[Treatment strategy of localized prostate cancer]

In recent years, early detection techniques including PSA have resulted in a dramatic increase in the number of patients with localized prostate cancer. The natural history of localized prostate cancer is unusually favorable as compared with many other common cancers. Because of this, the management is controversial. Radical prostatectomy (RP), various techniques of irradiation (RT), endocrine therapy (ET) and watchful waiting (WW) have been utilized, but well designed randomized clinical trials with end results are lacking. Currently, RP is generally accepted as the preferred treatment option for younger patients with lower PSA level. RT has been thought to be somewhat inferior in terms of long-term survival rate compared with RP. Aggressive treatments such as RP and RT are associated with side effects: RP has more urinary and sexual side effects, while RT has more bowel symptoms. For some patients of older age, with well-differentiated tumor and lower PSA level, WW is recommended. WW is devoid of treatment-related side effects, but patients have the risk of progression. Several clinical trials of treatment for localized prostate cancer are being conducted in Western countries. However, these studies will require at least 10 years to accumulate enough study endpoints to form any conclusion. Therefore, it is important for the treatment strategies that we should carry out interventions that are neither excessive nor insufficient for each patient, and take QOL into consideration.