Once cancer is diagnosed, other tests such as computerized tomography, lymph-node biopsies, and bone scans can determine if tumors have spread beyond the prostate. For cancer confined to the prostate, opinions are split over what to do. Orthodox wisdom holds that cancer should be treated aggressively. Experts say these options may offer good prospects for curing the disease if exercised early enough. Treatment choice usually depends on what specialist the patient consults.
Urologists tend to recommend surgery while oncologists generally advise radiation therapy.
Surgery may cause unpleasant adverse effects. Because radical prostatectomy can result in severing nerves and blood vessels related to sexual or bladder function, the operation in the past has left virtually all patients impotent, incontinent, or both. That is changing, however, thanks to pioneering research done in the 1980s by Patrick Walsh, M.D., urology chairman at Johns Hopkins University Hospital. Walsh says his patients under age 50 have about a 90 percent chance of regaining potency, but that number drops to 25 percent for patients in their 70s. Radiation therapy also has adverse effects, including impotence in about 40 to 50 percent of patients.