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Table ATreatment options for clinically localized prostate cancer

Treatment optionTreatment description
Radical retropubic or perineal prostatectomy (RP)Complete surgical removal of prostate gland with seminal vesicles, ampulla of vas, and sometimes pelvic lymph nodes. Sometimes done laparoscopically or with robotic assistance and attempt to preserve nerves for erectile function.
External beam radiotherapy (EBRT)Multiple doses of radiation from an external source applied over several weeks. Dose and physical characteristics of beam may vary. Conformal radiotherapy uses 3D planning systems to maximize dose to prostate cancer and attempt to spare normal tissue.
Intensity modulated radiation therapy (IMRT) provides the precise adjusted dose of radiation to target organs, with less irradiation of healthy tissues than conformal radiation therapy.
Proton radiation therapy is a form of EBRT in which protons rather than photons are directed in a conformal fashion to a tumor site. The use of the heavier single proton beam (vs. photon therapy) allows for a low entrance dose and maximal dose at the desired tumor location with no exit dose. This theoretically permits improved dose distribution (delivering higher dose to the tumor with lower dose to normal tissue) than other EBRT techniques. May be used alone or in combination with proton and photon-beam radiation therapy.
BrachytherapyRadioactive implants placed under anesthesia using radiologic guidance. Lower dose/permanent implants typically used. External beam “boost” radiotherapy and/or androgen deprivation sometimes recommended.
CryoablationDestruction of cells through rapid freezing and thawing using transrectal guided placement of probes and injection of freezing/thawing gases.
Androgen deprivation therapyOral or injection medications or surgical removal of testicles to lower or block circulating androgens.
Watchful waiting (active surveillance)Active plan to postpone intervention. May involve monitoring with digital rectal exam/prostate-specific antigen test and repeat prostate biopsy with further therapy (either curative or palliative) based on patient preference, symptoms, and/or clinical findings.
Laparoscopic radical prostatectomy (LRP) and robotic assisted radical prostatectomy (RLRP)Video-assisted, minimally invasive surgical method to remove the prostate.
High-intensity focused ultrasound therapy (HIFU)High-intensity focused ultrasound therapy has been used as a primary therapy in patients with localized prostate cancer not suitable for radical prostatectomy. Tissue ablation of the prostate is achieved by intense heat focused on the identified cancerous area.

From: Executive Summary

Cover of Comparative Effectiveness of Therapies for Clinically Localized Prostate Cancer
Comparative Effectiveness of Therapies for Clinically Localized Prostate Cancer [Internet].
Comparative Effectiveness Reviews, No. 13.
Wilt TJ, Shamliyan T, Taylor B, et al.

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