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Radical Prostectomy
buckking posted:
Husband had PSA level 18 and some difficulty with urination. He had prostate biopsy with all 12 sites positive with a 9 and 10 gleason scale. Bone scan and cat scan are negative. He his scheduled for radical prostectomy with frozen section of lymph nodes. We were told if lymph nodes are positive they would be removed but prostate would not be removed. When we asked why we were told removal benefits would not out weigh the risks. This would be followed by radiation and hormone therapy. We are confused and concerned about not removing the prostate. Is this typical treatment? Can anyone help us to understand why this is the treatment of choice?
Basir U Tareen, MD responded:
This is an excellent question. Even among experts, this is a somewhat controversial topic.

Historically it was believed that if the cancer had spread to the lymph nodes than it didn't make sense to remove the prostate because at that point you won't cure the cancer, so why put the patient through the risks of surgery. (ie, if the "cat is already out of the bag" and you can't cure the patient, why risk bleeding, incontinence, ED, etc.)

There is another school of thought, however, that in men who are symptomatic from their prostate, removing the gland (even if is not curative) may have other benefits such as local control and improved quality of life in the long run.

There is another school of thought that if there is only a small amount of lymph node disease, then a thorough lymph node dissection and proceeding with prostatectomy may provide long term "cure" or at least durable cancer control over the long term.

Best of luck