Issues on early diagnosis and treatment of localized prostate cancer

Controversies abound in relation to the treatment of every stage of prostate cancer and its natural history. We critically evaluate the controversies and information that exist. An ongoing autopsy project at Wayne State University aims to: define the prevalence of incidental cancer in subjects between 20 and 70 years of age; study the potential difference between Caucasians and Blacks; and to analyze other associated histological lesions such as prostatic intraepithelial neoplasia (PIN) and atypical adenomatous hyperplasia. Initial results note that there was only a weak correlation between high-grade PIN and incidental carcinoma, both lesions started to present at an early age with a progressive increase after the seventh decade, and there was no racial difference observed among Caucasians and African-American males. These results pose several questions which need further explanation. Most studies use digitorectal examination, transrectal 7-MHz ultrasonography and prostate-specific antigen for the early diagnosis of prostate cancer, we attempt to determine the best and most economical combination presently available. In discussing the therapeutic options for patients with localized prostate cancer, we review our personal experience with surgery and radiotherapy.