. Both steps have been reorganised around two newer scans, and because the reports arrive full of abbreviations, patients are often more confused after the scan than before it.
Multiparametric MRI (mpMRI): the scan before the biopsy
“Multiparametric” means the scanner takes several kinds of image of the prostate in one session, each sensitive to something different: the shape of the tissue, how freely water moves through it (cancer is denser, so water moves less) and how blood flows through it. The radiologist combines them into a single suspicion score, PI-RADS 1 to 5. A score of 1 or 2 means a significant cancer is unlikely and, in most men, the biopsy can be avoided or deferred. A score of 4 or 5 means there is an area that looks like a clinically significant cancer and should be sampled. A 3 is the grey zone, where the PSA density (PSA divided by the volume of the gland) usually settles the question.
The scan takes about half an hour lying still in the tunnel of the machine; many protocols now skip the contrast injection. It does not hurt and involves no radiation. Two things it cannot do: it cannot say what grade a cancer is, only the biopsy can, and it misses a minority of significant cancers, about one in ten, which is why a negative MRI in a man whose PSA keeps rising is not the end of the story.
PSMA PET/CT: the scan that looks for spread
PSMA stands for prostate-specific membrane antigen, a protein that sits on the surface of prostate cancer cells in far greater amounts than on normal cells. The scan uses a small dose of a radioactive tracer (usually gallium-68 or fluorine-18) attached to a molecule that binds to PSMA; after about an hour the man lies in a combined PET and CT scanner, and wherever the tracer has accumulated, the cancer lights up against the anatomical map of the CT. It takes about two hours all in, and the radiation dose is modest.
It has largely replaced the old pair of bone scan plus CT for staging, because it finds deposits in lymph nodes and bone that those scans missed, and it is now the guideline-recommended staging test for unfavourable-intermediate and high-risk cancer, for a rising PSA after treatment, and before PSMA-targeted therapy. Low-risk cancers do not need it: the chance of spread is too small for the scan to change anything. Its limit is size: deposits of a few millimetres are below what it can see, so a “clear” PSMA PET lowers the probability of spread substantially without making it zero.
The biopsy: targeted, systematic, and increasingly through the skin
The biopsy is the only test that gives a Grade Group. A modern one is done with the MRI images fused to the live ultrasound picture, so that the needle is aimed at the suspicious area (“targeted” cores) with a few additional cores from the rest of the gland (“systematic”), because the MRI occasionally misses a second lesion. The route matters: the traditional transrectal biopsy passes the needle through the rectal wall and carries a small but real risk of a serious infection; the transperineal route, through the skin between the scrotum and the anus, has nearly no infection risk and is now the preferred approach in European guidance. It is done under local anaesthetic or light sedation and takes about twenty minutes.
Other tests you may hear about
Bone scan and CT: the older staging pair, still used where PSMA PET is unavailable. PSA density: PSA divided by gland volume in millilitres; below about 0.15 argues against significant cancer. Genomic tests (Decipher and similar) read the biopsy tissue for the activity of a panel of genes and can refine the risk of a borderline case; they are an adjunct, not a decision-maker. Germline genetic testing for BRCA1, BRCA2 and related genes is recommended for men with metastatic or high-risk cancer and for those with a strong family history, because it changes both treatment (PARP inhibitors) and the advice given to relatives.
A high PSA is more often inflammation than cancer, and a chronically inflamed prostate also produces suspicious-looking areas on MRI and ultrasound. In a man under 60 with a PSA that jumped rather than crept, we investigate and treat the prostatitis first and then repeat the PSA; a surprising number of “suspicious” pictures resolve. That is not an argument for delay in a man with a PI-RADS 5 lesion or a hard nodule. It is an argument for a proper examination of the gland, with transrectal ultrasound and Doppler, before the needle, so that the biopsy is done for the right reason and read in the right context. Read how prostatitis and prostate cancer are connected.
