If you’ve been diagnosed with stage 3 prostate cancer, you probably have a lot of questions. How serious is this diagnosis? What symptoms might I experience? What treatments will I need?

About 1 in 8 men in the United States will be diagnosed with prostate cancer in their lifetime, according to the American Cancer Society. Due to routine screening, most cases are found early before spreading outside of the prostate, but about 14 percent of prostate cancer is found at stage 3 (often written with Roman numerals: stage III). Also called the “regional stage,” this is the stage when prostate cancer has reached just outside of the prostate to the surrounding structures, but it hasn’t metastasized (spread) to other parts of the body.

In this guide, we explain what stage 3 prostate cancer means and what you can expect after a diagnosis.

What Does Stage 3 Prostate Cancer Mean?

First, it’s important to understand how prostate cancer is staged and classified. Similar to other cancers, the TNM staging system is used to describe prostate cancer. These are the parts of the TNM system:

• T (tumor) — How large the main tumor is and whether it’s grown outside the prostate gland
• N (nodes) — Describes whether nearby lymph nodes are involved
• M (metastasis) — Notes whether cancer has spread to nonregional lymph nodes, distant organs, or bones

Stage 3 prostate cancer is sometimes called “locally advanced prostate cancer.” That’s because stage 3 is regional or locally invasive but hasn’t spread to more distant parts of the body. This makes it more treatable.

Stage 3 is further divided into three subcategories.

Stage 3A

In stage 3A, the cancer is still within the prostate. There may be a high prostate-specific antigen (PSA) level in the blood, but the cancer still has lower grade features (meaning the cells look relatively normal under a microscope).

Stage 3B

In stage 3B, the cancer has extended out of the prostate and into nearby structures, such as the seminal vesicles (glands behind the bladder that produce semen).

Stage 3C

In stage 3C, the cancer may be within or beyond the prostate. In this case, the cancer is higher grade, meaning the cells look more abnormal under a microscope. This indicates more aggressive disease that represents a higher risk than the previous stages.

Symptoms of Stage 3 Prostate Cancer

Many people with prostate cancer, including stage 3 disease, have no noticeable symptoms at first. These symptoms only begin when the tumor grows large enough to affect the surrounding structures. Common symptoms in stage 3 cancer include a combination of urinary changes and pelvic symptoms:

• A weaker urinary stream
• Increased need to urinate
• Need to urinate at night
• Sensation that the bladder doesn’t empty all the way
• Blood in the urine or semen
• Pelvic pain
• Erectile dysfunction

Since stage 3 cancer hasn’t spread to the rest of the body, you should talk to your doctor if you’re experiencing full-body symptoms, like bone pain, weight loss, or arm/leg weakness. These symptoms are more characteristic of stage 4 (metastatic) prostate cancer.

Treatment Options for Stage 3 Prostate Cancer

Creating a stage 3 prostate cancer treatment plan depends on several factors, including:

• Your age and overall health
• The grade of your cancer
• PSA blood test levels at diagnosis
• Personal preferences regarding quality of life and side effects

Some common treatment strategies include radiotherapy (radiation), hormonal therapy, surgery, or active surveillance.

Radiation Therapy

One way to treat prostate cancer, including stage 3 prostate cancer, includes targeted radiation to kill cancer cells. For stage 3 cancer, radiation is usually delivered externally (from outside the body, also called external beam radiation therapy). Radiation may be used in combination with other treatment options, like before hormone therapy or after surgery.

Side effects of radiation include urinary changes and erectile dysfunction.

Hormonal Therapy

Another prostate cancer treatment strategy, hormonal therapy, is often used in combination with other treatment methods to treat stage 3 prostate cancer. Hormonal therapy works in prostate cancer by lowering testosterone, which can slow cancer growth. This method may be given after radiotherapy. Side effects of hormone therapy may include hot flashes, decreased desire for sex, and bone weakening.

Surgery

Many people with stage 3 prostate cancer are candidates for a surgery called a radical prostatectomy. In this procedure, a surgeon removes the prostate gland and its surrounding tissue (like the seminal vesicles and lymph nodes).

Surgery comes with possible side effects (like changes to urination and sexual function) and complications (like bleeding and infection risk). Surgeons will attempt to protect the nerves that control erection, but erectile dysfunction is often a side effect.

Active Surveillance

In some specific cases, doctors may opt for active surveillance for people with stage 3 prostate cancer. This involves regular monitoring with PSA tests, digital (gloved-finger) rectal exams, and occasional biopsies. If the cancer shows signs of progressing, they may recommend adding hormone therapy to the treatment plan. This approach can help delay, or even avoid, side effects from surgery or radiation while still watching the cancer closely.

Your doctors may also recommend imaging tests, like MRI or positron emission tomography (PET) scans, to help guide treatment decisions and see how the cancer is responding to treatment.

Stage 3 Prostate Cancer Prognosis

Prostate cancer in stage 3, while more advanced than stage 1 or 2, is still often highly treatable. With modern treatments, most people with stage 3 prostate cancer have positive survival rates. One recent estimate reports that about 95 percent of people live at least five years after being diagnosed with stage 3 prostate cancer.

Certain factors can influence outlook, such as grade, PSA levels, age, health, and treatment response:

• Tumor grade — A higher grade group indicates more aggressive cancer that’s more likely to spread or come back after treatment.
• PSA levels — A lower PSA at diagnosis is associated with a better treatment response.
• Age and health — Younger, healthier people generally tolerate treatment better than people with many other health conditions.

Risk of Recurrence

Even after a curative treatment of prostate cancer, the disease can still come back. A rising PSA level after initial therapy is usually the first sign of recurrence. Recurrence can sometimes be managed effectively with additional therapies, like immunotherapy, chemotherapy, and targeted therapy. Talk to your healthcare team about your risk for recurrence and appropriate follow-up.

Living With Stage 3 Prostate Cancer

A diagnosis of stage 3 prostate cancer can be overwhelming. Luckily, there are many effective treatment options available to help you live a long, healthy life. Speak to your doctor about what to expect after a stage 3 diagnosis. Seek support from family members, friends, and others living with prostate cancer to navigate treatment decisions.

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