Radical prostatectomy in the management of localized prostate cancer

No data from prospective randomized studies comparing radical prostatectomy, radiotherapy and deferred treatment for localized prostatic cancer are currently available. Comparison of retrospective series, however, strongly suggests a clear superiority of radical prostatectomy over other attempts to cure prostate cancer, and especially over the ‘watchful waiting’ strategy. This concerns survival data as well as quality of life and psychological aspects. In 1994, the Department of Veterans Affairs and The National Cancer Institute in the United States initiated a randomized controlled study comparing radical prostatectomy vs expectant management for the treatment of localized prostate cancer;29 the ‘Prostate Cancer Intervention vs Observation Trial (PIVOT)’. Until the results of this study become available, the decision on how to manage a patient with a newly-diagnosed clinically localized prostate cancer has to be based on current knowledge. The current knowledge is that localized prostate cancer can be cured by radical prostatectomy with acceptable treatment-related morbidity. Therefore, the chance of receiving curative treatment should be offered to every man with localized prostate cancer and a life expectancy of 10 or more years.