Treatment of cancer that has not spread: stage by stage
The single most important fact about localised prostate cancer is that, for most men, the choice of treatment changes the side effects far more than it changes survival. The ProtecT trial followed 1,643 men randomised to surgery, radiotherapy or monitoring for fifteen years; death from prostate cancer was about 3% in every group. That is why the honest question at this stage is less “which treatment cures best?” than “which set of trade-offs can I live with?”
Low risk (Grade Group 1): the standard treatment is not to treat, yet
Grade Group 1 cancer almost never spreads and very rarely kills. European and American guidelines now say plainly that the default for these men is active surveillance: a PSA every six months, an MRI at intervals, and a repeat biopsy when either changes, with curative treatment held in reserve for the minority whose cancer is upgraded. Surveillance is a treatment, with a schedule and a doctor in charge of it, and it is not the same as doing nothing. In the ProtecT trial, men who were monitored had the same fifteen-year survival as those operated on or irradiated, and spared themselves the side effects. Modern surveillance, built around the MRI rather than blind repeat biopsies, is safer still than the version those men had.
A man who cannot tolerate living with an untreated cancer can still choose surgery or radiotherapy, and will be cured with near certainty, at the price described further down. What the guidelines advise against at this stage is the fashionable middle path of focal therapy, where only the part of the gland containing the tumour is destroyed with heat (HIFU), cold (cryotherapy), electrical pulses (IRE) or an MRI-guided ultrasound probe (TULSA). These techniques have no long-term randomised evidence, roughly a third to a half of men treated with them need further treatment within five to ten years, and in Grade Group 1 they are, bluntly, treating something that did not need treating. They belong in clinical trials.
Favourable intermediate risk (Grade Group 2): three good options, one newly proven
Here the cancer has some aggressive cells (Gleason pattern 4) and most men are advised to treat it, although selected men with a very small amount of pattern 4 can still be watched. Three treatments give similar cancer control, roughly nine men in ten free of recurrence at five to ten years, and differ in their side effects.
Radical prostatectomy removes the whole gland and the seminal vesicles, today almost always through a few small incisions with a surgical robot. The surgeon can spare the nerves that run beside the prostate and control erections, if the cancer’s position allows. Recovery is a few weeks; the catheter comes out after about a week. External radiotherapy delivers a precisely shaped dose over several weeks; the newest form, stereotactic body radiotherapy (SBRT), concentrates it into five sessions. The PACE-B trial compared the two in 874 men and found five-session SBRT just as effective (around 96% free of failure at five years versus 95% for the long course), with somewhat more urinary irritation in the first months. SBRT is no longer experimental; it is a standard option. Brachytherapy places radioactive seeds (low-dose-rate) or a temporary high-dose source directly in the gland in a single session and controls favourable intermediate cancer in more than 90% of men at five years. Hormone therapy is usually not needed in this group.
Unfavourable intermediate risk (Grade Group 3): treat, and add hormones to radiotherapy
With Gleason 4+3, or Grade Group 2 with several adverse features, the risk of recurrence rises and the treatment is intensified. Surgery now usually includes removal of the pelvic lymph nodes, and the man is told in advance that a third or more may need radiotherapy afterwards if the pathology is unfavourable. Radiotherapy is combined with four to six months of hormone therapy, which trials showed reduces recurrence, and in many centres with a brachytherapy boost to the gland. The FLAME trial added an extra dose of radiation to the MRI-visible tumour within the gland and raised five-year control from 85% to 92% with no excess of serious side effects; this “focal boost” is becoming routine where the planning tools exist. Focal therapy alone is not advised at this stage: too many of these cancers have more than one site.
High-risk and locally advanced cancer: where the real advances have been
This is the group, Grade Group 4 or 5, PSA above 20, cancer through the capsule or in the seminal vesicles (T3), or in pelvic lymph nodes (N1), in which single treatments are rarely enough and in which the last five years have produced genuine change. Two standard paths exist and both are combinations.
