Observation in the Management of Localized Prostate Cancer
Background: The widespread use of the prostate-specific antigen test, the availability of ultrasound, and improved techniques for prostate biopsy have led to the diagnosis of organ-confined prostate cancers at an earlier stage. An unknown number of these cancers will be incidental and will not impact the patient's quality or length of life.
Methods: The most recent published reports and decision analysis studies on observation management were reviewed. We also analyzed our own series of observed patients.
Results: Three contemporary series on observation and three reports on decision analysis for treatment of early prostate cancer define a group of patients who may be treated with observation. Our own preliminary experience, however, demonstrates that a significant number undergo definitive treatment within 3 years from diagnosis. The optimal treatment for men with early prostate cancer is currently unknown.
Conclusions: A subset of patients with newly diagnosed prostate cancer may be managed by observation.
Standard protocols for selection and follow-up of patients on observation need to be developed.

The majority of patients with newly diagnosed prostate cancer currently present with clinically localized disease. In contrast, until only 10 years ago, most patients presented with more advanced disease. This "stage migration" is a consequence of increased awareness of the disease by physicians and patients, the widespread use of the prostate-specific antigen (PSA) test, and the availability of transrectal ultrasound to more accurately guide prostate biopsies. Management options for clinically localized prostate cancer include surgery, external-beam radiation therapy, cryosurgery, brachytherapy, and observation. In this article, we discuss the most current literature on observation or "watchful waiting," present the clinical parameters of patients who would be most suitably managed by observation, and propose a follow-up schedule for patients who elect observation as primary management of their localized prostate cancer.