RADICAL PROSTATECTOMY OR WAIT-AND-WATCH

With intensified screening and the use of new diagnostic tools for pro state cancer (prostate-specific antigen, rectal ultrasound, magnetic r esonance imaging with rectal coils, etc), the number of newly diagnose d cases of prostate cancer is rising rapidly, whereas the frequency of death due to prostate cancer remains almost stable. It must therefore be assumed that the number of patients in whom a diagnosed prostate c ancer will not be fatal is also increasing. Consequently, not every pr ostatic carcinoma requires radical treatment when diagnosed. Also, it must be concluded that not every man who is a long-term survivor after radical prostatectomy owes his survival to the treatment. Long-term s urvivorship may reflect the relatively benign biological potential of this disease in an individual patient. Therefore, there is an inherent risk of overtreating patients and this must be weighed against the co sts, the postoperative morbidity and the, albeit low, mortality of a r adical prostatectomy. Nevertheless, as long as we do not have diagnost ic tools which, at an early stage of prostate cancer, enable us to det ermine whether a carcinoma will ultimately have a fatal outcome, we ar e obliged to offer radical prostatectomy to younger patients (who have a life expectancy of more than 10 years) as long as they have organ-c onfined disease.