Management of stage T1b (A2) and stage T1c adenocarcinoma of the prostate

The management of stage T1b (A2) and T1c adenocarcinoma of the prostate is somewhat controversial. With the widespread use of serum prostate-specific antigen (PSA) determinations, an increasing number of these cancers are likely to be diagnosed. Hence, it is important to formulate a cogent management strategy for these patients, because a large percentage of them can be expected to have clinically and pathologically localized disease. Expectant observation with deferred treatment, radical prostatectomy, radiation therapy (external beam or brachytherapy), and cryosurgical ablation are all primary therapeutic options that have individual merit. In this review, we attempt to analyze the results of the various treatment options for these patients and evolve a practical approach towards their management.