[Place of surveillance in the treatment of localized prostate cancer]

Surveillance with deferred treatment in patients with clinically prostate-confined prostate cancer is a controversial subject. The policy of prostate cancer screening for increasingly low PSA levels and the use of more extensive biopsy protocols result in the detection of a large number of small tumours, probably early in their subclinical course. Conversely, some patients who receive initial active treatment are understaged by the pretreatment assessment and develop treatment-related adverse effects without any oncological benefit. The main published series concerning surveillance were analysed with particular emphasis on those with the longest observation periods. Data concerning specific survival and progression-free survival are discussed, together with the results obtained in terms of the quality of life of patients submitted to surveillance. Analysis of these data show a potential benefit of surveillance in elderly patients (over the age of 70 years) with small, low-grade prostatic tumours.