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The Changing Face of Prostate Cancer

Matthew R. Cooperberg, Judd W. Moul, Peter R. Carroll

From the Department of Urology, Program in Urologic Oncology, Urologic Outcomes Research Group, UCSF Comprehensive Cancer Center, University of California, San Francisco, CA; and the Division of Urologic Surgery, Duke University Medical Center, Durham, NC

Address reprint requests to Peter R. Carroll, MD, UCSF Cancer Center, 1600 Divisadero St, 3rd Floor, San Francisco, CA 94115-1711; e-mail: pcarroll{at}urol.ucsf.edu.

Prostate cancer remains the most common noncutaneous human malignancy, and the second most lethal tumor among men. However, the natural history of the disease is often prolonged, and the survival benefits of local therapy for men with low-risk tumors may not be realized for a decade or more, as is increasingly well demonstrated in long-term observational cohorts in both the United States and Europe. A significant proportion of men with prostate cancer may be overdiagnosed, in the sense that diagnosis may not improve their lifespan or quality of life. However, the extent to which overdiagnosis represents a true problem relates to the consistency with which diagnosis leads invariably to active treatment. Prostate cancer is diagnosed at progressively earlier stages and with lower risk features; despite these trends, patients are less likely now than a decade ago to undergo a trial of active surveillance. Rates of brachytherapy and hormonal therapy use, in particular, have risen markedly. Important progress has been made in recent years in prostate cancer risk assessment. These advances, in combination with biomarkers in later stages of development, should be expected in the coming years to yield further improvements in clinicians' ability to diagnose prostate cancer early, and guide appropriately selected patients toward increasingly tailored treatment.

CaPSURE is supported by TAP Pharmaceutical Products Inc (Lake Forest, IL). Additionally funded by National Institutes of Health/National Cancer Institute University of California-San Francisco SPORE Special Program of Research Excellence p50 c89520.

Authors' disclosures of potential conflicts of interest are found at the end of this article.

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