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Revisiting the role of radical surgery in early stage prostate cancer

Anthony J Costello, Niall M Corcoran and Scott Van Appledorn
Med J Aust 2005; 183 (6): . || doi: 10.5694/j.1326-5377.2005.tb07055.x
Published online: 19 September 2005

Is it time to walk the line between overtreating indolent disease and undertreating aggressive disease?

Few other health care issues in Australia have been as contentious as the diagnosis and treatment of early prostate cancer. Debate centres on two hotly contested but important issues: do prostate cancers diagnosed by an elevated serum prostate-specific antigen (PSA) level pose a significant threat to health, and if they do, can intervention alter the natural history of the disease? In this editorial, we consider the contribution that two recently published studies make to this debate, with a focus on survival and the role of surgical management.


  • Department of Urology, The Royal Melbourne Hospital, Melbourne, VIC.


Correspondence: 

  • 1. Albertsen PC, Hanley JA, Fine J. 20-year outcomes following conservative management of clinically localised prostate cancer. JAMA 2005; 293: 2095-2101.
  • 2. Higano CS. Side effects of androgen deprivation therapy: monitoring and minimizing toxicity. Urology 2003; 61 (2 Suppl 1): 32-38.
  • 3. Johansson JE, Andren O, Andersson SO, et al. Natural history of early, localised prostate cancer. JAMA 2004; 291: 2713-2719.
  • 4. Bill-Axelson A, Holmberg L, Ruutu M, et al. Radical prostatectomy versus watchful waiting in early prostate cancer. N Engl J Med 2005; 352: 1977-1984.
  • 5. Catalona WJ, Bartsh G, Rittenhouse HG, et al. Serum pro-prostate specific antigen preferentially detects aggressive prostate cancers in men with 2 to 4 ng/ml prostate specific antigen. J Urol 2004; 171: 2239-2244.
  • 6. Guillonneau B, Cathelineau X, Doublet JD, et al. Laparoscopic radical prostatectomy: assessment after 550 procedures. Crit Rev Oncol Hematol 2002; 43: 123-133.
  • 7. Tewari A, Srivasatava A, Menon M, et al. A comparison of radical retropubic and robot-assisted prostatectomy: experience in one institution. BJU Int 2003; 92: 205.
  • 8. Herrell SD, Smith JA Jr. Laparoscopic and robotic radical prostatectomy: what are the real advantages? BJU Int 2005; 95: 3-4.
  • 9. Klotz L. Active surveillance with selective delayed intervention: using natural history to guide treatment in good risk prostate cancer. J Urol 2004; 172: S48-S51.

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