Surgery to remove prostate is practically never done for Metastastic prostrate carcinoma
Treatment by watchful waiting/active surveillance, HIFU, external beam radiation therapy, brachytherapy, cryosurgery, and surgery are, in general, offered to men whose cancer remains within the prostate. Hormonal therapy and chemotherapy are often reserved for disease that has spread beyond the prostate.
Selecting initial treatment requires assessing the risk of the disease spreading or progressing, which is based on evaluating life expectancy, comorbidities, biopsy grade (Gleason score), clinical stage, and prostate-specific antigen (PSA) levels of patients.
Patients diagnosed with impending paralysis due to spinal cord compression or patients with pathologic fractures should be immediately immobilized until appropriate consultations are obtained. Consultations
Consultation with a radiation oncologist should be obtained for palliative radiation therapy for bone metastases and for locally extensive tumors and on an emergent basis for spinal cord compression. Also consider consultations with a neurosurgeon for spinal cord compression, an orthopedic surgeon for pathologic fractures, and a medical oncologist for chemotherapy.
In patients with metastatic prostate cancer, radiation is also applied for palliative purposes. It is used in patients with hormone-refractory disease with painful bone metastases and in patients with impending spinal cord compression.
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