The risks outweigh the benefits of radical prostatectomy in localised prostate cancer: the argument for.

Abstract

Prostate cancer represents a major menace to Western society. Since it is asymptomatic in its early stages and there is no curative therapy for advanced stages, our only hope to decrease the mortality rate from prostate cancer is through annual prostatic evaluations of men who agree to undergo such testing. It is important to emphasise that these patients should be carefully informed about the possible consequences. Since prostate cancer is a slow growing tumour and its clinical significance decreases with advancing in age, only young men with a life expectancy of 10-15 years or more should participate in early detection efforts. These men should be evaluated as diligently as possible through the combined use of digital rectal examination and the newly described prostate-specific antigen testing, i.e. analysis of the ratio between different forms of serum prostate-specific antigen. Radical prostatectomy, when performed on men with a life expectancy of 15 years or more who truly have organ-confined prostate cancer, is an acceptable and effective treatment for this group of patients who would benefit most from a radical approach to their disease.