The advent of prostate specific antigen (PSA) screening has greatly increased the frequency of diagnosis of prostate cancer. Prostate cancer is being diagnosed more and more frequently at an early stage.

Prostate cancer originates in the peripheral zone of the prostate while benign prostatic hyperplasia (BPH) develops in the central zone of the prostate. Both prostate cancer and BPH cause prostate enlargement and can present with LUTS. Prostate cancer may present with or without coincident BPH.

Prostate cancer or BPH can cause elevation of serum prostate specific antigen (PSA). Therefore increased levels of PSA can be due to BPH or prostate cancer, or both.

Localized prostate cancer can be treated equally well by radical prostatectomy (RP) or external beam radiation therapy (EBRT). Symptomatic BPH can be treated by transurethral resection of the prostate (TURP) or enucleation of the benign adenomatous enlargement, so called simple prostatectomy.

Open or robot assisted radical prostatectomy (RARP) is a complex operation which many untoward adverse effects including urinary incontinence (UI) and erectile dysfunction (ED). TURP or simple prostatectomy is often complicated by loss of ejaculatory function, but urinary incontinence is unusual.

RT is noninvasive treatment of prostate cancer that rarely results in UI. RT may reduce the volume of the ejaculate, but carries a lower incidence of ED compared to RP.  RT is most effective in treating prostate cancer in the non-enlarged or minimally enlarged prostate. RT does not shrink BPH.  The presence of BPH can reduce the effectiveness of RT on the treatment of prostate cancer. TURP or simple prostatectomy can simultaneously relieve LUTS and shrink the size of the prostate, allowing for more effective RT in treating residual prostate cancer.

Given a choice, most patients would prefer RT over RP if the oncologic outcome is the same.

Historical Perspective

Patients with prostate cancer usually come to the attention of the clinician due to the onset of lower urinary tract symptoms (LUTS).

Before the advent of PSA screening, patients with smooth enlargement of the prostate and LUTS would undergo TURP or simple prostatectomy. If small volume, low grade prostate cancer was found, this was termed ‘incidental’ prostate cancer and nothing further was done. This approach would now be called watchful waiting. If a larger volume of prostate cancer or higher grade prostate cancer was discovered, these patients were treated with EBRT. The results of this approach were excellent and no patient suffered the devastating effects of RP.

Treatment of Prostate Cancer Made Simple

The PowerPoint (PPT) presentations summarize contemporary guidelines for treatment of localized prostate cancer. The guideline offer RP or EBRT as choices. There is notably limited discussion in the guidelines regarding prostate cancer and the enlarged prostate. TURP or simple prostatectomy in the management of localized prostate cancer.