The ideal candidates for radical prostatectomy are the men most likely to benefit from it. Therefore, radical prostatectomy should only be considered in men who have cancer that appears to be confined to the prostate and therefore is potentially curable. Also, it should only be considered in men who are young enough and healthy enough to live long enough to benefit from being cured.
Good candidates for surgery, then, are men in their fifties or sixties, in otherwise good health, with localized prostate cancer. This includes men with stage T1b (A2), T2a (B1N), T2b (B1), and T2C (B2) cancer. It also includes some men with stage T1a (A1) cancer, and most patients with stage T1c disease.
Men with stage T3 (C) disease generally are not considered candidates for radical prostatectomy. However, sometimes the interpretation of the digital rectal examination can be wrong. Sometimes, doctors overestimate the tumor’s actual extent—when indeed it may not have spread beyond the prostate. Twenty-five percent of these men who undergo surgery turn out to have organ-confined cancer. (Again, tallying the results of the PSA test, Gleason score and clinical stage may help doctors avoid such overestimation).
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