Conservative management of localized prostatic cancer

Radical prostatectomy (RP), irradiation (RT), early endocrine therapy (EET), and expectant treatment (DT) are strategies for the management of clinically localized prostatic cancer. EET has not been systematically studied, but warrants prospective exploration. DT in uncontrolled studies results in disease-specific survival rates at 10 years that appear comparable to those achieved following RP or RT and may be considered a management option in patients with limited life expectancy. Serial observations in untreated patients provide a clinical indication of the rate of tumor progression, but better indicators of growth rate, metastatic potential, and responsiveness to a particular therapy are needed. Decision analysis may ultimately provide a practical supplement to clinical judgment in the choice of treatment.