Last reviewed: May 2007
For general information about Cancerbackup's Discussion topics please see the introductory page.
This statement explores some of the issues involved in the treatment of early prostate cancer. Prostate cancer is the most commonly diagnosed cancer in men in the UK. In 2003, almost 32,000 new cases were diagnosed, accounting for 23% of all cancers in men(1).
Despite these large numbers the management of early prostate cancer remains the subject of much controversy and continued debate. This is due to the fact that many men with prostate cancer will do very well whether they are treated or not and it can be difficult to know what difference treatment makes. Also, because the natural course of prostate cancer is generally slow, it has been difficult to establish whether radical treatments improve overall survival compared to active monitoring.
The Royal College of Radiologists Clinical Oncology Information Network & British Association of Urological Surgeons (COIN & BAUS)(2) guidelines state
'there can be few areas in medicine more controversial than the management of prostate cancer. Every aspect of the disease is the subject of lively and often heated debate. At the same time the evidence base in prostate cancer is narrower than in some other common cancers.'
Treatment decisions for men with early prostate cancer must be made on an individual basis. Various factors should be considered, including: the stage and grade of tumour; PSA levels; age, and potential side effects of the treatment. Performance status, general health and the personal choices and values of the patient must also be taken into account.
Stage and grade of the tumour play a large part in decision making. The main staging system used in the UK is the TNM system and the Gleason score is universally used as the best system to grade the histology of the tumour.
Early disease is considered to be confined to the prostate (stage T1–T2), with no lymph nodes affected (N0), and no metastatic spread (M0).
The National Institute for Health and Clinical Excellence (NICE) are producing guidelines on the management of prostate cancer. The guidelines are due to be published in January 2008.
For information on the management of locally advanced and metastatic prostate cancers, please refer to Cancerbackup's additional Clinical Advisory Board statements.