An update on prostate cancer
Maurie Markman, MD
Eric A. Klein, MDAddress reprint requests to E.A.K., Department of Urology, A100, The Cleveland Clinic Foundation, 9500 Euclid Avenue, Cleveland, OH 44195.
As screening for prostate cancer has become more common, the issues surrounding its diagnosis and treatment have grown more complex. This review surveys recent advances and controversies, including definition of risk factors, the role of screening, and current treatment strategies.KEY POINTS
African American heritage and age are risk factors for prostate cancer. There appear to be familial and hereditary forms of prostate cancer, which are separate and distinct. A link to vasectomy is speculative. Whether PSA should be used for screening remains controversial. The high incidence of occult carcinoma associated with prostate intraepithelial neoplasia dictates early re-evaluation of patients with this finding on biopsy. Observation rather than treatment may be a reasonable option for older patients or those with low-grade tumors and life expectancy of less than 10 years.
The major advantage of radiation therapy over surgery is that it is less invasive, but it is associated with a higher risk of symptomatic local recurrences. Cryotherapy should be considered an investigational technique with unknown long-term results.