The prognosis depends on the stage as well as on the histological grade of the tumor. A poorly differentiated tumor tends to metastasize more often than a well- or moderately differentiated tumor. Organ-confined disease Treatment is intended to be curative, which in the United States includes either radical prostatectomy or radiation therapy. Radical prostatectomy has been preferred throughout the last decade after new techniques like nerve sparing surgery and autologous transfusions decreased morbidity and mortality. Radical prostatectomy is generally reserved for men with more than 10 years life expectancy.
Radiation therapy is performed most often as external beam radiation.
However, a prospective study randomizing patients to either radiation therapy or radical prostatectomy is not available making any comparison between the two treatment options and between treatment and watchful waiting difficult. Untreated regional PC causes local complications due to growth into adjacent structures, e.g., urethra, bladder, ureters, nerves and rectum, leading to bleeding, obstructive symptoms of bowel and bladder, and pain. A common approach to regional disease is radiation therapy, but therapy varies from watchful waiting to radical prostatectomy, radiation therapy or hormonal treatment. Metastatic disease Initial metastasis is often to pelvic lymph nodes. Another prime metastatic site is to bone, especially vertebrae, pelvis, ribs and femur, causing isolated or diffuse pain due to bone fractures.