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Watchful Waiting

• Watchful waiting is the decision to monitor symptoms and progression of the disease without aggressive intervention.

• Watchful waiting involves ongoing monitoring of the progression of the disease by digital rectal examination (DRE) and PSA levels every 6-12 months.

• Watchful waiting is a reasonable option in elderly men with low-grade tumors and men with other medical illnesses that reduce life expectancy to less than 10 years.

• Depending upon a variety of factors including the patient's age, overall health status, and whether or not symptoms of the disease are present, watchful waiting may be considered as an option for all Stages (I thru IV) of prostate cancer.

Surgery

There are several types of surgery that may be performed for patients with prostate cancer. These procedures include:

• Orchiectomy
• Radical Prostatectomy
• Transurethral Resection of the Prostate (TURP)

Orchiectomy

Orchiectomy is the surgical removal of the testes (castration) to reduce the production of male hormones (androgens). It is usually performed as an outpatient procedure.

Orchiectomy may be utilized as part of a curative regimen, or in advanced disease, orchiectomy may be used to control progression and symptoms of the disease (palliation) without pursuing a cure as the goal of treatment.

Radical Prostatectomy

Radical prostatectomy is the surgical removal of the entire prostate gland, seminal vesicles, and adjacent tissue with resection of the lymph nodes. This procedure is performed in a hospital and the average hospital stay is usually 2-4 days.

A radical prostatectomy can be performed by several techniques, each of which has its own advantages and disadvantages:

• Radical Retropubic Prostatectomy

Radical retropubic prostatectomy is a surgical procedure that requires an incision in the lower abdomen to remove the prostate gland. It is the approach that is generally preferred by surgeons because it enables simultaneous assessment of the pelvic lymph nodes.

During the surgery, the surgeon may remove some lymph nodes from around the prostate. If any of the nodes contain cancer cells, the surgery will most likely be stopped as this would indicate that the cancer has already spread and could not be cured.

• Radical Perineal Prostatectomy

Radical perineal prostatectomy is a procedure that is performed through an incision in the skin between the anus and scrotum (the perineum). This approach is used less often because the nerves cannot easily be spared and lymph nodes cannot be removed. However, the procedure takes less time and may be an option if lymph node removal and erectile function are not major concerns.

• Laparoscopic Radical Prostatectomy

Laparoscopic radical prostatectomy is a newer technique that uses several small incisions and special long instruments to remove the prostate. This type of surgery is known as minimally invasive surgery because it does not involve a large open incision into the abdomen as with the standard open radical prostatectomy.

Laparoscopic radical prostatectomy has several advantages over the usual open radical prostatectomy, including less blood loss and pain, shorter hospital stays, and faster recovery times.

Transurethral Resection of the Prostate

Transurethral resection of the prostate (TURP) is a surgical procedure that is usually performed to treat men with non-cancerous enlargement of the prostate called benign prostatic hyperplasia (BPH). In the setting of prostate cancer, however, it may be performed as a palliative intervention to relieve symptoms, such as trouble urinating.