**Introduction**

**1** 

*USA* 

**Prostate Cancer: Essential Diagnostic** 

*Department of Urologic Oncology, Moffitt Cancer Center, Tampa, FL* 

The potential impact imparted by prostate cancer on our society is immense. In this chapter, we provide a general overview of current concepts, diagnostic advances, and novel therapeutic approaches to the management of prostate cancer. It is widely reported that prostate cancer is the most common malignancy diagnosed in U.S. males. The current lifetime risk of developing prostate cancer is 17%, with an estimated lifetime cancerspecific mortality risk of 3%. The diagnosis of prostate cancer rapidly increased in the mid-1980s, with the advent of the serological biomarker prostate specific antigen (PSA) which has played a pivotal role in the screening and early detection of prostate cancer

From what was almost uniformly a poor prognostic malignancy associated with highly morbid therapies, prostate cancer emerged as a potentially curable disease, with state of the art diagnostic and therapeutic approaches. Advancements in the last 30 years have redefined the surgical approach of localized prostate cancer with minimally invasive surgical approaches for the most part being our primary treatment approach. Additionally radiotherapy techniques have been refined increasing the efficacy and limiting the toxicity to adjacent organs. New systemic and vaccine therapies have most recently emerged as

Prostate cancer screening has evolved since the initial introduction of serum PSA in our screening armamentarium. The discovery of PSA in the 1980s along with an appreciation of its prognostic significance has greatly impacted patient education and surveillance recommendations. Over the last two decades, a stage migration has occurred in favor of small volume, localized disease which we believe is in large part as a direct consequence of the utilization of serum PSA screening. Between 1986 and 1999, there has been a dramatic reduction in the incidence of locally advanced, high volume disease for the similarly proposed reasons. The Prostate, Lung, Colorectal, and Ovary (PLCO) cancer trial of the National Cancer Institute (NCI) was designed to evaluate the effectiveness of prostate cancer screening. It began accruing patients between 1993 and 2001. The study demonstrated a 22% increase in the detection of prostate cancer at 7 years and a 17% increase at 10 years in the patient cohort undergoing annual digital rectal examination

**1. Introduction** 

worldwide.

effective approaches to advanced disease.

**2. Prostate cancer screening** 

 **and Therapeutic Considerations** 

Paul Bradley and Philippe E. Spiess