Path A: radiotherapy with long hormone therapy, now often with abiraterone
High-dose radiotherapy to the prostate (and often the pelvic nodes) combined with two to three years of hormone therapy has been the backbone for twenty years. The STAMPEDE trial then showed that adding abiraterone, a tablet that blocks the body’s remaining testosterone production, for two years cut the risk of metastasis by about half: 82% of men free of metastases at six years against 69% without it, with a similar gain in survival. For men with two or more high-risk features, or with positive pelvic nodes, this is now the European guideline recommendation. Cancer in pelvic nodes, which was once treated as incurable, is treated with curative intent on this path.
Path B: surgery with lymph nodes, now with hormone treatment around it
Radical prostatectomy with an extended lymph-node dissection remains an option for fit men, accepting that many will need radiotherapy or hormone therapy afterwards. What changed in 2026 is the PROTEUS trial of more than 2,000 men, which gave apalutamide, a newer anti-androgen tablet, together with hormone therapy for six months before and six months after surgery: at five years 78% of those men were free of metastases against 74% without the drug, and nearly one in ten had no cancer left to find in the removed gland. It is the first randomised proof that drug treatment around surgery improves outcomes in localised prostate cancer, and it is entering the guidelines now.
Two points of orientation. First, cancer that has gone through the capsule (T3) is not the same as cancer that has spread: it remains curable, and radiotherapy with long hormone therapy is the best-supported route to that cure. Second, this is the stage at which the PSMA PET earns its keep: in roughly one man in ten to one in five with high-risk disease and apparently clean conventional scans it finds a deposit elsewhere, which changes the plan before the treatment starts rather than after it fails.
PSA rising after treatment: what “biochemical recurrence” means and what is done
After a prostatectomy the PSA should become undetectable, because the organ that makes it has gone. After radiotherapy it falls over a year or two to a low point, the nadir, and stays there. A PSA that climbs again, to 0.2 ng/ml or more after surgery or to 2 ng/ml above the nadir after radiotherapy, is called a biochemical recurrence. It is common, affecting roughly a quarter to a third of men treated for intermediate and high-risk cancer within ten years, and it is not the same as symptoms, spread or danger: many men live for decades after one. What it means is that cancer cells remain somewhere, and the first task is to find out where, which is exactly what the PSMA PET is for. It can locate the recurrence at PSA levels well below 1 ng/ml, where older scans saw nothing.
After surgery, the standard is early salvage radiotherapy to the bed where the prostate was, started while the PSA is still low (below about 0.5 ng/ml), often with six months to two years of hormone therapy if the pathology was unfavourable. Three large trials settled that waiting for the PSA to rise and then treating gives the same results as irradiating everyone immediately after surgery, with fewer men exposed to radiotherapy they did not need. Given early, salvage radiotherapy controls the cancer long-term in roughly half to two-thirds of men.
After radiotherapy, and when the PET finds a few spots
After radiotherapy the options are narrower, because operating on an irradiated gland is difficult. In specialised centres a salvage prostatectomy, re-irradiation with brachytherapy, or focal salvage with HIFU or cryotherapy can cure about half of men whose recurrence is confined to the gland, at the cost of higher rates of incontinence and stricture than first-line treatment. When the recurrence is slow-growing and the man is older, watching with deferred hormone therapy is entirely reasonable.
When the PSMA PET shows only a few deposits, in nodes or bone, the term is oligometastatic, and highly focused radiotherapy to each spot (metastasis-directed therapy) can postpone hormone therapy by a year or more. The guidelines still call this approach investigational, because it has not yet been shown to prolong life; it is widely offered in trials and in practice for the time it buys.
Metastatic prostate cancer: a disease now controlled for years, and the drugs that do it
When cancer has spread to bone or distant nodes it is rarely eliminated, but it is controlled, often for many years, and the controlling treatments have multiplied. The organising idea is simple: prostate cancer feeds on testosterone, so the first move is to remove the fuel, and the advances of the last decade consist of removing it more completely, earlier, and in combination.
