Management of clinically localized prostate cancer by radical prostatectomy followed by watchful waiting.

BACKGROUND

A 65-year-old married man requested a PSA screening test and was found to have an elevated PSA level of 5.26 ng/ml.

INVESTIGATIONS

Digital rectal examination, sextant biopsy, bone scan, and MRI to confirm diagnosis and stage the disease. Subsequent histopathologic examination of the excised prostate.

DIAGNOSIS

Preoperative stage cT2b prostate cancer (Gleason score 7 [3 + 4]). Postoperative stage pT3b, N0, M0 prostate cancer (Gleason score 9 [4 + 5]), with extensive cancer within the left side of the prostate gland, involving several of the surgical margins and extending to the proximal portion of the left seminal vesicle.

MANAGEMENT

Open radical retropubic prostatectomy, then watchful waiting with further treatment deferred until disease progression. Postoperative erectile dysfunction treated with sildenafil plus prostaglandin E(1) combination therapy.