The Next Era for Prostate Cancer Controlled Clinical Trials

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Abstract
The field of prostate cancer is important, changing, and confusing. Prostate cancer is the most frequent cancer and the second most common cause of cancer death among US men. Yet autopsy studies show that many men without clinical prostate cancer have some cancer in their prostates, albeit in small volumes. This, plus the fact that prostate cancer occurs in aging men and often grows slowly, means that many more men die with prostate cancer than of it. In the past, early diagnosis was advocated by periodic digital rectal examinations (DREs), treatments for curative intent consisted of radical prostatectomy and/or radiation therapy, and significant palliation as afforded by androgen ablation therapies. Yet the mortality from prostate cancer has not altered in decades.1Today, concepts about prostatic cancer treatment are changing rapidly, principally because of the availability of spring-loaded biopsy guns and transrectal ultrasonography (which make prostate biopsies safer, easier, and