Hormone therapy and its partners
Androgen-deprivation therapy (ADT), by injection every one to six months, switches off testicular testosterone. Used alone it is no longer the standard. Four trials showed that adding a newer hormonal tablet from the start, abiraterone, enzalutamide, apalutamide or darolutamide, prolongs life substantially, and for men with extensive disease adding six cycles of docetaxel chemotherapy on top (the “triplet”) prolongs it further. For men whose spread is limited, radiotherapy to the prostate itself also improves survival. The side effects of hormone therapy are real and are discussed below.
Lutetium-177 PSMA: radiation that travels to the cancer
The same PSMA molecule that makes the PET scan work can carry a therapeutic radioactive atom, lutetium-177, delivered by infusion every six weeks for up to six doses. It binds to the cancer cells wherever they are and irradiates them from within. The VISION trial established it in men whose cancer had stopped responding to hormones and chemotherapy, where survival rose from about 11 months to about 15, and in 2025 the PSMAddition trial showed that adding it to hormone treatment at the very first line of metastatic disease delays progression by about a quarter. The PSMA PET is done first, to confirm that the cancer takes up the tracer. The main side effects are dry mouth, fatigue and lowered blood counts.
Castration-resistant cancer: choosing by biology
Eventually the cancer learns to grow on very little testosterone; the term is castration-resistant. The sequence of treatments is then chosen by the tumour’s biology. Men whose cancer carries a BRCA or related mutation (around one in ten) benefit from PARP inhibitors (olaparib, niraparib, talazoparib), which is why genetic testing of the tumour is now routine at this stage. Lutetium-PSMA, docetaxel and cabazitaxel chemotherapy, and radium-223 for painful bone disease each have their place. Immunotherapy helps only the small group with a particular DNA-repair defect (MSI-high).
Several approaches are generating excitement and, for now, nothing more than trial enrolment: actinium-225 PSMA, an alpha-emitting cousin of lutetium that is more potent and harder on the salivary glands; bispecific antibodies that drag the body’s own T cells onto the cancer and frequently cause a flu-like cytokine reaction; CAR-T cells engineered against PSMA or STEAP1; antibody-drug conjugates; and drugs targeting the AKT and PTEN pathway in the subset of tumours that have lost PTEN. A man offered any of these outside a clinical trial should ask why.
Side effects compared: what each treatment costs
This is where the choice between treatments is really made, and where patients are most often under-informed. The numbers below come from the one trial that randomised men between surgery, radiotherapy and monitoring and asked them, year after year, how they were.
Surgery
Urinary leakage is almost universal in the first weeks and improves steadily; by a year most men are dry or use at most a small pad, but a persistent minority, around one in six in the ProtecT trial and fewer in modern robotic series, still need pads years later. Erections depend on whether the nerves could be spared, on age and on how good they were before; with nerve-sparing roughly half of men regain erections adequate for intercourse within two years, often with tablets, and the rest need injections or an implant. Ejaculation stops permanently, since the glands that produce the fluid are removed, and the penis may shorten slightly. Bowel function is unaffected.
Radiotherapy, brachytherapy, SBRT
Urinary symptoms are the opposite kind: urgency, frequency and burning rather than leakage, worst during and just after treatment and usually settling within months, with a small risk of stricture or chronic bladder irritation later. Bowel symptoms, loose or occasionally bloody stools, occur in a minority, mostly in the first year, and are reduced by modern planning and by a gel spacer placed between the prostate and the rectum. Erections are preserved initially and decline gradually over several years, so that by five years the rates approach those after surgery. Ejaculation is preserved, though the volume falls. Brachytherapy spares continence almost completely and shares the urinary irritation.
Hormone therapy
Switching off testosterone, for six months or for three years, brings hot flushes, loss of libido and erections, fatigue, loss of muscle and bone, weight gain and, in some men, low mood and poorer concentration. Over years it raises the risk of fractures, diabetes and cardiovascular events, which is why bone density, blood sugar and blood pressure are monitored and why exercise during hormone therapy is prescribed rather than merely suggested. The newer tablets add their own effects: abiraterone raises blood pressure and needs a steroid alongside it, enzalutamide and apalutamide cause fatigue and, less often, rashes or falls. Most effects reverse when a short course ends; after a long course testosterone can take a year or more to return.
