Recent results of management of palpable clinically localized prostate cancer

Abstract

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.