RADICAL PROSTATECTOMY OR DEFERRED TREATMENT

Screening for prostate cancer has intensified, due both to increased p atient and physician awareness and to the availability of new, more se nsitive diagnostic tools (prostate-specific antigen [PSA], rectal ultr asound, etc.). Consequently, the number of newly diagnosed cases of pr ostatic cancer is rising rapidly, whereas the frequency of death due t o prostate cancer remains almost stable. It must therefore be assumed that the number of patients in whom a diagnosed prostate cancer will n ot be fatal is also increasing. Consequently, not every prostatic carc inoma requires radical treatment when diagnosed. Also, it must be conc luded that not every man who is a long-term survivor after radical pro statectomy owes his survival to the treatment. Long-term survival may reflect the relatively benign biological potential of this disease in an individual patient. Therefore there is an inherent risk of overtrea ting patients and this must be weighed against the costs, the postoper ative morbidity, and the mortality, albeit low, of a radical prostatec tomy. Nevertheless, as long as we do not have diagnostic tools which, stage of prostatic cancer, enable us to determine whether a will ultim ately have a fatal outcome, we are obliged to offer a radical prostate ctomy to younger patients (who have a life expectancy of more than 10 years) as long as they have organ-confined disease. (C) 1995 Wiley-Lis s, Inc.