Prostate cancer in the era of prostate-specific antigen.

Overview

The number of cases of prostate cancer diagnosed increased by 15% in the past year. This trend is likely to continue as prostate-specific antigen testing was approved for screening during the past year. The result is that mroe patients are being diagnosed at an earlier and presumably curable stage, although the long-term impact on survival has not been proven. Two large national randomized comparisons were initiated to assess the value of early detection (Prostate, Lung, Colorectal, and Ovarian cancer screening trial) and of early treatment (Prostate Cancer Intervention Versus Observation Trial). Evolving data from early detection studies suggest that the majority of cancers diagnosed are clinically significant. Further, criteria for "deferred treatment" approaches are likewise beginning to evolve. The more widespread use of nomograms based on digital rectal examination findings, Gleason grade, and baseline prostate-specific antigen has led to more refined treatment selection. Patients deemed incurable by local means are being referred for combined modality approaches. For more advanced disease, several new hormonal approaches are evolving, and for those with relapsing tumors, responses to antiandrogen withdrawal were extended to Casodex, (Zeneca Pharmaceuticals, Macclesfield, UK) and a number of nonhormonal treatments such as combinations of estramustine and etoposide estramustine and vinblastine, and doxorubicin and ketoconazole are showing clinical benefit.