The epidemiology of high-risk prostate cancer

Concern for over and under-treatment of men with prostate cancer has led to an increased focus on the identification and selective treatment of men with high-risk features. The purpose of this review is to summarize the epidemiology, risk factors, and treatment trends of men with high-risk prostate cancer.

Findings from recent trials on prostate-specific antigen-based screening suggest that screening has substantially reduced the incidence of high-risk prostate cancer. Men with high-risk disease tend to be older at diagnosis than those with low-risk disease. There is marked variation in the treatment of men with high-risk features; contemporary studies favor multimodal therapy, but high-risk disease is often under-treated with androgen deprivation alone, particularly among older men.

Variations in the incidence, mortality, and treatment of men with high-risk prostate cancer may reflect heterogeneity among studies in the definition of high-risk disease. Future research should attempt to standardize definitions of high-risk prostate cancer to allow better comparison between studies and provide a more homogeneous assessment of natural history.