Prostate cancer. Finding and managing it

Despite development of new technology for the diagnosis and treatment of prostate cancer, the age-adjusted mortality rate for the disease has not declined for nearly half a century. Physicians now have the ability to diagnose very small tumors in asymptomatic patients, but it remains to be determined which subset of patients would benefit most from early identification and treatment. Studies that are currently under way hopefully will clarify what screening protocols, if any, actually reduce the mortality and morbidity that are associated with prostate cancer and its treatment. Until such evidence becomes available, screening measures for the general population are unwarranted, with the possible exception of digital rectal examination performed as part of other healthcare services. Prostate-specific antigen (PSA) determination may have a place in screening patients whose family history puts them at increased risk. In patients with symptoms or findings suggestive of prostate cancer, diagnosis and staging can be accomplished more accurately and easily than ever before with a combination of PSA determination, transrectal ultrasound, ultrasound-guided tissue sampling using a biopsy gun, and the judicious use of imaging techniques such as bone scans, magnetic resonance imaging, and computed tomography. New treatment methods are being studied, and the options available, especially for management of disease progression, are expected to increase. Monitoring of treated patients has been greatly facilitated by determination of PSA levels, which are predictive of both long- and short-term prognosis. Although much work remains to be done, we may finally be on the verge of making real progress in control of prostate cancer.