Treatment options for prostate cancer.

The reader of the prostate cancer literature is often stunned by the lack of evidence of efficacy of one form of treatment over that of others. Indeed, information suggests that "no treatment" may be an effective option. Analyzing the available literature that reports the results of treatment versus observation for prostate cancer, Fleming et al. from the Prostate Patient Outcomes Research Team found that in most cases, treatment offered less than a 1-year improvement in quality-adjusted life expectancy. Using less optimistic assumptions, the authors also found that treatment could actually reduce quality-adjusted life expectancy. The decision of what form of treatment to offer the individual patient requires considerable discussion with the patient concerning his priorities and goals of therapy. For the younger patient with localized disease, the prevailing trend in the United States is toward radical prostatectomy. As the patient approaches the age of 70 years, the advantages of treatment versus observation alone evaporate. Because the disease is often of low biologic potential with a long doubling time, the option of observation initially with serial determinations of PSA is not unreasonable. If a slow rate of rise is noted, some patients may elect observation. However, with more rapid rises in PSA, a more aggressive stance may be appropriate. Because of the uncertainties inherent to treating this disease, it is imperative that the patient be brought into the treatment planning through education and through extensive discussions with health care providers and with family members. Only through such informed and deliberate discussions can a plan for treatment be reached with which the patient will be comfortable.