ABSTRACT
In the UK in 2002 there were nearly 32 000 new cases of prostate cancer recorded, accounting for 12% of all cancers diagnosed, resulting in the condition being the most commonly diagnosed male malignancy 1 . Across the Western world the incidence has increased dramatically over the past 50 years, initially as a consequence of an increase in the number of men under going transurethral resection of the prostate (TURP) for lower urinary tract symptoms and since 1989 following the introduction of prostate specific antigen (PSA) screening programs. However, prostate cancer represents a unique problem amongst the solid tumors as it essentially exists in two forms: a histological or latent form which can be identified in autopsy specimens in approximately 30% of men over the age of 50 years and 70% of men over the age of 80 2 , and the clinically evident form which affects approximately one in six men in their lifetimes 3 . Indeed the risk of dying of prostate cancer is small with it only accounting for approximately 5% of all male cancer deaths 4 . Separating those who need treatment from those whose disease will remain indolent and then initiating appropriate intervention is the conundrum that most vexes urology today.
