Prostate Cancer
Editorial – Controversy in managing patients with prostate cancer. Mulley, A. and Barry, M. General Medical Division, Massachusetts General Hospital and Harvard Medical School, Boston, MA, USA.
BMJ, 316(7149): 19219-19220, 27 June 1998.
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Dilemmas in treating early prostate cancer: the evidence and a questionnaire survey of consultant urologists in the United Kingdom. Donovan, J., Frankel, S., Faulkner, A., Selley, S., Gillat, E. and Hamdy, F. Department of Social Medicine, University of Bristol, Bristol, UK.
BNU, 318(7179): 299-300, 30 Jan. 1999.
The effectiveness of radical treatments (prostatectomy and radiotherapy) for prostate cancer over conservative management (surveillance plus hormonal therapy if required) is debatable. Also, quality of life after radical treatment may be poor compared with conservative management. Because of this lack of evidence, controversy still remains over the best form of treatment. Two surveys of British urologists (Savage asked 274 urologists, Br J Urol, 1997; Donovan asked 244 urologists, BMJ, Jan. 1999), found that most favoured active treatment in men aged under 70 years. However, the Savage survey found that this view was contradictory to their views on screening. Most felt that early detection did not confer any survival advantage. Because of these dilemmas, the Prostate Cancer Clinical Guidelines Panel of the American Urological Association have advised that patients should be presented with all the possible treatment alternatives so that they can make informed choices for themselves.