Active surveillance
No physical side effects beyond the discomfort of the repeat biopsies, which the MRI has made less frequent. The cost is psychological: living with a known cancer suits some men and not others, and about a quarter eventually choose treatment for reasons of anxiety rather than progression. That is a legitimate reason. What surveillance does not cost, in the groups for which it is recommended, is survival.
Hype check: claims to be careful with
Prostate cancer treatment is a competitive market and the language used to sell it is not always the language of the evidence. A few of the claims we hear most often from patients, and what the studies actually say.
“Robotic surgery is more precise and cures more”
The robot gives the surgeon magnified 3D vision and steadier instruments, less blood loss and a faster recovery than open surgery. No randomised trial has shown that it removes the cancer more completely or preserves erections better than skilled laparoscopic or open surgery. The variable that predicts outcome is the surgeon’s experience, not the brand of the machine. Ask how many prostatectomies the surgeon does a year.
“HIFU treats the cancer with no side effects”
Focal HIFU does preserve continence in most men and avoids some of the sexual side effects of whole-gland treatment. It also leaves the rest of the gland in place, misses cancer outside the treated zone, and in the published series a third to half of men need further treatment within a decade, often whole-gland treatment with its full side effects after all. European guidelines classify all focal therapies as experimental.
“Proton therapy is superior to ordinary radiotherapy”
Protons deposit less stray dose in surrounding tissue, which is an attractive physical property. In prostate cancer no randomised comparison has shown better cancer control or fewer side effects than modern photon radiotherapy (IMRT, VMAT, SBRT), and the cost is several times higher. It is a reasonable choice where it is available and affordable; it is not a reason to travel.
“The PSMA PET was clear, so it has not spread” and “90% success”
A clear PET means no deposit large enough to see, not no deposit. And any percentage quoted as “success” should come with its definition: “free of a rising PSA at five years” is a very different claim from “free of metastases at ten” or “alive at fifteen”. When you are given a number, ask what was measured and for how long.
Our work is chronic prostatitis, and we do not perform prostate cancer surgery, radiotherapy or systemic treatment; men with a confirmed cancer are referred to the uro-oncology and radiotherapy colleagues we trust. What we do, and what we would urge any man with a rising PSA or a suspicious scan to insist on, is a thorough diagnosis before anything irreversible: a proper examination of the gland with transrectal ultrasound and Doppler, a repeat PSA after any inflammation has been treated, an MRI read by a radiologist who reads prostates every week, and a biopsy done for the right reason and by the safer route. A great deal of what is treated as cancer risk in a younger man is chronic inflammation, and a great deal of cancer in older men is found late because the yearly check was skipped. Both are avoidable.
A rising PSA, a suspicious MRI, or a diagnosis you do not understand?
Send us your PSA history, any ultrasound, MRI or biopsy reports and your symptoms. We will tell you honestly whether the picture points to inflammation or to cancer, what the next test should be, and, if the diagnosis is cancer, what the stage means and which questions to take to the oncology team.
Questions patients ask about prostate cancer treatment
What is the best treatment for prostate cancer in the early stages?
For Grade Group 1 cancer the best treatment is usually active surveillance; for Grade Group 2, surgery, radiotherapy (including five-session SBRT) and brachytherapy give similar cancer control and the choice turns on side effects and personal preference. No trial has shown one to cure more men than another at this stage.
What is the success rate of radiation therapy for prostate cancer?
For localised cancer, around 90 to 95% of men are free of recurrence at five years and most of those remain so at ten; for high-risk cancer combined with long hormone therapy and abiraterone, about 80% are free of metastases at six years. Always ask which outcome a quoted figure refers to.
How long does radiation treatment for prostate cancer take?
