A 65-year-old male is diagnosed as having prostatic cancer based on transrectal biopsy of a 1 cm palpable nodule. Which of the following statement(s) are true concerning his management?

a. If the tumor is confined within the prostatic capsule (stage A or B), radical prostatectomy is an appropriate option

d. External beam radiation is an appropriate treatment if the tumor is confined to the prostate

The treatment of prostatic cancer depends on whether the disease is localized to the prostate or advanced beyond the gland. Because prostate cancer advances slowly, the morbidity of therapy may exceed the therapeutic benefit in the elderly and debilitated. Patients who have a limited life expectancy and low stage disease are frequently treated with observation only. If the tumor is confined within the prostatic capsule (Stage A or B), options include radical prostatectomy, external beam radiation therapy, and radioactive implants. Radical prostatectomy is usually carried out through the retropubic approach. Through this approach a node dissection can be done for further staging, and the procedure abandoned if the nodes contain tumor. In patients with a high index of suspicion for positive nodes, a laparoscopic pelvic node dissection can be performed to decrease postoperative morbidity. The use of the nerve-sparing prostatectomy can be used to preserve penile erection in those patients who are potent. In this approach, the nerves concerned with penile erection are excluded from the dissection. The incidence of impotence following traditional radical prostatectomy is l00% but can be cut in half with the nerve-sparing approach. Hormonal ablation is the initial treatment of choice for advanced prostatic cancer. Most prostatic cancers are androgen-responsive. Androgen ablation will cause improvement in 80-90% of patients with regression of tumor in about 40%. The testis is the primary source of androgen and orchiectomy remains the gold standard and treatment of choice for advanced prostatic cancer. Estrogen will produce castrate levels of testosterone, but the side effects of fluid retention and increased incidence of thromboembolic diseases such as heart attacks and strokes make this hormone a poor choice in this high risk age group.