Prostate cancer facts and fiction.

1. The observed increase in prostate cancer incidence followed by a decrease, was not an epidemic, but the result of generalized prostate cancer screening in the United States. 2. The increase showed a shift in stage, to mainly early disease in grade 2 (Gleason's 4-6) clinically significant cancers with a decrease in advanced disease. 3. There was an increase in the use of radical prostatectomy, mainly in men 40 to 75 years of age with a 10-year relative survival rate of 100%. It appears that 15% were grade 1 cancers and in the absence of more information may have been clinically unimportant. 4. There was a 20% increase in the overall relative survival rate for prostate cancer. 5. There was a decrease in the incidence of advanced disease followed by a 6.3% decrease in the United States mortality rate for prostate cancer. 6. It appears that an annual PSA blood test and a DRE on all men over 50 years of age followed by appropriate treatment has decreased deaths from prostate cancer.