Who is best benefited by radical prostatectomy?

The last several years have witnessed a profound increase in earlier detection of prostate cancer due to widespread implementation of prostate-specific antigen (PSA)-based screening programs. For various reasons, radical prostatectomy has been used increasingly to treat men with early-stage prostate cancer. Although some believe that this strategy constitutes overtreatment for men with early-stage prostate cancer, new information on the long-term natural history of prostate cancer seems to suggest otherwise. Refinements in the use of specific prognostic factors in the future may permit the tailoring of radical prostatectomy more appropriately to men who have both clinically significant and surgically curable prostate cancer.