The dilemma of hereditary prostate cancer.

The observation that a family history of prostate cancer significantly increases a man's risk of the disease (see pages 895 to 900 of this issue) highlights many of the ethical, emotional and pragmatic controversies in medical circles concerning the management of this common form of cancer. This editorial describes a patient's personal dilemma when he learns that his brother is dying of prostate cancer, a dilemma that illustrates the potential harms and benefits of early detection and treatment. Current evidence does not justify screening asymptomatic men for prostate cancer, but many Canadian physicians do practise early case detection for some patients with a high risk of the disease. Men with a family history of prostate cancer must be informed by their physicians about the known and unknown risks and benefits of early detection and treatment, before they undergo the cascade of diagnostic and therapeutic procedures associated with prostate cancer.