Who Needs to be Treated?

Controversy surrounds the appropriate treatment of clinically localized prostate cancer. Physicians debate not only which treatment is best but also who needs to be treated. Men at high risk of developing symptomatic metastatic disease are clearly in need of therapy designed to relieve symptoms and, if possible, prolong life. Risk factors that predict disease progression include high-grade tumor (Gleason score 7-10), tumor volume >0.5 cc, younger age at diagnosis (<72 years), and the absence of competing medical hazards. These are the men destined to die from prostate cancer and who should be enrolled in randomized studies designed to optimize treatment strategies.