Radical Prostatectomy

• Radical retropubic prostatectomy
• Radical perineal prostatectomy
• Laparoscopic radical prostatectomy

Definitive Radiotherapy

• External Beam Radiotherapy (3-D conformational therapy or IMRT)
• Interstitial Radioactive seed implantation (Brachytherapy)
• Combined Eternal Beam Radiotherapy and Brachytherapy

Watchful Waiting

Watchful waiting is the name given to the practice of delaying hormonal therapy at the time of clinical progression or symptoms. Prostate cancer, relative to other malignancies, is a slow growing tumor. As such, approximately 25% of men will die from it. The majority of men with prostate cancer may die with it and succumb to other causes. This is especially true for older or ill men with prostate cancer. Patients with less than a ten-year life expectancy (i.e. men with heart disease, heart failure, severe diabetes mellitus, etc.), or older men, may not require aggressive treatment for their prostate cancers. This is especially relevant in men with low grade (well-differentiated tumors: Gleason score 2 – 4) and low stage disease (less than or equal to stage T2a). (Go to Treatment Strategies for details.)The limited benefit of radical prostatectomy or definitive radiotherapy in these patients should be weighed against the side effects of the treatment. When physicians are considering men for watchful waiting, the decision should not be based solely on the patient’s age (date of birth). Older men (75 and older) who are otherwise in excellent health should be considered for local therapy. In addition, older men who may have some medical issues with higher stage and higher-grade cancers should also be treated with active therapy. In summary, the keys to selecting patients for watchful waiting include the general health of the patient, the presence or absence of other medical conditions, grade and stage of the cancer, and, finally, the age of the patient

Radiation | Surgery | Prognostic Stategies | Treatment of Metastatic Prostate Cancer