[A paradigm shift. Defensive strategies for the treatment of localized prostate cancer in the new S3 guideline]

Abstract

Early detection based on measurement of the prostate-specific antigen (PSA) has resulted in more cases of prostate cancer being discovered that would have remained unnoticed without screening. Against this background, defensive strategies gain in importance. The current S3 guideline takes this development into account by recommending "active surveillance" (AS) and "watchful waiting" (WW) as equally accepted treatment options for localized prostate cancer. The available data concerning AS, on which the guideline recommendations rely, indicate that it is a safe treatment option for a well-defined patient cohort with low-risk tumors. Nevertheless, defensive strategies are regarded with considerable reservation in clinical practice, although curative measures in patients with low-risk tumors are of little therapeutic value.