Prostate Cancer

Introduction

Prostate cancer is the most common cancer among men in the United States. In 2010, an estimated 217,730 men will be diagnosed with the disease, and 32,050 will die from prostate cancer.1 Despite a lack of consensus regarding optimal diagnosis and management strategies for prostate cancer, recent data suggest that prostate cancer mortality is decreasing, from 38.6 per 100,000 in 1990 to 25.5 per 100,000 in 2004.1 The current chapter provides an overview of the epidemiology of prostate cancer, current strategies for screening and diagnosis, and treatments for both localized and advanced disease.

Epidemiology

Age

The risk of prostate cancer increases as men age, with 85% of men diagnosed after the age of 65, as compared to less than 0.1% of cases diagnosed among men under 50 years of age.2 Autopsy series demonstrate an increasing incidence of microscopic foci of cancer without a peak or modal distribution. During the PSA testing era, an age migration at diagnosis has occurred, such that the age at diagnosis has significantly declined among men with prostate cancer. From birth to death, men in the United

States have a one in six probability of developing prostate cancer.1

Race

Significant variation in prostate cancer incidence and mortality exists among various racial groups. The incidence of prostate cancer among AfricanAmerican men is 1.6 times that of whiteAmerican men, and the mortality from prostate cancer among African-American men is 2.4 times that of white American men.1 Conversely, AsianAmerican men have a much lower incidence and mortality of prostate cancer as compared to white Americans, and Hispanic-American men have similar incidence and mortality to white Americans. The etiology for the differences among these groups, which are more cultural and social than biological, is likely multifactorial, including environment, access to care, and diet/lifestyle factors.

Geographic Variation

Significant variation exists in prostate cancer mortality and incidence between countries and ethnicities worldwide. North American and Scandinavian men experience the highest incidence and mortality from this disease, whereas the incidence and mortality are lowest in Asia.3,4 The cause of this geographic variation is not entirely understood, but likely involves a number