Thus, the above considerations relating to stage A disease may not be relevant to patients with stage T1c disease, which is detected by an elevated PSA level, but without physical or radiographic abnormalities. Available therapeutic modalities include radical prostatectomy and definitive radiation therapy, which can be given by external-beam radiation or by interstitial implantation of radioactive compounds. Radical prostatectomy can be performed by a retropubic or perineal approach. The two approaches have comparable survival rates. The retropubic approach allows the surgeon to take lymph node samples for frozen section before beginning prostatectomy.
Patients undergoing perineal prostatectomy can have their lymph nodes evaluated by laparoscopy.
If the lymph nodes are positive, the operation is usually aborted. However, the likelihood of finding positive pelvic lymph nodes in this era of treating earlier stages of prostate cancer is low. Thus, many surgeons may opt not to sample the nodes at the time of radical prostatectomy. If the nodes are sampled and appear grossly normal, the operation is not delayed by awaiting the frozen-section results. External-beam radiation therapy is usually chosen for larger lesions.