Future studies in localized prostate cancer. What should we think? What can we do?

The proper approach to the diagnosis and treatment of localized prostate cancer is controversial and emotionally charged. The controversy from a urological viewpoint is reviewed, and the future clinical studies that must be done to prevent the disease, improve therapy and validate aggressive early diagnostic strategies are described briefly. It is proposed that the greatest need for the future is a change in the attitudes of the participants. This attitudinal change must occur in several areas: 1) a new determination to conduct the appropriate clinical trials, 2) different ways of conceptualizing the disease that better explain the current screening data, paradox between cancer incidence and lethality, and conflict between aggressive (United States) and conservative (Scandinavian) styles of management, and 3) renewed tolerance, understanding and humility toward the different points of view.