Who is best benefited by radical prostatectomy?

The last few years have taught us much about prostate cancer. We now recognize that prostate cancer, even if it is of low stage and low grade, is a relentlessly progressive disease, especially if found in men with prolonged (greater than 15 years) life expectancy. We now know that serum PSA is a valid endpoint after radical prostatectomy to definitively assess its ability to eradicate prostate cancer. We are learning better how to use a variety of clinical parameters to predict pathologic stage, and we are in the process of developing other markers that may be exploited to predict which patients with early-stage prostate cancer have surgically curable lesions. From these observations it is reasonable to conclude that the best candidates for radical prostatectomy are young men (those with 10 to 20 years of life expectancy) with impalpable, clinically organ-confined low- or moderate-grade prostate cancers.