Common prostate cancer, a.k.a. prostatic adenocarcinoma, develops gradually (like any cancer I guess): Increasing in size, breaching the prostate capsule, settling in nearby lymph nodes etc.
However, it seems that the main avenues of recommended treatment are dichotomous: Surgical removal of some/all the prostate, on the one hand, and radiation and chemotherapy on the other hand. The former is recommended for less-developed tumors which have not breached the capsule, and the latter for metastasized tumors.
(I realize the above is an oversimplification, and these aren't the only kinds of treatment, and there are different kinds and ways of doing surgery and of applying radiation, and maybe some others are more significant than I am assuming etc.)
My question regards the liminal state of affairs: When an adenocarcinoma is about to breach or has just breached the prostate capsule, but no cancerous cells are observed (*) anywhere else. I guess this would be a Stage IIIA or IIIB case.
In such situations, is it customary to still choose dichotomously between these two main avenues?
On the one hand, if a prostatectomy is chosen - some cancer cells may already be out and about and settling into a new location, in which they will later re-grow (and that's doubly the case for a partial prostatectomy I would guess).
On the other hand - if almost all, if not all, of the cancer cells are perfectly located in one spot, albeit a large one - does it really make sense to leave them be and attack a much wider area?
... or maybe there is some sort of combination of those which increases the chances of clearing all cancerous cells relative to the prostatectomy-only, but doesn't incur the full brunt of adverse effects of the radiation and/or chemotherapy?