Acknowledgments: Hema Samaratunga, Chris Schmidt, Mark Frydenberg, John Yaxley for their guidance and advice in preparation of this document and to the authors of the previous edition Mitchell H Sokoloff, William B Isaacs, and Leland WK Chung.
Prostate Cancer is an increasingly common diagnosis in Western societies and in those emulating Western lifestyles and diets. In the year 2001 there were estimated to be 198,100 new cases and almost 31,900 deaths attributable to this condition in the United States (1). Approximately one in seven American men will be diagnosed with prostate cancer during their lifetime, making it the most common solid tissue cancer in the United States.
Despite advances in prevention and early detection, refinements in surgical technique and improvements in adjuvant radio-therapy and chemotherapy, the ability to cure many patients with prostate cancer remains elusive. However, mortality rates are changing. Baade et al recently reviewed international trends in prostate cancer mortality and reported significant reductions in prostate-cancer mortality in the UK, USA, Austria, Canada, Italy, France, Germany, Australia and Spain with downward trends in the Netherlands, Ireland and Sweden (2).
Detection of this disease earlier, as a consequence of introduction of the prostate specific antigen (PSA) blood test, has been acknowledged by the NCI as one factor contributing to lowering the mortality rate over the past few years (3-6). The use of PSA testing has been estimated to provide a diagnostic lead-time of up to 10 years (7-11). In the mid to late 1980s only one third of prostate cancers were diagnosed at curable stages compared with today when 80% are staged clinically as organ-confined and potentially curable (12-14). Unfortunately, however, even when the tumour is thought to be localized, up to 25% of men have non-localised disease which declares itself subsequently (15).
Since curative therapies are directed to localised tumours (3,4,7,16), extending effective but non-invasive treatments to include both primary and secondary lesions remains a major goal and challenge. Once prostate cancer metastasizes, apart from causing loss of life, its toll is often considerable with regard to morbidity from both the disease itself and administered therapies.
As a result of increasing numbers of men having their prostate cancers diagnosed earlier, more patients are now eligible for treatment with curative intent. Improved surgical and radiation-based treatments have been developed so that the prognosis of a man diagnosed today with prostate cancer is better than ever before.