Urologic oncology
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Management options for favorable risk prostate cancer are diverse, varying from a conservative approach (expectant management) to definitive treatment (radical prostatectomy or radiotherapy.) Several studies have suggested that expectant management provides similar 10-year survival rates and quality-adjusted life years compared with radical prostatectomy or radiotherapy. Expectant management alone clearly deprives some patients with potentially curable life-threatening disease of the opportunity for curative therapy. However, every series of conservative management contains a substantial subset of long-term survivors, particularly in the group with favorable clinical parameters. ⋯ Furthermore, many healthy patients fall into a grey zone where the benefits of treatment are unclear. In these patients, a policy of close monitoring with selective intervention for the 15-20% who progress rapidly is appealing. This approach is currently the focus of several clinical trials.