David C. Cunningham, MD

For now, a reasonable strategy is to consider watchful waiting as an acceptable alternative to radical prostatectomy for patients with early prostate cancer and a lifespan of less than 10 years. For other patients, discuss the benefits and risks of the treatment options, balancing expected side effects of the operation and the impact of other illnesses on survival with the possible benefit of the operation or other kinds of treatment.

We still lack sufficient evidence whether early detection by PSA screening can reduce morbidity or mortality.

In this study, radical prostatectomy for early prostate cancer decreased disease-specific mortality, but did not improve overall mortality. A companion study¹ showed that non–nerve-sparing radical prostatectomy yielded no difference in subjective quality of life, although clinically important increases in erectile dysfunction (number needed to harm [NNH]=3) and urinary leakage (NNH=4) did occur, compared with watchful waiting.

Clinicians should understand that these results might not apply to patients with highly undifferentiated cancer; patients identified by screening to have elevated prostate-specific antigen (PSA) concentrations and no clinically symptomatic disease; or patients with significant comorbidities.

For now, a reasonable strategy is to consider watchful waiting as an acceptable alternative to radical prostatectomy for patients with early prostate cancer and a lifespan of less than 10 years. For other patients, discuss the benefits and risks of the treatment options, balancing expected side effects of the operation and the impact of other illnesses on survival with the possible benefit of the operation or other kinds of treatment.

We still lack sufficient evidence whether early detection by PSA screening can reduce morbidity or mortality.

In this study, radical prostatectomy for early prostate cancer decreased disease-specific mortality, but did not improve overall mortality. A companion study¹ showed that non–nerve-sparing radical prostatectomy yielded no difference in subjective quality of life, although clinically important increases in erectile dysfunction (number needed to harm [NNH]=3) and urinary leakage (NNH=4) did occur, compared with watchful waiting.

Clinicians should understand that these results might not apply to patients with highly undifferentiated cancer; patients identified by screening to have elevated prostate-specific antigen (PSA) concentrations and no clinically symptomatic disease; or patients with significant comorbidities.

For now, a reasonable strategy is to consider watchful waiting as an acceptable alternative to radical prostatectomy for patients with early prostate cancer and a lifespan of less than 10 years. For other patients, discuss the benefits and risks of the treatment options, balancing expected side effects of the operation and the impact of other illnesses on survival with the possible benefit of the operation or other kinds of treatment.

We still lack sufficient evidence whether early detection by PSA screening can reduce morbidity or mortality.

In this study, radical prostatectomy for early prostate cancer decreased disease-specific mortality, but did not improve overall mortality. A companion study¹ showed that non–nerve-sparing radical prostatectomy yielded no difference in subjective quality of life, although clinically important increases in erectile dysfunction (number needed to harm [NNH]=3) and urinary leakage (NNH=4) did occur, compared with watchful waiting.

Clinicians should understand that these results might not apply to patients with highly undifferentiated cancer; patients identified by screening to have elevated prostate-specific antigen (PSA) concentrations and no clinically symptomatic disease; or patients with significant comorbidities.