The management of localised cancer of the prostate.

Abstract

Localised prostate cancer (T1/T2) can be managed using a conservative (expectant) approach or by radical treatment with curative intent. Expectant management involves observation until symptoms of local/distant progression appear. Radical treatment with intent to cure is based on the destruction (radiation therapy or cryosurgery) or removal (surgery) of the tumour. Many options are offered to patients with T1/T2 prostate cancer. Expectant therapy may be considered in patients with limited life expectancy, curative treatment should be considered in the others, taking into account the high rate of cancer-related deaths after 10 years. Moreover, accurate staging should lead to a better selection of patients likely to be cured by monotherapy (surgery or radiation therapy depending on the patient's and doctor's biases). Surgery probably offers the advantage of the certainty of removal over the hypothetical destruction of the whole tumour provided by radiation therapy.