Prostate cancer--some aspects of epidemiology, risk factors, treatment and survival

In Western populations prostate cancer was probably rare in the past, yet in many populations the mortality rate has risen 3-5-fold since 1910. The disease now affects 1 man in 20. While the incidence in Third World populations living traditionally remains low, it increases with urbanization and prosperity, as in South African blacks. While the disease is age-related, more common in married than in single men and family-orientated, knowledge of specific aetiological factors is meagre. Abnormal hormonal status may well be involved, and possibly diet (Western v. Third World diet). There is a strong hormonal influence on tumour development. Treatment, according to the stage of the disease, includes prostatectomy, hormonal manipulation, external irradiation and chemotherapy; 70% of patients are surgically incurable at the time of presentation. Survival is greatly affected by the stage at diagnosis; the percentage surviving 5 years is 3 times higher for patients at stage A than for those at stage D. Little can be done to avoid prostate cancer because of inadequate understanding of risk factors. Annual rectal examination between 40 and 65 years is urged, since surgical cure is possible when metastases are absent.