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Invited Commentary
March 8, 2010

The Prostate Cancer Treatment Bazaar: Comment on “Physician Visits Prior to Treatment for Clinically Localized Prostate Cancer”

Author Affiliations

Author Affiliation: Foundation for Informed Medical Decision Making, Boston, Massachusetts.

Arch Intern Med. 2010;170(5):450-452. doi:10.1001/archinternmed.2010.2

Few medical decisions are as difficult as the one faced by a man newly diagnosed as having prostate cancer. There is a virtual bazaar of treatment options. Available choices include surgery, radiation, cryotherapy, and expectant management. If surgery, it can be performed through an open approach, laparoscopically, or assisted by a robot. If radiation, external beam radiotherapy can be delivered by 3-dimensional conformal or intensity-modulated radiotherapy techniques, while brachytherapy can be performed with various methods to accurately implant seeds, including with robotic assistance, and proton beam therapy is available at an increasing number of centers. Even expectant management has variations, such as watchful waiting, when therapy is withheld for overt clinical evidence of progression, and active surveillance, when curative treatment is attempted for paraclinical evidence of progression.

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