ABSTRACT
Recently, the prostate and the diseases to which it is so prone seem to have come to the forefront. The level of public interest has risen swiftly and with it the opportunities for research funding. This, in tandem with the recent explosive development of molecular biology, has produced new insights into the causes of benign prostatic hyperplasia, prostate cancer and prostatitis. For example, a hereditary factor in the pathogenesis of prostate cancer has been localized to a region of the long arm of chromosome 193; this may account for the tendency for prostate cancer, like breast cancer, to run in certain families. New consensus has now been reached concerning the diagnosis of prostatic diseases. PSA testing, although still controversial as a screening tool, is now established as a means of early detection, as well as staging. Ultrasound studies, guided biopsy and bone scans provide the cornerstone of the diagnosis of prostatic cancer. Biopsy confirmation is not usually required either for benign prostatic hyperplasia or prostatitis. Ultrasound studies and flow rate measurement usually suffice for the former, while culture of expressed prostatic secretions is indicated for prostatitis. Benign prostatic hyperplasia therapy has seen a shift from surgery towards medical therapy. Both α-blockers56 and 5α-reductase inhibitors appear safe and effective. The latter also have an important preventative effect57. A combination of α-blocker and 5αreductase inhibitor has recently been demonstrated to be the most effective means of reducing the risk of benign prostatic hyperplasia progression60. While treatment of advanced prostate cancer is generally agreed upon, therapy for localized prostate malignancy is much more controversial74. In the absence of firm evidence from randomized controlled trials, the best we can do at present is explain to patients the advan tages and disadvantages of radical retropubic prostatectomy, radical radiotherapy, brachytherapy, cryotherapy or watchful waiting. Although significant progress has been made in these disease areas, much work remains to be done to improve the quality of life of those who suffer from benign prostatic hyperplasia and prostatitis, and to reduce significantly the death toll from prostate cancer. We also need to enhance the evidence base concerning the safety and effectiveness of the various competing treatment options. We can safely anticipate that the monumental effort currently being undertaken in many laboratories and clinics internationally will eventually translate into improvement of the outcomes for the many millions of prostate sufferers around the world.
