A 65-year-old male is diagnosed as having prostatic cancer based on transrectal biopsy of a 1 cm palpable nodule. Which of the following statement(s) are true concerning his management?
The treatment of prostatic cancer depends on whether the disease is localized to the prostate or advanced beyond the gland. Because prostate cancer advances slowly, the morbidity of therapy may exceed the therapeutic benefit in the elderly and debilitated. Patients who have a limited life expectancy and low stage disease are frequently treated with observation only. 8th AJCC TNM Classification for Ca Prostate Classification Definition Tumor Tis Carcinoma in Situ T1a up to 5% of tissue in resection for benign disease has cancer, DREnormal T1b T1c >5% of tissue in resection for benign disease has cancer, DREnormal Tumor is identified by needle biopsy T2 a T2 b T2 c Tumor involves one half of lobe Tumor involves more than one half of lobe Tumor involves both lobes T3 a T3 b Extra capsular extension on one or both sides including bladderneck Seminal vesicle involvement T4 Tumor is fixed/ invades adjacent structures other than seminalvesicle like* External sphincter* Rectum* Levator muscles and or pelvic wall Nearby (regional) lymph nodes (N) N0 No regional Lymph node metastasis N1 Metastasis to regional LN (obturator, internal iliac, External iliac,presacral) Distant Metastasis (M) M0 M1 a M1 b M1 c No metastasis Distant metastasis in non-regional LN Distant metastasis to bone Distant metastasis to other sites Management of CA prostate- T1a - observation + Follow up (DRE + PSA)- T1b, T1c & T2* > 70 years - Observation + follow up* < 70 years - Radical prostatectomy Or Radiotherapy- T3 & T4* Androgen ablation> Palliative radiotherapy* Bilateral Orchidectomy + Flutamide* LHRH Agonist (Goserelin, Leuprolide) + Flutamide- Goserelin - Recently FDA approved for advanced and metastatic CA prostate- New drugs for castration resistant metastatic CA Prostate* Cabazitaxel* Sipuleucel (vaccine)
If the tumour is confined within the prostatic capsule, radical prostatectomy is an appropriate option
If positive lymph nodes are detected on laparoscopic pelvic lymph node dissection, radical prostatectomy is indicated
Radical prostatectomy is invariably associated with impotence
There is currently no role for orchidectomy in the management of prostatic cancer
Prostate and seminal vesicles