Prostate cancer: how can a common disease be so controversial?

By 1994, the number of cases of prostate cancer diagnosed will increase by 50% over a 2-year period. Treatment of all cases diagnosed decrease prostate cancer mortality; however, not all of these cases are destined to cause symptoms or impact adversely on the quality of life of the patient. For the latter patients, a deferred approach is appropriate. Selecting which patient requires treatment, and if so, which treatment to use remains an area of increasing controversy. For those with tumors outside of the gland, improving local control rates and defining metastatic risk are of importance. In this regard, significant advances in our understanding of the biology of prostatic cancers have been made, and some of the specific genetic abnormalities associated with the metastatic phenotype defined. For those with established metastases, improving the results with standard hormonal therapies is an area of active investigation. Selected patients who progress while using androgen-ablation remain sensitive to second-line therapies such as flutamide withdrawal or other hormonal treatments. A new definition of so-called hormone-independent disease is defined. Ultimately, more effective therapies aimed at hormone-refractory cells will be required to improve survival.