Place of surveillance in the treatment of localized prostate cancer.

Surveillance with deferred treatment in patients with clinically prostate-c onfined prostate cancer is a controversial subject. The policy of prostate cancer screening for increasingly low PSA levels and the use of more extens ive biopsy protocols result in the detection of a large number of small tum ours, probably early in their subclinical course. Conversely some patients who receive initial active treatment are understaged by the pretreatment as sessment and develop treatment-related adverse effects without any oncologi cal benefit. The main published series concerning surveillance were analyse d with particular emphasis on those with the longest observation pediods. D ata concerning specific survival and progression-free survival are discusse d together with the results obtained in terms of the quality of life of pat ients submitted to surveillance. Analysis of these data show a potential be nefit of surveillance in elderly patients (over the age of 70 years) with s mall, low-grade prostatic tumours.