Prognostic and predictive factors in prostate cancer

Prostate cancer is a major public health problem in the Western world. and the second most common male malignancies in the European Union. Detection o f the disease is possible at an early stage, using serum prostate specific antigen measurement and prostatic biopsies. To date, however; screening for prostate cancer has not been shown to be of benefit to patients in improvi ng outcome. This is compounded by uncertainties surrounding treatment effic acy, as more men appear to die with prostate cancer than from it. Studies a ddressing these issues are underway in Europe and the U.S.A. Clinicians are currently unable to advise their patients with any degree of certainty as to the appropriateness or treatment for prostate cancer, beca use of their inability to differentiate tumours that will progress from tho se that will remain quiescent. This article reviews the various clinical, p athological and experimental markers available, and their value in providin g prognostic information, which may assist clinicians and patients in makin g management decisions. Further research is still required to understand th e biological behaviour of prostate cancer and to assess the value of screen ing and treatment efficacy in order to advise patients, clinicians and heal th care systems accordingly. (C) 2001 Harcourt Publishers Ltd.