Being told that prostate cancer has spread outside the prostate is frightening. Many men assume the spread means the cancer is no longer curable.
That assumption is often wrong.
Evidence indicates that many men with T3 prostate cancer live long lives, and a large proportion do not die from prostate cancer, even when the disease is locally advanced.
What does it mean when prostate cancer has spread outside the prostate?
When prostate cancer grows beyond the prostate gland but has not spread to distant organs, it is called T3 prostate cancer.
There are two primary forms:
- pT3a – cancer has grown just outside the prostate
- pT3b – cancer has grown into the seminal vesicles (glands behind the prostate)
This difference matters because outcomes are not the same.
Is prostate cancer still treatable at the T3 stage?
Yes. Radical prostatectomy (surgical removal of the prostate) remains an effective treatment for carefully selected men with T3 disease.
Surgery:
- Removes the main cancer bulk
- Provides excellent local cancer control
- Gives precise information about cancer aggressiveness
- Helps guide further treatment only when needed
Importantly, surgery does not exclude additional treatments later.
If I Have T3 Prostate Cancer, Can It Still Be Cured?
An extensive peer-reviewed study of men with T3 prostate cancer who underwent surgery showed the following 5-year outcomes:
- Overall survival: 91% (Most men were alive five years after surgery.)
- Cancer-specific survival: 94% (Very few died from prostate cancer).
Does the exact type of T3 cancer affect outcomes?
Yes — significantly.
Outcomes after robotic prostatectomy
pT3a (spread just outside the prostate):
- Cancer-specific survival: 98% chance of dying from prostate cancer.
- Overall survival: 96% chance of being still alive at 5 years.
pT3b (spread into seminal vesicles):
- Cancer-specific survival: 77% chance of dying from prostate cancer.
- Overall survival: 72% chance of being still alive at 5 years.
The difference between T3a and T3b is striking, and it explains why treatment decisions must be personalised.
How Aggressive Is My Prostate Cancer, and Why Does It Matter?
The Gleason score describes how aggressive prostate cancer cells appear under the microscope.
- Lower Gleason scores (≤7) behave more slowly
- Higher Gleason scores (≥8) behave aggressively
- Men with a Gleason score ≤7 had a 99% survival rate for prostate cancer.
- Men with a Gleason score ≥8 had a much higher risk of recurrence and death
Cancer biology matters as much as cancer stage.
Does Lymph Node Involvement Affect Survival in Prostate Cancer?
Lymph node involvement made a significant difference.
· Around 10% of men were found to have cancer in the pelvic lymph nodes at surgery
· These men had significantly worse outcomes than those without lymph node involvement
At five years:
· Men lymph node involvement had high survival rates
· Men with cancer in the lymph nodes had:
o Much higher risk of PSA recurrence
o Lower overall survival
In fact, men with positive lymph nodes had a five-year overall survival of around 40%, compared with much higher survival among men with clear lymph nodes.
Lymph node status is one of the strongest predictors of outcome after surgery for T3 prostate cancer.
What Does a Rising PSA After Prostate Surgery Mean?
After prostate removal, PSA should be close to zero or at undetectable levels.
A rise in PSA (called biochemical recurrence) means:
- Microscopic cancer cells may remain
- It does not mean symptoms
- It does not mean immediate danger
Data in men who underwent radical prostatectomy shows that
- Around 50% of men developed a PSA rise
- Yet most did not die from prostate cancer
PSA recurrence and survival are not the same thing.
Is Further Treatment Common After Prostate Cancer Surgery for T3 Disease?
Yes — and this is expected.
Around 1 in 3 men needed additional treatment, such as:
- Radiotherapy combined with Hormone therapy
A multimodal treatment is often planned rather than reactive.
Who benefits most from surgery for T3 prostate cancer?
Surgery works best in men who have:
- Cancer just outside the prostate (pT3a)
- Lower or intermediate Gleason score
- No lymph node involvement
These men often achieve excellent long-term cancer control.
When is radical prostatectomy alone not enough?
Men with:
- Seminal vesicle invasion (pT3b)
- High Gleason score
- Cancer in the lymph nodes
Although it often requires a combination of treatments, robotic prostatectomy remains a crucial factor in controlling and staging the disease.
Key facts for men with T3 prostate cancer want to know
- T3 prostate cancer is not automatically incurable
- Over 90% of men are alive five years after surgery
- Many men never die from prostate cancer
- A PSA rise does not mean treatment failure
- Surgery keeps future treatment options open
Frequently Asked Questions About T3 Prostate Cancer and Surgery
Is surgery worth having if prostate cancer has spread outside the prostate?
Yes. In carefully selected men with T3 prostate cancer, surgery can provide excellent long-term cancer control.
Studies indicate that over 90% of men are alive five years after surgery, and prostate cancer is uncommon, particularly when it does not spread to lymph nodes.
Does T3 prostate cancer always come back after surgery?
No. While a PSA rise is common, this does not mean the cancer will cause symptoms or shorten life.
Many men remain stable for years, and PSA changes can often be managed effectively with additional treatment if needed.
Is surgery still recommended for advanced (T3) prostate cancer?
Yes. Modern evidence supports surgery as part of a planned treatment strategy for selected men with T3 disease.
Surgery removes the primary cancer, improves local control, and provides vital information that helps tailor further treatment.
Will I need radiotherapy or hormone treatment after surgery for T3 prostate cancer?
Possibly. Around 1 in 3 men will need additional treatments, such as radiotherapy and hormone therapy.
Further prostate cancer treatment is often anticipated and does not mean surgery has failed.
Does the presence of cancer in the lymph nodes change treatment decisions?
Yes. Cancer found in the lymph nodes is associated with a higher risk of recurrence and usually means that combined treatment is required.
The presence of cancer in the lymph nodes is one of the strongest predictors of outcome after surgery.
