Radical Treatment for Localized Disease: An Overview of Options and Strategies for Decision Making
It is a daunting task for a man diagnosed with apparently localized carcinoma of the prostate to become sufficiently educated that he can make an informed decision about the best management approach. Although there are numerous sources of information incl
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Joseph A. Smith Jr
It is a daunting task for a man diagnosed with apparently localized carcinoma of the prostate to become sufficiently educated that he can make an informed decision about the best management approach. Although there are numerous sources of information including books, internet web sites, and support groups, patients often rely to a great extent upon the advice of their physician. It is incumbent upon the physician, then, to provide information which is sufficiently comprehensive that patients can adequately weigh all options yet is devoid of personal agendas or biases. However, this is not easy, even for professionals who devote their careers to the study and treatment of prostate cancer. The remarkable disparity of opinions and recommendations among clinicians with access to the same information and, often, the same treatments contributes to the controversies about prostate cancer management. This chapter will review some of the considerations which must be addressed in deciding upon a treatment recommendation for a man with clinically localized carcinoma of the prostate. Parameters which can help select appropriate therapy are discussed. Treatment of prostate cancer is the ultimate example of “personalized” medicine. Matching the right treatment with the right individual is paramount, and attention must be addressed toward balancing of cancer cure versus quality of life. Given the same clinical setting and the same options, not all men make the same choice. The clinician’s role is to help the patient make a personalized choice.
J.A. Smith Jr, M.D. Department of Urologic Surgery, Vanderbilt University Medical Center, A-1302 MCN, Nashville, TN 37232-2765, USA e-mail: [email protected] A. Tewari (ed.), Prostate Cancer: A Comprehensive Perspective, DOI 10.1007/978-1-4471-2864-9_49, © Springer-Verlag London 2013
To Treat or Not to Treat? The concept that not all men with prostate cancer need treatment is certainly not novel. For over half a century, the literature has been replete with discussions of which men need therapy and which ones do not. The tremendous increase in diagnosis of prostate cancer which occurred with the advent of widespread PSA testing, though, has increased the importance of the treatment versus surveillance debate. Further, early detection programs have been successful in permitting a stage migration wherein most cancers detected in contemporary series are localized and of relatively low grade. In prior decades, the primary consideration was not that cancers were being found too early but, often, too late. The lay public is now becoming much more aware of and accepting of an option for surveillance rather than active treatment. A general benchmark that has been used is that observation alone is appropriate for a man with a low-grade cancer who has an anticipated life expectancy of less than ten or, perhaps, 15 years. Typically, then, men over the age of 70 or 75 years are at low risk to die from a localized and low-grade prostate cancer [1]. Although there is s
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