Updated 30 June 2009
Intermediate Risk (neither low nor high risk, and therefore have any of the following):
- PSA >10 ng/mL
- Gleason =7
- Stage 2c (2002 TNM)
In the physically fit individual with life expectancies longer than ten years, radical prostatectomy or radiotherapy should be considered. In general, radical surgery is reserved for patients less than 72 years of age who are otherwise in excellent health.
Treatment Options
a) Radical Surgery
Radical surgery is indicated in selected patients with tumours clinically confined to the prostate and life expectancies longer than 10 years. A nerve sparing procedure should be avoided on the side of the lesion or with significant apical disease. Neoadjuvant androgen withdrawal therapy reduces the risk of positive margins by 50%, but since the effects on recurrence rates are not yet known, it should not be routinely employed off study.
b) Radical Radiotherapy
Patients with high-intermediate risk disease (those with PSA >=15, or Gleason >=7 scores or with a bulky primary tumour) are considered for neoadjuvant-adjuvant androgen ablation as described in the section for high risk disease.
- External beam radiation
- Brachytherapy
A comprehensive program for prostate brachytherapy was introduced at the BC Cancer Agency (BCCA) in November 1997 and the first cases were done July 20, 1998. As of June 2009, nearly 2,600 men have been treated with prostate implants at BCCA, making it the largest prostate brachytherapy program in Canada. On average, eight to ten men in BC undergo this form of treatment each week.
About two thirds of all newly diagnosed prostate cancer patients are considered good candidates for prostate brachytherapy within the BCCA program. Eligible patients.
Patients seeking a consultation with a Radiation Oncologist must be referred to one of the regional cancer centres by their specialist (Urologist) or family physician. Patients should feel free to request such a referral if it is not initially offered to them.
