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Diseases of the prostate

Prevalence (1996): 2.803 million men (in the noninstitutionalized population)¹

• General Considerations
  Adenocarcinoma of the prostate is the most common cancer in men and the second leading cause of cancer related deaths in men. The detection and treatment of this condition has been revolutionized by the introduction of serum prostate specific antigen [PSA] testing as part of the evaluation for this disease. Refinements in surgical techniques and the application of radiotherapy allow for the treatment of clinically localized disease with decreased morbidity. The choice of therapy is guided by clinical factors and patient preferences as well as tumor characteristics. Androgen blockade is still the foundation for treating advanced disease, yet the treatment of hormonal refractory tumors is limited. Further advances may occur with recently developed cytoreductive agents as well discoveries in tumor immunology and cell biology.
• Incidence
  There will be an estimated 220,000 new cases of prostate cancer this year and 29,200 prostate cancer related deaths. After the abrupt rise in prostate cancer diagnosis with the introduction of PSA and the detection of disease in the prevalence population [cull effect] the yearly incidence is somewhat stable. The death rate has been gradually decreasing over the past several years, yet it is too early to say if this is a direct result of early detection and treatment.

Sources:

1. Current Estimates From the National Health Interview Survey, 1996. Atlanta, GA: National Center for Health Statistics (NCHS), Centers for Disease Control and Prevention (CDC), U.S. Dept. of Health and Human Services (DHHS); October 1999. Vital and Health Statistics. Series 10, No. 200.

References

• Albertson PC, Hanley JA, Gleason DR, Barry MJ: Competing risk analysis of men aged 55 to 74 years at diagnosis managed conservatively for clinically localized prostate cancer. JAMA 280:975-980, 1998.
• D'Amico AV, Whittington R, Malkowicz SB, et al: Biochemical outcome after radical prostatectomy, external beam radiation therapy, or interstitial radiation therapy for clinically localized prostate cancer. JAMA 280:969-974, 1998.
• Droller MJ: Bladder: Anatomical overview in surgical management of urologic disease: An anatomic approach, MJ Droller, St. Louis, Mosby Yearbook, p 575, 1992.
• Eastham JA, Scardino PT: Radical prostatectomy. In: Walsh PC, et al, eds: Campbell's Urology, 7th ed. Philadelphia, Saunders, 1998, pp 2547-2564. Eisenberger MA, Blumenstein BA, Crawford ED, et al: Bilateral orchiectomy with or without flutamide for metastatic prostate cancer. N Engl J Med 339:1036-1042, 1998.
• Herr HW, Schwalb DM, Zhang ZF, et al: Intravesical bacillus Calmette-Guerin therapy prevents tumor progression and death from superficial bladder cancer: Ten-year follow-up of a prospective randomized trial. J Clin Oncol 13:1404, 1995.
• Lamm DL: Complications of bacillus Calmette-Guerin immunotherapy. Urol Clin North Am 19:565, 1992.
• Malkowicz SB: Superficial bladder cancer: The role of molecular markers in the treatment of high-risk superficial disease. Semin Urol Oncol 15:169-178, 1997.
• Messing EM, Catalona W: Urothelial tumors of the urinary tract. In: Campbell's Urology 7th ed. PC Walsh, AB ED Vaughan, AJ Wein, Vol 3, Chap 77, 2327, 1998.
• Partin AW, Kattan MW, Subong EN, Walsh PC, Wojno KJ, Oesterling JE, Scardino PT, Pearson JD. Combination of prostate-specific antigen, clinical stage, and Gleason score to predict pathological stage of localized prostate cancer. A multi-institutional update. JAMA 277:1445-1451, 1997.
• Polascik TJ, Oesterling JE, Parting AW: Prostate specific antigen: A decade of discovery-What we have learned and where we are going. J Ural 162:293-306, 1999.
• Ragde H, Blasko JC, Grimm PD, et al: Interstitial iodine-125 radiation without adjuvant therapy in the treatment of clinically localized prostate carcinoma. Cancer 80:442-453, 1997.
• Spruck CH, Ohneseit PE, Gonzalez-Zulueta M, et al: Two molecular pathways to transitional cell carcinoma of the bladder. Cancer Res 54:784-788, 1994. Walsh PC, Partin AW, Epstein JI: Cancer control and quality of life following anatomical radical retropubic prostatectomy: Results at 10 years. J Urol 152:1831-1836, 1994.
• Zincke H, Oesterling JE, Blute ML, et al: Long-term (15 years) results after radical prostatectomy for clinically localized (stage T2c or lower) prostate cancer. J Urol 152:1850-1857, 1994.

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