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Treatment Option Overview for Prostate Cancer

    Local treatment modalities are associated with prolonged disease-free survival for many patients with localized prostate cancer but are rarely curative in patients with locally extensive tumors. Because of clinical understaging using current diagnostic techniques, even when the cancer appears clinically localized to the prostate gland, some patients develop disseminated tumors after local therapy with surgery or radiation. Metastatic prostate cancer is currently not curable.

    Treatment options for each stage of prostate cancer are presented in Table 9.

    Table 9. Treatment Options by Stage for Prostate Cancer

    Stage (TNM Staging Criteria)Standard Treatment Options
    TURP = transurethral resection of the prostate.
    Stage I Prostate CancerWatchful waiting or active surveillance
    Radical prostatectomy
    External-beam radiation therapy (EBRT)
    Interstitial implantation of radioisotopes
    Stage II Prostate CancerWatchful waiting or active surveillance
    Radical prostatectomy
    External-beam radiation therapy (EBRT) with or without hormonal therapy
    Interstitial implantation of radioisotopes
    Stage III Prostate CancerExternal-beam radiation therapy (EBRT) with or without hormonal therapy
    Hormonal manipulations (orchiectomy or luteinizing hormone-releasing hormone [LH-RH] agonist)
    Radical prostatectomy with or without EBRT
    Watchful waiting or active surveillance
    Stage IV Prostate CancerHormonal manipulations
    Bisphosphonates
    External-beam radiation therapy (EBRT) with or without hormonal therapy
    Palliative radiation therapy
    Palliative surgery with transurethral resection of the prostate (TURP)
    Watchful waiting or active surveillance
    Recurrent Prostate CancerChemotherapy for hormonal management of prostate cancer
    Immunotherapy

    Watchful Waiting or Active Surveillance

    Asymptomatic patients of advanced age or with concomitant illness may warrant consideration of careful observation without immediate active treatment.[1,2] Watch and wait, observation, expectant management, and active surveillance are terms indicating a strategy that does not employ immediate therapy with curative intent.

    Watchful waiting and active surveillance are the most commonly used terms, and the literature does not always clearly distinguish them, making the interpretation of results difficult. The general concept of watchful waiting is patient follow-up with the application of palliative care as needed to alleviate symptoms of tumor progression. There is no planned attempt at curative therapy at any point in follow-up. For example, TURP or hormonal therapy may be used to alleviate tumor-related urethral obstruction should there be local tumor growth; hormonal therapy or bone radiation might be used to alleviate pain from metastases. Radical prostatectomy has been compared with watchful waiting or active surveillance in men with early-stage disease (i.e., clinical stages T1b, T1c, or T2).[3] (Refer to the Radical Prostatectomy section in the Treatment Option Overview for Prostate Cancer section of this summary.)

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