ABSTRACT
Prostate cancer is the most commonly diagnosed non-cutaneous cancer in men, alone accounting for almost 1 in 5 new diagnoses in Western countries (1). In Europe in 2012, there were just over 3.4 million new cases of cancer (excluding non-melanoma skin cancers) and a total of 417,000 prostate cancer cases (12.1% of all cancer cases). The highest prostate cancer incidence is reported in Norway, with 193 per 100,000 males (2). From autopsy studies, it is known that prostate cancer can be found in 55% of men in their fifth decade and 64% in their seventh decade (3). A sharp reduction in prostate cancer incidence of about 10% annually from 2010 to 2014 is seen. The drop in prostate cancer incidence has been attributed to decreased prostate-specific antigen (PSA) testing from 2008 to 2013 in the wake of US Preventive Services Task Force recommendations against routine use of the test to screen for prostate cancer (Grade D) in ages 75 and older in 2008 and in all men in 2011 because of growing concerns about overdiagnosis and overtreatment (4,5).
Despite the extensive clinical experience with this disease, from screening, to diagnosis, to treatment selection, it continues to be one of the most controversial areas in oncology. The tendency of prostate cancer to develop multifocally has been demonstrated by many studies, with rates found to range anywhere from 60% to 90% (6). Pathological stage and tumour grade together with PSA are the most important indicators of outcome (7). Furthermore, prostate cancer comprises a wide spectrum of biological and clinical behaviour, ranging from a minute latent tumour to a highly aggressive, life-threatening disease (8). The 5-year survival rate is almost 100% for local or regional disease, but decreases to 32% when distant metastases are present.
