Because the aging male population has an increasingly longer life expectancy, concerns regarding prostate cancer, the leading cause of mortality in this group, will increase. Attempts to decrease mortality due to prostate cancer can only follow three avenues: (1) prevention of cancer in high-risk populations; (2) the development of efficient strategies for diagnosing cancer at an early stage, where available therapy may be curative; and (3) improving the effectiveness of therapy by combining treatment approaches. The results of screening studies suggest that it is now possible to achieve early detection and to detect cancers that are in more than 70% of cases clinically localized to the prostate. Even in these optimal circumstances, up to 20% of patients will have clinical stage C prostate cancer. Moreover, the more precise pathologic staging with step-sectioning of prostate specimens obtained by radical prostatectomy has demonstrated a soberingly high incidence of capsular penetration, invasion of seminal vesicles, and positive margins in as high as 30% to 60% of cases with clinical stage B prostate cancer. These findings are predictive of long-term failure as evidenced by results of long-term follow-up as well as by the high rate of early rising prostate-specific antigen (PSA) in such patients.

From another point of view, in experienced hands improved surgical techniques have led to confidence in achieving reduced morbidity rates associated with radical prostatectomy. This has lead to an expanded use of this therapeutic approach in the last 5 to 10 years. It has also resulted in a relaxation of the previously stringent indications for radical prostatectomy. The dichotomy of operating on larger cancers, while appreciating the increasing rate of apparent involvement of surgical margins, has prompted a renewed interest in adjuvant therapies to improve local control by either radiation therapy or hormonal treatment.