The risks outweigh the benefits of radical prostatectomy in localised prostate cancer: the argument against.

Abstract

The value of early detection, via screening and/or treatment of localised prostate cancer has not been established in well-designed clinical trials. However, radical prostatectomy in localised disease can be justified for a number of reasons. Cure of localised prostate cancer is necessary: 3% of men over 50 years of age will die of prostate cancer. Cure is possible: prostate tumours take 10-15 years to grow from 0.5 cm3 to, for example, 8 cm3--the window where cure is possible by radical prostatectomy. Large series of studies show that the probability of remaining progression free, as determined by prostate specific antigen, can be up to 90% for pT2 tumours and 60-75% for pT3a/b tumours. A radical, anatomic technique is necessary with a low positive margin rate (zero in pT2 tumours) to achieve such results. Radical prostatectomy has a low morbidity: perioperative mortality is far below 1%, complete continence rate is 80-90%, complete incontinence rate 4%, stricture rate 6%, and relaparotomy rate <5%. To conclude, in suitable patients (for example, younger than 70 years of age) with tumours at suitable stages, cure is necessary, possible, and safe using the right technique of radical prostatectomy.