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Prostate Cancer: Screening, Diagnosis and Management

Prostate cancer is a major public health issue in the United Sates and European countries. Recent. Correspondence in the Lancet last year turned up the heat in Britain as well. A number of studies are underway examining screening for prostate cancer.

The combination of an ageing population and greater awareness has led to increases in the number of these cancers being diagnosed. In the US in 1993 about 165,000 new cases of prostate cancer were diagnosed and 35,000 men died from the disease. There have been estimates that by the year 2000, the number of prostate cancer cases will increase by 90%, and the mortality by 37%. A 50-year old American man has a 40% chance of developing microscopic prostate cancer, a 10% chance of being diagnosed, and a 2-3% chance of dying from the disease.

This makes an up-to-date review quite important, and Marc Garnick provides that in Annals of Internal Medicine. The data source was a MEDLINE search of articles relating to the diagnosis, staging, screening, surgery, radiation therapy, medical management and research in prostate cancer. Results from long term studies (>5 years) are reported. A total of 139 references are included, up to about mid-1993.

This is an excellent review, and brings the reader up-to-date with developments. If it has a failing, it is perhaps that because of its breadth it lacks a little in depth.

Other useful papers

Two other, slightly earlier reviews by the practising urologist and active researcher, Joseph Oesterling of the Mayo Clinic, on the role of the effective tumour marker, prostate specific antigen (PSA), are useful in adding flesh to the bones. Much urological practice in prostate cancer treatment is now being driven by reference to tumour markers, and the Oesterling papers cover the use of PSA in considerable detail, as well as reviewing in detail a significant number of the published accounts.

References:

  1. Garnick. Annals of Internal Medicine 1993 118: 804-18.
  2. Oesterling. Current Opinion in Urology 1992 2: 348-55.
  3. Oesterling. Journal of Urology 1991 145: 907-23.

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