Treatment of localized prostatic cancer

Discovery of a localized prostatic cancer frequently creates a therapeutic dilemma. A significant number of patients do well for an extended period of time without treatment, while others suffer rapid tumor progression and death from prostatic cancer. Without treatment nearly one third of patients with stage B prostatic cancer can be expected to develop distant metastatic disease or death from prostatic cancer within 10 years. In patients who otherwise have a reasonable life expectancy of 10 years or more, aggressive therapy is justified. Long-term disease-free survival has been reported after both radical prostatectomy and external irradiation. The fact that nearly 50% of patients treated with external irradiation for stage B prostatic cancer have positive postirradiation biopsies is of concern, but the impact of this finding on overall survival is yet to be determined. The only randomized prospective study comparing radical prostatectomy with external irradiation showed a statistically significant decrease in the time to Nevertheless, as evidenced by the National Institutes of Health Consensus Development Panel, further randomized prospective trials are needed to determine the relative value of radical prostatectomy versus external irradiation for localized prostatic cancer. For the forseeable future, definitive scientific data on which to base treatment recommendations will not be available. Therefore, patients should be well informed of the various treatment options available, and the wishes of the patient are paramount. The clinician's roles are to interpret the data, present it in a meaningful manner to patients, be guided in discussions by patient preferences, and make recommendations.(ABSTRACT TRUNCATED AT 250 WORDS)