CURRENT CONTROVERSIES IN THE MANAGEMENT OF LOCALIZED PROSTATE-CANCER

As longevity has improved and mortality from cardiovascular and other diseases has declined, the risk of death from prostate cancer has incr eased steadily. Though slow growing, prostate cancer is not a benign d isease. Nearly 10% of men in Western countries will be diagnosed with prostate cancer sometime during their life and 3% will die of the dise ase. The prospects for long-term control of prostate cancer diminish r apidly once the cancer has spread beyond the immediate periprostatic t issue. The 5-year survival rate for men with metastases is less than 3 0% and almost all will eventually die of their disease. A simple blood test, prostate-specific antigen (PSA), is available. This test, when used in conjunction with ultrasound-guided systematic needle biopsy of the prostate, will detect potentially lethal prostate cancers earlier than digital rectal examination (DRE). Definitive treatment, especial ly with radical prostatectomy, can eradicate the tumor in 90% of patie nts if the cancer is still confined to the prostate pathologically, re gardless of the tumor grade. Randomized, prospective clinical trials a re now underway to demonstrate conclusively whether screening or early definitive therapy will substantially reduce the mortality rate from this disease. Until the results of these trials are available, we reco mmend that healthy men over age 50, who have a life expectancy of 10 y ears or longer, have an annual PSA and DRE to detect prostate cancer w hile it is still curable.