Ref: The Washington Manual of Surgery, 6th editionExplanation:"Hormonal therapy with either bilateral orchiectomy or luteinizing hormone-releasing hormone agonists usually is reserved for men with locally advanced or metastatic disease"Management of Prostate cancerIncidentally diagnosed Tla and T1b disease.For men >70 years: Conservative treatment would usually he the correct approach.For men < 65 years: Radical surgical treatmentLocalised T2 disease.In younger fitter men (<65 years): Radical prostatectomy or radical radiotherapy.In patients with outflow obstruction: Transurethral resection +- hormone therapyLocally advanced T3 and T4 disease.These patients are at significant risk of disease progression.Early androgen ablation is favouredFor the sexually active: Conservative approach with the adoption of androgen ablationMetastatic disease.Once nietastases have developed the out-look is poor.For patients with symptoms: androgen ablation will provide symptomatic reliefGnrH analoguesTreatment options for men with organ-confined prostate cancer includeRadical prostatectomyExternal-beam radiation therapyInterstitial radiotherapy (brachytherapy)Hormonal therapy with either bilateral orchiectomy orLuteinizing hormone-releasing hormone agonists (reserved for men with locally advanced or metastatic disease)Staging using the Ca ProstateT1a, T1b and T1c:These are incidentally found tumours in a clinically benign gland after histological examination of a prostatec-tomy specimen.T1a is a well or moderately well- differentiated tumour involving less than 5 per cent of the resected specimen.T1b is a poorly differentiated tumour or a tumour involving >5 percent of the resected specimen.T1c tumours are impalpable tumours found following PSA screeningT2a disease presents as a suspicious nodule on rectal examination of <2 cmT2b disease is a nodule involving greater than 2 cmT2e is tumour in both lobes but still clinically confinedT3 is a tumour involving the seminal vesicles or bladder neckT4 is a tumour involving the rectum or pelvic side wall