[Organ and function preservation in prostate cancer]

Curative treatment for prostate cancer is associated with risks which may adversely influence quality of life. Furthermore, there is a considerable rate of overdiagnosis of tumors which would be non-life-threatening if left untreated. Efforts have been made to reduce overtreatment.

Beside the traditional conservative symptomatic management especially in elderly patients with meaningful comorbidity, several prostate-sparing or deferred treatment options are currently discussed. For all of them, insufficient data on efficacy and safety are available.

Because of the required long-term follow-up of large sample sizes, conclusive data will not become available in the near future. Therefore, these treatment options have to be considered experimental to a large degree. This applies both to focally ablative techniques and to active surveillance of prostate cancer in patients with a long further life expectancy. Only in carefully selected patients with favorable tumor-associated risk profiles and high risk of medium-term competing mortality may active surveillance be considered a valid and relatively safe treatment option.