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Essentials of diagnosis

• Prostatic indurations on digital rectal examination or elevation of PSA.
• Most often asymptomatic.
• Systemic symptoms (weight loss, bone pain) in 20% of patients.

General considerations

Prostatic cancer is the most common cancer detected in American men. In the United States in 2007, over 300,000 new cases of prostate cancer will be diagnosed, and over 41,000 deaths will result. However, the clinical incidence of the disease does not match the prevalence noted at autopsy, where more than 40% of men over 50 years of age are found to have prostatic carcinoma. Most such occult cancers are small and contained within the prostate gland few are associated with regional or distant disease. The incidence of prostatic cancer increases with age. Whereas 30% of men age 60-69 will have the disease, autopsy specimens around the world varies little, the clinical incidence is considerably different, suggesting that environmental or dietary differences among populations may be important for prostatic cancer growth. A 50 – years – old American man has a lifetime risk of 40% for latent cancer, 9.5% for developing clinically apparent cancer, and 2.9% risk of death due to prostatic cancer. Blacks and others with a family history of prostatic cancer and perhaps men who have undergone vasectomy are at an increased risk of developing it.

The incidence of prostatic cancer is increasing in this country, partly due to wider application of detection techniques (transrectal ultrasound and PSA testing). The goal of a screening effort should be to detect and treat only those prostatic carcinomas most likely to cause morbidity or mortality if left untreated. Detection of latent, non progressive cancers exposes patients to unnecessary treatment and attendant complications and costs. Whether screening for prostatic cancer will result in a decrease in yearly mortality rates are unknown and the subject of much debate.