Prostatic cancer: are we closer to rational treatment selection?

Despite the controversies in management for all stages of prostatic cancer, guidelines are emerging that allow for better selection of treatments for individual patients. For early stage disease, prostate-specific antigen determinations in conjunction with other staging procedures have refined our ability to define truly organ-confined disease. The more widespread use of laparoscopic lymph node dissections has spared many patients needless laparotomies. For patients with metastatic disease, the overall effect of potency-sparing antiandrogens as monotherapy needs to be investigated. Most encouraging is that more groups are using prostate-specific antigen changes to assess disease activity and the rapid translation of recent laboratory investigations into the clinic. As our ability to predict the biologic potential of an individual patient's tumor is improved, more individualized treatment recommendations will be possible.