Should chemotherapy be used in nonmetastatic prostate cancer?—Yes
The controversy surrounding overdiagnosis and overtreatment of prostate cancer (PC) has received substantial attention with the US Preventive Services Task Force (USPSTF) recommendations on prostate-specific antigen (PSA) screening.1 Although the majority of men with PC die with the disease rather than as a result of the disease,2 the natural history is quite heterogeneous. In addition, the incidence and prevalence of men with PC is high, and more than 26 000 men succumb to the disease annually in the United States.2 Therefore, selection of patients appropriate for aggressive intervention is important, not only to avoid overtreatment but also to ameliorate undertreatment.