Incidence rate and management of prostate carcinoma

The age-standardised incidence of prostate cancer varies more than one hund redfold between the areas with the highest and lowest incidences in the wor ld. In certain areas, in particular the Western countries, the incidence ha s increased rapidly over the last 20 years. There are several environmental and genetic factors which partly explain these variations, although the in cidence probably depends most of all on the extent to which small latent tu mours are detected. As the clinical significance of small tumours is uncert ain, the value of early diagnosis and early aggressive treatment is controv ersial. Randomised trials addressing this question have been initiated and will hopefully provide more evidence-based data in a decade from now. Small localised tumours are managed by radical surgery or radiation therapy. In elderly men or men unfit for operation or radiation therapy surveillance is often preferred. For advanced or metastatic prostate cancers androgen depr ivation has been the mainstay of treatment since the early 1940s. Recently, several new treatment strategies have evolved but have not yet been introd uced into clinical routine. (C) 2001 Editions scientifiques et medicales El sevier SAS.