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Management of clinically localized prostate cancer by radical prostatectomy followed by watchful waiting

Nature Clinical Practice Urology volume 2, pages 298–303 (2005)Cite this article

Abstract

Background A 65-year-old married man requested a PSA screening test and was found to have an elevated PSA level of 5.26 ng/ml.

Investigations Digital rectal examination, sextant biopsy, bone scan, and MRI to confirm diagnosis and stage the disease. Subsequent histopathologic examination of the excised prostate.

Diagnosis Preoperative stage cT2b prostate cancer (Gleason score 7 [3 + 4]). Postoperative stage pT3b, N0, M0 prostate cancer (Gleason score 9 [4 + 5]), with extensive cancer within the left side of the prostate gland, involving several of the surgical margins and extending to the proximal portion of the left seminal vesicle.

Management Open radical retropubic prostatectomy, then watchful waiting with further treatment deferred until disease progression. Postoperative erectile dysfunction treated with sildenafil plus prostaglandin E1 combination therapy.

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Figure 1: Histopathology of the prostate.

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Acknowledgements

Written permission to publish the case was obtained from the patient concerned. Editorial assistance was provided by Louise Picken, PhD; financial support for this assistance was provided by AstraZeneca.

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Authors and Affiliations

  1. Visiting Professor in the Department of Urology at St George's Hospital, London, UK

    Roger Kirby

Authors
  1. Roger Kirby
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Corresponding author

Correspondence to Roger Kirby.

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Competing interests

The author declares no competing financial interests.

Glossary

PSA (PROSTATE-SPECIFIC ANTIGEN)

An enzyme secreted by epithelial cells of both benign and malignant prostate tissue; an important marker for the diagnosis of prostate cancer commonly used to monitor disease progression following diagnosis

GLEASON SCORE

Sum of grades assigned to the two largest cancerous areas of tissue samples; grades range from 1 (least aggressive) to 5 (most aggressive)

BRACHYTHERAPY

Radiotherapy in which closed sources of radiation (e.g. seeds) are placed (e.g. by implantation) in or close to the area being treated

LUTEINIZING HORMONE-RELEASING HORMONE AGONISTS

Drugs that inhibit the secretion of luteinizing hormone, causing testosterone levels to fall to castrate levels in men

ANTIANDROGENS

Drugs that interfere with the function of androgens by binding to the androgen receptor

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Kirby, R. Management of clinically localized prostate cancer by radical prostatectomy followed by watchful waiting. Nat Rev Urol 2, 298–303 (2005). https://doi.org/10.1038/ncpuro0210

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