A 65 year old male presents with CA prostate. The tumour is limited to the capsule and it is palpable on PR examination. The patient is diagnosed as stage T1b. The best treatment would be –
**Core Concept**
The question tests the understanding of prostate cancer staging and treatment options. The correct staging of prostate cancer is based on the TNM system, which considers the tumor size, lymph node involvement, and distant metastasis. T1b refers to a non-palpable tumor that is visible on imaging studies, but this option seems incorrect as the tumor is palpable on PR examination.
**Why the Correct Answer is Right**
Given that the tumor is palpable on PR examination and limited to the capsule, it is classified as T2a, not T1b. T2a is a palpable tumor that is confined to the prostate. The best treatment option for a patient with T2a prostate cancer is active surveillance or watchful waiting, which involves regular monitoring with PSA, digital rectal examination, and imaging studies to monitor for any changes in the tumor. This approach is recommended for patients with early-stage prostate cancer and a low risk of progression.
**Why Each Wrong Option is Incorrect**
**Option A:** Active surveillance is not the best treatment option for a patient with a palpable tumor, as it is not suitable for tumors that are easily palpable on examination.
**Option B:** Radical prostatectomy may be considered for patients with T2a prostate cancer, but it is not the best initial treatment option, especially if the patient is asymptomatic and has a low risk of progression.
**Option C:** Radiation therapy is not the best treatment option for a patient with T2a prostate cancer, as it is typically reserved for patients with more advanced disease or those who are not suitable for surgery.
**Clinical Pearl / High-Yield Fact**
Patients with early-stage prostate cancer and a low risk of progression may be suitable for active surveillance, which involves regular monitoring with PSA, digital rectal examination, and imaging studies to monitor for any changes in the tumor.
**Correct Answer: B. Radical prostatectomy is not the best initial treatment option.**