Reasons for delay of endocrine treatment in cancer of the prostate (until symptomatic metastases occur).

The VACURG studies showed that 1) In early (stage I and II) cancer of the prostate, radical prostatectomy dose not increase survival compared with initial placebo treatment, it is therefore a definite option (and possibly advisable) to initially just observe the patients with early cancer of the prostate (the "watch and see" or "watchful waiting" policy), 2) 1.0 mg as well as 5.0 mg DES daily retards progression from stage III to stage IV but does not improve survival in stage III, 3) 5.0 mg DES daily is associated with increased risk of cardiovascular death, and 4) in stage IV patients, early endocrine treatment (e.g. 1 mg DES) is advisable, especially in younger patients with high-grade tumors.