Radical prostatectomy or deferred treatment?
Screening for prostate cancer has intensified, due both to increased patient and physician awareness and to the availability of new, more sensitive diagnostic tools (prostate-specific antigen [PSA], rectal ultrasound, etc.). Consequently, the number of newly diagnosed cases of prostatic cancer is rising rapidly, whereas the frequency of death due to prostate cancer remains almost stable. It must therefore be assumed that the number of patients in whom a diagnosed prostate cancer will not be fatal is also increasing. Consequently, not every prostatic carcinoma requires radical treatment when diagnosed. Also, it must be concluded that not every man who is a long-term survivor after radical prostatectomy owes his survival to the treatment. Long-term survival may reflect the relatively benign biological potential of this disease in an individual patient. Therefore there is an inherent risk of overtreating patients and this must be weighed against the costs, the postoperative morbidity, and the mortality, albeit low, of a radical prostatectomy. Nevertheless, as long as we do not have diagnostic tools which, at an early stage of prostatic cancer, enable us to determine whether a carcinoma will ultimately have a fatal outcome, we are obliged to offer a radical prostatectomy to younger patients (who have a life expectancy of more than 10 years) as long as they have organ-confined disease.
Studer
U E
UE
Department of Urology, University of Berne, Switzerland.
D005500:Follow-Up Studies; D006801:Humans; D015994:Incidence; D008017:Life Expectancy; D008297:Male; D009367:Neoplasm Staging; D011184:Postoperative Period; D017430:Prostate-Specific Antigen / Q000097:blood; D011468:Prostatectomy / Q000401:mortality; D011471:Prostatic Neoplasms / Q000097:blood / Q000175:diagnosis / Q000453:epidemiology / Q000473:pathology / Q000601:surgery*; D012307:Risk Factors; D015996:Survival Rate; D013997:Time Factors; D016896:Treatment Outcome; D014463:Ultrasonography / Q000379:methods
D017430:Prostate-Specific Antigen