The Changing Face of Prostate Cancer

Abstract

Prostate cancer remains the most common noncutaneous human malignancy, and the second most lethal tumor among men. However, the natural history of the disease is often prolonged, and the survival benefits of local therapy for men with low-risk tumors may not be realized for a decade or more, as is increasingly well demonstrated in long-term observational cohorts in both the United States and Europe. A significant proportion of men with prostate cancer may be overdiagnosed, in the sense that diagnosis may not improve their lifespan or quality of life. However, the extent to which overdiagnosis represents a true problem relates to the consistency with which diagnosis leads invariably to active treatment. Prostate cancer is diagnosed at progressively earlier stages and with lower risk features; despite these trends, patients are less likely now than a decade ago to undergo a trial of active surveillance. Rates of brachytherapy and hormonal therapy use, in particular, have risen markedly. Important progress has been made in recent years in prostate cancer risk assessment. These advances, in combination with biomarkers in later stages of development, should be expected in the coming years to yield further improvements in clinicians' ability to diagnose prostate cancer early, and guide appropriately selected patients toward increasingly tailored treatment.

Expectant Management of Prostate Cancer With Curative Intent: An Update of The Johns Hopkins Experience

“…2 A substantial proportion of these men will gain no benefit from treatment in terms of additional years of life. In a randomized trial comparing surgically treated to untreated patients with prostate cancers that were not screen detected, more than 300 men 65 years or older would need to be treated to prevent 1 prostate cancer death during 10 years.…”

“…1 Most men diagnosed with prostate cancer today have low to intermediate risk prostate cancers diagnosed at a median age of 68 years and more than 90% of them undergo active treatments. 2 Overtreatment of prostate cancer is more common among older men. The absolute decrease in prostate cancer specific death in men 65 years or older randomized to surgery vs observation was 0.3% at 10 years, compared to 11% in those younger than 65 years.…”

Genetic services for men: The preferences of men with a family history of prostate cancer

“…This supposition is consistent with risk-management advice being of greatest interest to respondents. Given the lack of agreement about factors that reduce the risk of prostate cancer 37 and the current uncertainty about whether screening for prostate cancer reduces mortality, 38 meeting these needs provides a potential challenge for health care providers in the short term.…”

Comparison of urologist reimbursement for managing patients with low-risk prostate cancer by active surveillance versus total prostatectomy

“…1 The introduction of PSA screening for PC has resulted in a dramatic increase in the diagnosis and stage migration, with a significant number of newly diagnosed patients having clinically localized low-risk PC. 2 In a recent review, Klotz 3 reported 90% of low-risk PC patients undergo treatment. He also concluded that to prevent one low-risk PC death, 80-100 men need to be treated.…”