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Prostate Cancer Treatment (PDQ®): Treatment - Health Professional Information [NCI] - Stage I Prostate Cancer Treatment

Overview

Stage I prostate cancer is defined by the American Joint Committee on Cancer's TNM classification system:[1]

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Understanding Prostate Cancer -- Symptoms

There are no warning signs of early prostate cancer. Once a tumor causes the prostate gland to swell, or once cancer spreads beyond the prostate, the following symptoms may happen: A frequent need to urinate, especially at night Difficulty starting or stopping a stream of urine A weak or interrupted urinary stream Leaking of urine when laughing or coughing Inability to urinate standing up A painful or burning sensation during urination or ejaculation Blood in urine or...

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  • T1a–c, N0, M0, prostate-specific antigen (PSA) <10 ng/ml, Gleason ≤6.
  • T2a, N0, M0, PSA <10 ng/ml, Gleason ≤6.
  • T1–2a, N0, M0, PSA X, Gleason X.

The frequency of clinically silent, nonmetastatic prostate cancer that can be found at autopsy greatly increases with age and may be as high as 50% to 60% in men aged 90 years and older. Undoubtedly, the incidental discovery of these occult cancers at prostatic surgery performed for other reasons accounts for the similar survival of men with stage I prostate cancer, compared with the normal male population, adjusted for age.

Many stage I cancers are well differentiated and only focally involve the gland (T1a, N0, M0); most require no treatment other than careful follow-up.[2]

In younger patients (aged 50–60 years) whose expected survival is long, treatment should be considered.[3] Radical prostatectomy, external-beam radiation therapy (EBRT), interstitial implantation of radioisotopes, and watchful waiting and active surveillance yield apparently similar survival rates in noncontrolled, selected series. The decision to treat should be made in the context of the patient's age, associated medical illnesses, and personal desires.[3]

Standard Treatment Options for Stage I Prostate Cancer

Standard treatment options for stage I prostate cancer include the following:

  1. Watchful waiting or active surveillance.
  2. Radical prostatectomy.
  3. External-beam radiation therapy (EBRT).
  4. Interstitial implantation of radioisotopes.

Watchful waiting or active surveillance

Asymptomatic patients of advanced age or with concomitant illness may warrant consideration of careful observation without immediate active treatment.[4,5,6] Watch and wait, observation, expectant management, and active surveillance are terms indicating a strategy that does not employ immediate therapy with curative intent. (Refer to the Watchful Waiting or Active Surveillance section in the Treatment Option Overview for Prostate Cancer section of this summary for more information.)

Evidence (observation with delayed hormonal therapy):

  1. In a retrospective pooled analysis, 828 men with clinically localized prostate cancer were managed by initial conservative therapy with subsequent hormonal therapy given at the time of symptomatic disease progression.
    • This study showed that the patients with grade 1 or grade 2 tumors experienced a disease-specific survival of 87% at 10 years and that their overall survival (OS) closely approximated the expected survival among men of similar ages in the general population.[4]
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