Prostate Cancer: Options in Therapy for Early-Stage Cancer
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The current treatments for organ-confined prostate cancer are watchful waiting, radical prostatectomy (RP), and radiation therapy (RT).
Watchful Waiting: When patients opt to go without treatment and wait until there is observed disease progression, this is termed watchful waiting. For the first year, patients who choose watchful waiting will have a prostate-specific antigen (PSA) test and a DRE every three months, then less frequently if there is no evidence of disease progression.
Radical Prostatectomy and Radiation Therapy: There is a need for randomized controlled trials to determine which of the standard treatments are most appropriate in early prostate cancer, since there has not been convincing data as to whether radical prostatectomy or radiation therapy is the better treatment in the early stage. Currently, the patient’s Gleason score and life expectancy determine the method of treatment. For example, a man with a low Gleason score who is expected to live for more than 20 years should be considered for a radical prostatectomy or radiation therapy, whereas a man with a high Gleason score who is not expected to live 10 years should be considered for no treatment until he is symptomatic or for radiation therapy immediately, depending on the aggressiveness and stage of the disease. For long-term survival, radical prostatectomy is thought to provide the best outcomes. Common complications from radical prostatectomy include urinary incontinence and erectile dysfunction.
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