James Brown, MD, Minimally Invasive Urologic Oncology Fellow
Department of Urology, Thomas Jefferson University, Assistant Professor of Urology
Medical College of Georgia, Augusta, GA, USA.
Leonard G. Gomella, MD, Bernard Godwin Associate Professor of Prostate Cancer
Director of Urologic Oncology, Department of Urology, Kimmel Cancer Center,
Thomas Jefferson University, Philadelphia, PA, USA.
The treatment options for localized prostate cancer are extensive and highly controversial. Although there is general agreement that symptomatic metastatic disease should be treated by hormonal ablation, there is no consensus on how to treat patients with localized disease. While an argument can be made not to screen any patient for prostate cancer, many organizations, including the American Urological Association, support both screening and the treatment of prostate cancer in men with a life expectancy of greater than 10 years. In the asymptomatic, older man with localized, low-risk disease, characterized by a low Gleason score, low PSA and low clinical stage, observation may be the treatment of choice. However, in the older man with localized prostate cancer and high-risk features such as a high Gleason score, aggressive treatment is warranted since many of these men will progress and ultimately die of prostate cancer.