PROSTATE-CANCER - SCREENING, DIAGNOSIS, AND MANAGEMENT

Objective: To provide physicians with a review of diagnosis, screening , staging evaluation, treatment options, prognosis, psychosocial issue s, economic considerations, and future research directions in the mana gement of patients with all stages of prostate cancer. Data Sources:A MEDLINE search of articles relating to the diagnosis, staging, screeni ng, surgery, radiation therapy, medical management, and research in pr ostate cancer. Emphasis on information reported from government- and n ongovernment-sponsored large cooperative trials, consensus development conferences, and proceedings of prostate cancer organ site workshops. Study Selection: Results of randomized treatment trials and consensus summary statements are reported where long-term results (> 5 years fo llow-up) are available for localized prostate cancer treatment and whe re survival outcomes are available for metastatic disease treatment. D ata Synthesis: Both qualitative and quantitative data are reported. In formation on staging, management, and prognosis of localized prostate cancer is based on studies that are predominantly nonrandomized, inclu de heterogeneous patient groups, and often use differing outcome measu res. Information on management of metastatic prostate cancer is more q uantitative and includes side effects of treatment and survival result s obtained from randomized, prospective, multi-institutional studies. Conclusions: Despite the increase in prostate cancer incidence and det ection, substantial controversy still exists about the advisability an d effectiveness of screening programs, the most appropriate staging ev aluation, and the optimal management of patients with all stages of pr ostate cancer, Although randomized, prospective studies attempt to add ress some of these issues, physicians must appreciate inherent ambigui ties involved in recommending staging and treatment choices.