Defining the role of surveillance in the management of localized prostate cancer.

With the dramatic increase in the detection of prostate cancer in the last 5 years, there has been an enormous challenge for physicians to recommend the "best" therapy for patients with localized prostate cancer. This challenge, however, has been difficult to meet because of the absence of well-conducted comparative trials. Because the primary goal of the urologist has been to "cure" prostate cancer and prolong life, the concept of surveillance therapy seems to be quite inappropriate; however, few other diseases have treatments that can so negatively impact on a man's daily quality of life. In addition, the natural history of this cancer, in contrast to many others, does not invariably lead to metastasis or death during the normal life span of most patients. Therefore, in contrast to physicians, many men may wish to maximize their quality of life rather than their duration of survival. This choice depends on the probability of good and bad outcomes that are possible with each treatment option. Ultimately, it is the patient's choice to make with help and unbiased guidance from the physician.