Adenocarcinoma of the prostate. Stage-by-stage treatment alternatives

The best treatment for adenocarcinoma of the prostate depends on the patient's age, general medical condition, life expectancy, and willingness to accept such side effects as impotence. Radical prostatectomy or full-dose radiation therapy are usually curative when cancer is confined to the gland. The technique of prostatectomy has been improved and potency often can be preserved. Once the tumor extends beyond the gland, treatment alternatives are radiation or endocrine therapy. If lymph nodes are negative, radiation therapy may result in a long period without progression. If lymph nodes are positive, the expense and morbidity of radiation therapy may not be worthwhile because the likelihood of cure is low. Androgen deprivation, or endocrine manipulation, is preferred for metastatic disease. Response is varied and may depend on the patient's testosterone level when therapy is initiated. Survival is shorter in those with levels below normal.