| Abstract: |
Nineteen eighty-nine marked a turning point as prostate cancer became the most common and second leading cause of cancer deaths in men [1]. By the year 2000, a 90% increase in annual incidence and a 37% increase in annual mortality are projected [2]. In all stages, prostatic cancer is a heterogeneous disorder with diverse biologic potential, and few diseases are as controversial relative to management. The dilemma in localized disease is apparent when one considers the autopsy prevalence of prostatic cancer, which is 30% in men over 50 years of age or more than 8 million potential cases in the US population, relative to the clinical incidence-103,000 cases in 1989. On the surface most cancers do not appear to require therapy [3]. For patients with metastatic disease, prostatic cancer responds dramatically to androgen ablation. Yet even in this setting, 20% die within 1 year and 50% die within 2 years (Bruchovsky et al., in Karr and Yamanamaka, eds., Prostate Cancer: The Second Tokyo Symposium. Elsevier, 1989, pp 1-10). The challenge for clinicians treating patients with localized disease is to diagnose and treat tumors destined to cause symptoms, and for metastatic disease, to anticipate which patients are destined to do poorly with primary hormone therapy. |
