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Prostate Cancer Treatment

Because prostate cancer usually develops deep in the parenchyma of the gland, complete resection of tumor is not possible through a transurethral approach, which simply cores out or scrapes away the tissue adjacent to the urethra.

Both radical prostatectomy and external beam radiation therapy have potential complications; which modality to use must be a mutual decision of the attending physician and the patient.

Treatment Options by Stage

American Urologic Association (AUA) Staging System.

The AUA Staging System roughly equates to the AJCC Staging System (For example, Stage A = Stage I, Stage B = Stage II, etc.).

Stage A1 (occult)

Observation without immediate treatment. If the patient is younger (age 50-60), immediate treatment may be considered.

Stage A2 (diffuse tumor)

  1. External beam radiation therapy following transurethral resection
  2. Radical prostatectomy with pelvic lymphadenectomy
  3. Interstitial radioisotopes

Stage B (palpable prostate tumor at diagnosis)

  1. Radical prostatectomy with pelvic lymphadenectomy
  2. External beam radiation therapy following transurethral resection
  3. Interstitial radioisotopes (under clinical evaluation)

Stage C (extracapsular extension)

  1. External beam radiation therapy following transurethral resection (for cure)
  2. Radical prostatectomy with pelvic lymphadenectomy in selected patients (for cure)
  3. Orchiectomy for symptomatic patients
  4. Transurethral resection (for palliation)
  5. Hormone therapy (Leuprolide or estrogens)
  6. Interstitial radioisotopes (under clinical evaluation)

Stage D1 (regional lymph node involvement, distant metastases)

  1. Orchiectomy
  2. Hormone therapy - single agents or combinations
  3. Systemic chemotherapy (under clinical evaluation)