Carcinoma of the prostate has become a growing health problem in the United States. It is now the most common solid tumor in adult men, with an annual incidence of over 200,000 and a mortality over 40,000. Since the beginning of this decade, earlier detection of this disease has occurred because of the use of a blood test to measure prostate-specific antigen (PSA) combined with increased testing of asymptomatic men. The optimal management of localized prostate cancer remains controversial, however, partly due to a lack of randomized controlled trials. This is reflected by the wide fluctuation in rates of radical prostatectomy across the United States.<sup>18Lu-Yao G.L., McLerran D., Wasson J., et al. An assessment of radical prostatectomy-time trends, geographic variation, and outcomes JAMA 1993 ;  269 : 2633-2636

Cliquez ici pour aller à la section Références</sup> Unlike most other malignancies, there is a wide disparity between the prevalence and mortality of this disease; prostate cancer is present histologically in approximately 30% of 50-year-old men and over 50% of 80-year-old men, yet only a small percentage of men actually die from the disease.<sup>10Franks L.M. Etiology, epidemiology and pathology of prostatic cancer Cancer 1973 ;  32 : 1092-1095 [cross-ref]

Cliquez ici pour aller à la section Références</sup> Nearly 50% of new cases are found in men over age 70 where competing causes of death are increasingly common. Thus, the value of screening and treatment may diminish with age. Factors that make management decisions problematic are the rates of local and distant progression and the interval between diagnosis and death from the disease. Therefore, more than 90 years since the first radical prostatectomy was performed,<sup>25Young H.H. The early diagnosis and radical cure of carcinoma of the prostate Johns Hopkins Hospital Bulletin 1904 ;  16 : 315-320

Cliquez ici pour aller à la section Références</sup> the management of localized prostate cancer continues to be controversial. In recent years, the role of the urologist has undergone change as well. Whereas the traditional physician-patient relationship involved a recommendation for treatment followed by an agreement to proceed, increasingly the physician's role now is to present the relative risks and benefits of all options, which is followed by an informed choice of therapy by the patient. To make this possible, patients need detailed information about the probability of each outcome that might result from each therapy rather than simply a list of what is possible. This information is critical to enable each patient to assess the relative value of each option in relation to his personal goals and fears.

Because of the unusual biology of prostate cancer, watchful waiting or surveillance therapy has received increased attention as an option for patients with early-stage disease. Clearly, watchful waiting is not a curative therapy. The risks from this therapy, however, are for many men more than offset by the complication rates of the alternative treatments available, which can make conservative therapy a very reasonable choice for some men. The focus of this article is on the outcomes associated with this therapy combined with a discussion of how to present this information to patients diagnosed with the disease.