Recent declines in cause-specific mortality rates among men with prostate cancer suggest that early diagnosis and treatment for localized tumors may improve survival.1,2 In particular, in a randomized controlled trial from Scandinavia, Bill-Axelson et al3 demonstrated that patients with clinically detected, early stage prostate cancers who were assigned to radical prostatectomy had better survival than those assigned to watchful waiting.3 An important caveat is that the survival benefits of prostatectomy were concentrated among men younger than 65 years.3 Given that the frequently indolent nature of prostate cancer in older men,4,5 this finding begets clinical uncertainty regarding the role of initial local therapy in this population.
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