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

Overview

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

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Stage IIA

  1. T1a–c, N0, M0, prostate-specific antigen (PSA) <20 ng/ml, Gleason 7.
  2. T1a–c, N0, M0, PSA ≥10 <20 ng/ml, Gleason ≤6.
  3. T2a, N0, M0, PSA ≥10 <20 ng/ml, Gleason ≤6.
  4. T2a, N0, M0, PSA <20 ng/ml, Gleason 7.
  5. T2b, N0, M0, PSA <20 ng/ml, Gleason ≤7.
  6. T2b, N0, M0, PSA X, Gleason X.

Stage IIB

  1. T2c, N0, M0, any PSA, any Gleason.
  2. T1–2, N0, M0, PSA ≥20 ng/ml, any Gleason.
  3. T1–2, N0, M0, any PSA, Gleason ≥8.

Radical prostatectomy, external-beam radiation therapy (EBRT), and interstitial implantation of radioisotopes are each employed in the treatment of stage II prostate cancer with apparently similar therapeutic effects. Radical prostatectomy and radiation therapy yield apparently similar survival rates with as many as 10 years of follow-up. For well-selected patients, radical prostatectomy associated with a 15-year survival comparable to an age-matched population without prostate cancer.[2] Unfortunately, randomized comparative trials of these treatment methods with prolonged follow-up are lacking.

Patients with a small, palpable cancer (T2a, N0, and M0) fare better than patients in whom the disease involves both sides of the gland (T2c, N0, and M0). Patients proven free of node metastases by pelvic lymphadenectomy fare better than patients in whom this staging procedure is not performed; however, this is the result of selection of patients who have a more favorable prognosis.

Side effects of the various forms of therapy—including impotence, incontinence, and bowel injury—should be considered in determining the type of treatment to employ. (Refer to the PDQ summary on Sexuality and Reproductive Issues for more information on impotence.)

Prostate-specific antigen (PSA) changes as markers of tumor progression

Often, changes in PSA are thought to be markers of tumor progression. Even though a tumor marker or characteristic may be consistently associated with a high risk of prostate cancer progression or death, it may be a very poor predictor of very limited utility in making therapeutic decisions.

Baseline PSA and rate of PSA change were associated with subsequent metastasis or prostate cancer death in a cohort of 267 men with clinically localized prostate cancer who were managed by watchful waiting or active surveillance in the control arm of a randomized trial comparing radical prostatectomy to watchful waiting.[3,4] Nevertheless, the accuracy of classifying men into groups whose cancer remained indolent versus those whose cancer progressed was poor at all examined cut points of PSA or PSA rate of change.

Bisphosphonates and risk of bone metastases

Patients with locally advanced nonmetastatic disease (T2–T4, N0–N1, and M0) are at risk for developing bone metastases. Bisphosphonates are being studied as a strategy to decrease this risk.

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WebMD Public Information from the National Cancer Institute

Last Updated: February 25, 2014
This information is not intended to replace the advice of a doctor. Healthwise disclaims any liability for the decisions you make based on this information.
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