Observation in the management of localized prostate cancer

Abstract

Background: The widespread use of the prostate-specific antigen test, the availability of ultrasound, and improved techniques for prostate biopsy have led to the diagnosis of organ-confined prostate cancers at an earlier stage. An unknown number of these cancers will be incidental and will not impact the patient's quality or length of life. Methods: The most recent published reports and decision analysis studies on observation management were reviewed. We also analyzed our own series of observed patients. Results: Three contemporary series on observation and three reports on decision analysis for treatment of early prostate cancer define a group of patients who may be treated with observation. Our own preliminary experience, however, demonstrates that a significant number undergo definitive treatment within 3 years from diagnosis. The optimal treatment for men with early prostate cancer is currently unknown. Conclusions: A subset of patients with newly diagnosed prostate cancer may be managed by observation. Standard protocols for selection and follow-up of patients on observation need to be developed.