Bone metastasis generally not seen with PSA’s less than 20.
Treatment for localized prostate cancer include radical prostatectomy or radiation. If 10 year survival is unlikely then watchful waiting is usually Tx of choice. Brachytherapy using interstitial implantation of iodine-125 or palladium -103, is currently being used but there is limited long-term follow-up for this treatment.
During radical prostatectomy the neurovascular bundle which lies posteriolaterally to the prostate and urethra. Potency can be preserved in 2/3’s of cases.
Survival rate post-prostatectomy with no surgical margins = 15-years disease free in 50%.
Tx for Metastatic Prostate Cancer – androgen deprivation is often used. Suppression of serum testosterone can be achieved by bilat orchiectomy, and oral estrogen therapy. Estrogen therapy has been replaced with Lutenizing hormone-releasing hormone LHRH. Loss of libido and impotency are consequences of orchiectomy and hormone therapy. Hormone therapy is effective for 18 -24 months after this disease progression resumes. Pts with metastatic carcinoma of the prostate die within 2-3 years of diagnosis.