Management of clinically localized prostate cancer by radical prostatectomy followed by watchful waiting.

BACKGROUND: A 65-year-old married man requested a PSA screening test and was found to have an elevated PSA level of 5.26 ng/ml. INVESTIGATIONS: Digital rectal examination, sextant biopsy, bone scan, and MRI to confirm diagnosis and stage the disease. Subsequent histopathologic examination of the excised prostate. DIAGNOSIS: Preoperative stage cT2b prostate cancer (Gleason score 7 [3 + 4]). Postoperative stage pT3b, N0, M0 prostate cancer (Gleason score 9 [4 + 5]), with extensive cancer within the left side of the prostate gland, involving several of the surgical margins and extending to the proximal portion of the left seminal vesicle. MANAGEMENT: Open radical retropubic prostatectomy, then watchful waiting with further treatment deferred until disease progression. Postoperative erectile dysfunction treated with sildenafil plus prostaglandin E(1) combination therapy.