Prostate Cancer: To Treat or Not to Treat?

Context: To treat or not to treat is one of the most difficult dilemmas facing prostate cancer patients, especially elderly men with early prostate cancer or small cancer that is contained within the prostate. Objective: The primary objective of this review is to analyse the treatment options for patients with localised prostate cancer. This information can be considered alongside other important factors like natural history of disease and diagnostic tests. Evidence acquisition: Several randomised and nonrandomised clinical trials published in the literature investigating the natural history of the disease, diagnostic tests, and treatment options for localised prostate cancer have been reviewed for this paper. Evidence synthesis: Analysis of prostate-specific antigen (PSA) kinetics should play a major role in the management of localised prostate cancer. Trials investigating long-term outcomes of active surveillance are under way. Conclusion: Taking all these factors into consideration, the data support active surveillance as an appropriate choice for patients with well-differentiated or moderately differentiated, low-volume prostate cancer who have a life expectancy of <10 yr. Men with higher grade tumours and longer life expectancy may be at excess risk of death from prostate cancer if managed with active surveillance. (c) 2009 European Association of Urology. Published by Elsevier B.V. All rights reserved.