[Treating 'healthy' men who have localised cancer of the prostate]

In 2011, 11,428 men were diagnosed with prostate cancer in the Netherlands and 2,500 men died from the disease. Since the introduction of the prostate specific antigen (PSA) measurements, few men have metastatic disease at the time diagnosis. More than half of prostate cancer patients are currently being diagnosed with low-volume localised prostate cancer. This raises the question whether all of these men should be treated, especially when prostate cancer-specific mortality is low compared to overall mortality even in men without known comorbidity at the time of diagnosis. In recent series of such 'healthy' men treated for localised prostate cancer, the overall mortality exceeded prostate cancer mortality four to five-fold. Both tumour-related factors and general health status affect the outcome of prostate cancer treatment. In 'healthy' men with a low-volume, low-risk tumour, initial active surveillance is preferred above actual treatment. The small chance of progression and the possibility of curative treatment at the time of progression should be communicated to the patient. In men with an intermediate- or high-risk tumour, active treatment is preferred and depends on age and life expectancy.