Recent results of management of palpable clinically localized prostate cancer

BACKGROUND: There is uncertainty regarding if, when, and how localized prostate cancer should be managed. METHODS: To examine evidence of a beneficial effect of aggressive treatment on metastatic failure and disease-specific mortality in clinically localized prostate cancer, the authors compiled data from the literature since 1980 regarding radical prostatectomy, external radiation therapy, and deferred treatment. RESULTS: The weighted mean of reported disease-specific survival at 10 years was 93% for radical prostatectomy, 83% for deferred treatment, and 74% for external radiation therapy. To broaden the database we have also computed, from the recorded number of patients who died of prostate cancer and the number of person-years at risk, a calculated disease-specific survival at 10 years of 93% for radical prostatectomy, 83% for deferred treatment, and 62% for external radiation therapy. The data suggest a favorable treatment effect with regard to disease-specific mortality for radical prostatectomy, but not for external radiation therapy at 10 years of follow-up. This observation must be tempered by the absence of convincing randomized trials and by the possibility of selection biases in the reviewed studies. CONCLUSIONS: As judged from our analysis, clinically localized prostate cancer often has a protracted course associated with a significant competing mortality and marginal benefit from radical prostatectomy at 10 years in terms of the endpoints used.