Screening and hormonal therapy of localized prostate cancer shows major benefits on survival

Five recent randomized studies demonstrate that treatment of localized prostate cancer saves lives. Since prostate cancer grows insidiously without signs or symptoms until it reaches the bones-when cure has become an exception-screening is essential to diagnose the disease at an earlier stage when cure is possible in the majority of patients. At 7 years' median follow-up with continuous hormonal therapy, cancer-specific death was observed in less than 5% of patients with treatment started at the stage of clinically localized disease, compared to 70% to 90% when treatment is started in patients with bone metastases. With appropriate screening, 99% of prostate cancers can be diagnosed at the localized stage with no sign of bone metastases. Starting androgen blockade at time of diagnosis of localized disease can achieve long-term control of the disease in close to 100% of patients and even cure the disease in the majority of them, as evidenced by maintenance of undetectable PSA in 85% of patients after cessation of long-term combined hormonal therapy. The available data indicate that the use of regular PSA screening and immediate treatment can markedly reduce mortality rates among prostate cancer patients. Next steps toward improving the quality of life for prostate cancer patients including more tolerable treatments and prevention steps are underway.