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May 26, 1993

Management of Clinically Localized Prostatic CancerAn Unresolved Problem

JAMA. 1993;269(20):2676-2677. doi:10.1001/jama.1993.03500200090040

Two timely and relevant reports concerning the management of clinically localized prostatic cancer are included in this issue of The Journal. The apparently rising incidence of and mortality with this neoplasm coupled with an expanding population and an increasing life expectancy have made prostatic cancer a major medical and socioeconomic problem. Recognized clinically primarily during the terminal third of the life span and characterized by an often protracted course, rational decisions regarding treatment are compromised by the inability to predict reliably either the life expectancy of the individual host or the natural course of the particular neoplasm. Confounding therapeutic decisions are long-persisting uncertainties regarding the relative merits of surgical excision, irradiation, and watchful waiting, not only with respect to cause-specific survival but also relative to the quality of life between diagnosis and death.

See also pp 2633 and 2650.

The report by Fleming et al1 uses decision analysis to