[Staging and therapeutic options in local prostatic carcinoma]

Since the introduction of prostate specific antigen (PSA) into widespread use in clinical practice for early detection of prostate cancer (PCa), in combination with digital rectal examination (DRE), there has been a marked increase in the incidence of localized, potentially curable, disease coupled with a simultaneous decline in regional and metastatic prostate cancer in the least years. After the diagnosis of adenocarcinoma of the prostate has been histologically confirmed, an accurate assessment of the stage--or extent--of the disease should be made. We will provide a critical assessment of the currently employed PCa staging modalities. Therapeutic options in locally defined PCa are analyzed. Intracapsular PCa (T1a-T2b N0 M0) is preferably managed by radical prostatectomy, "insignificant" cancers may be treated by watchful waiting. The outcome of irradiation is not as predictable as radical surgery. Neoadjuvant treatment with radical prostatectomy in locally advanced PCa is probably not as efficient as believed; in some instances the value of adjuvant treatment is undecided. As it seems irradiation in conjunction with androgen deprivation can equal efficacy of surgery.