Early-stage prostate cancer. When is observation appropriate?
The diagnosis of early-stage prostate cancer poses difficult management questions. Some clinicians recommend aggressive treatment strategies, whereas others suggest a more conservative approach. The controversy stems in part from the absence of randomized clinical trials that clearly document a net benefit of one treatment modality over another. From a clinician's perspective, the safest approach is to recommend an aggressive treatment such as surgery or radiation therapy. If it succeeds, the clinician claims a cure; if it fails, he has done everything possible. For patients, however, the choice of therapy should depend upon their assessment of the risks of disease progression versus the potential efficacy and risks associated with aggressive treatment options. Observation management appears to be most appropriate for older men who face minimal risk of disease progression. Men over age 65 with low-grade disease and/or minimal tumor volume, and men in their mid-seventies with low- to moderate-grade disease confined to the prostate, may decide that conservative management offers a low probability of prostate cancer-associated death without the potential for treatment-associated morbidity. Men who are at highest risk of disease progression may also wish to consider conservative management, because unfortunately neither radical surgery nor radiation therapy have been shown to be effective in controlling poorly differentiated disease. In these cases, some patients might feel that the morbidity associated with treatment is greater than the potential gain in longevity. Conservative management of younger patients with minimal comorbidities and relatively modest tumor volumes should be considered very cautiously. These patients are at significant risk of developing symptomatic disease and dying from prostate cancer, and they usually have the most to gain from either radical prostatectomy or radiation therapy.
Albertsen
P C
PC
Division of Urology, University of Connecticut Health Center, Farmington, USA.
D004273:DNA, Neoplasm / Q000032:analysis; D018450:Disease Progression; D006801:Humans; D008297:Male; D009367:Neoplasm Staging; D019370:Observation; D011003:Ploidies; D011379:Prognosis; D011471:Prostatic Neoplasms / Q000235:genetics / Q000473:pathology* / Q000628:therapy; D012307:Risk Factors
D004273:DNA, Neoplasm