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Prostate Cancer Treatment (PDQ®): Treatment - Health Professional Information [NCI] - 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 Cancer Watchful waiting or active surveillance
Radical prostatectomy
External-beam radiation therapy (EBRT)
Interstitial implantation of radioisotopes
Stage II Prostate Cancer Watchful waiting or active surveillance
Radical prostatectomy
External-beam radiation therapy (EBRT) with or without hormonal therapy
Interstitial implantation of radioisotopes
Stage III Prostate Cancer External-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 Cancer Hormonal 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 Cancer Chemotherapy 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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