Conventional external radiotherapy is given in 20 to 39 daily sessions over four to eight weeks; SBRT in five sessions over one to two weeks; brachytherapy with seeds in a single procedure. Each external session takes about fifteen minutes, most of it positioning.
What do Gleason 6, 7, 8 and 9 mean?
Gleason 6 (3+3) is Grade Group 1, the least aggressive pattern. Gleason 7 is either 3+4 (Grade Group 2) or 4+3 (Grade Group 3); the order matters, because the first number is the dominant pattern. Gleason 8 is Grade Group 4 and Gleason 9 to 10 is Grade Group 5, the aggressive patterns that need combined treatment.
My PSA is rising on hormone therapy. What does it mean?
It usually means the cancer has become castration-resistant, able to grow on very little testosterone. It is not the end of treatment: the newer hormonal tablets, lutetium-PSMA therapy, PARP inhibitors for BRCA-mutated cancers and chemotherapy all work at this stage, and a PSMA PET and a genetic test of the tumour decide the order.
What is a normal PSA after radiotherapy?
There is no single number. After radiotherapy the PSA falls slowly over one to two years to a low point, often below 0.5 ng/ml, and small fluctuations (“bounces”) are common and harmless. A recurrence is defined as a rise of 2 ng/ml above the lowest value reached.
Is stage T3 prostate cancer curable, and what is the outlook?
Yes. T3 means the cancer has grown through the capsule, not that it has spread. Treated with radiotherapy and two to three years of hormone therapy, with abiraterone added when other high-risk features are present, about four men in five are free of metastases at six years, and most of those are cured.
What is “bloodless” treatment for prostate cancer?
The phrase usually refers to radiotherapy, brachytherapy or focal therapies such as HIFU, which involve no operation. Radiotherapy and brachytherapy are fully established alternatives to surgery with their own side effects; HIFU and the other focal treatments are still experimental and should be offered within trials.
Do I need a PSMA PET scan?
If your cancer is unfavourable-intermediate or high risk, yes, before treatment is planned. If it is low risk, no: the chance of spread is too small for the scan to change the plan. It is also the right scan when the PSA rises after treatment, and before lutetium-PSMA therapy.
Could my high PSA be prostatitis rather than cancer?
Often. Chronic inflammation raises PSA, sometimes dramatically, and can produce suspicious areas on MRI. In a man under 60 with a PSA that jumped, inflammation is the likelier cause and should be looked for and treated before any biopsy is interpreted. Read about PSA on our prostate cancer page.
Sources
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- National Comprehensive Cancer Network. NCCN Clinical Practice Guidelines in Oncology: Prostate Cancer, 2026.
- Hamdy FC, Donovan JL, Lane JA et al. Fifteen-year outcomes after monitoring, surgery, or radiotherapy for prostate cancer. N Engl J Med 2023;388:1547–58.
- Donovan JL, Hamdy FC, Lane JA et al. Patient-reported outcomes after monitoring, surgery, or radiotherapy for prostate cancer. N Engl J Med 2016;375:1425–37.
- Kasivisvanathan V et al. MRI-targeted or standard biopsy for prostate-cancer diagnosis (PRECISION). N Engl J Med 2018;378:1767–77.
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- Attard G et al. Abiraterone acetate and prednisolone with or without enzalutamide for high-risk non-metastatic prostate cancer (STAMPEDE). Lancet 2022;399:447–60.
- Taplin ME et al. Perioperative apalutamide in high-risk localized prostate cancer (PROTEUS). N Engl J Med 2026.
- Sartor O et al. Lutetium-177-PSMA-617 for metastatic castration-resistant prostate cancer (VISION). N Engl J Med 2021;385:1091–103.
- PSMAddition investigators. 177Lu-PSMA-617 plus standard of care versus standard of care in PSMA-positive metastatic hormone-sensitive prostate cancer. Presented at ESMO 2025; full publication 2026.
- Smith MR et al. Darolutamide and survival in metastatic hormone-sensitive prostate cancer (ARASENS). N Engl J Med 2022;386:1132–42.
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