ABSTRACT
Introduction Adenocarcinoma of the prostate is a growing health problem in the US, and is now the most common solid tumor in adult men. Unlike most malignancies, there is a wide disparity between the prevalence and mortality of this disease; prostate cancer is present in approximately 30% of 50-year-old men, and over 50% of 80-year-old men,1
Although one in every six men living in the US will be diagnosed with prostate cancer during his lifetime,4 the risk of dying is only 3%.2 In 2004, the number of prostate cancer-related deaths is predicted to be 30,000.4
The advent of the prostate-specific antigen (PSA) blood test, combined with the increased testing of asymptomatic men and the use of more core biopsies in each patient, has increased the chances of finding clinically insignificant cancers. Up to a third of men in PSA-screened populations, diagnosed with nonpalpable prostate cancer and undergoing radical prostatectomy, have small (<0.5 cm3) low-grade (Gleason 6 or less) tumors.5,6 Such tumors are associated with a long natural history and are unlikely to affect the lifespan of select older men.7 The median time from diagnosis to death from prostate cancer for men diagnosed with nonpalpable disease in the pre-PSA era was approximately 17 years.7 Since the US male lifeexpectancy at 65 years of age is estimated at 15 years, it is unlikely that aggressive treatment is going to add significantly to the average lifespan of most men.8 Thus, PSA overdetects prostate cancer and may subject many patients to the morbidity of treatment with only a small, if any, measurable gain. The challenge is to identify those patients who harbor non-life-threatening tumors and those whose tumor is progressing rapidly.
