Treatment Decision in prostatic cancer ;
1- T1a ;
- Incidentally found tumors at TURP, by defnition low volume (≤5%), usually well differentiated associated with very slow growth rate .
- Managed by watchful waiting (Regular follow up with DRE and PSA) every 3 - 6 month.
2- localized T1b, T1c and T2 ;
- Management depends on patient’s age, life expectancy, performance status and patient’s preference.
- In younger, fitter men (<70 years): Radical prostatectomy or radiotherapy , if surgery is contraindicated
- Elderly (>70 years) with life expectancy <10 years: Watchful waiting (Progress rate is very slow, 10% at 10 years)
3- Advanced disease (T3, T4 or any metastasis) ;
- Palliative treatment, androgen ablation or palliative radiotherapy
- Androgen ablation (Hormone therapy) is frst line of treatment: Orchiectomy + Flutamide or LHRH + Flutamide
- Palliative radiotherapy .