The Prostate Cancer Conundrum

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Abstract
In 2003, the American Cancer Society estimates that 220 900 men will be diagnosed with prostate cancer and that 28 900 will die from this disease (1). Since the introduction of testing for prostate-specific antigen (PSA), the incidence of prostate cancer has increased, whereas the mortality from this disease has decreased. During the early 1990s, mortality from prostate cancer peaked in the United States at a rate of 26.4 prostate cancer deaths per 100 000 men at risk. By 1998, this rate had fallen to 21.5 per 100 000 men at risk, a decline of 2.6% per year (2). The drop in prostate cancer mortality has continued, and the rate in 2003 is now similar to levels seen during the 1950s, 1960s, and early 1970s, the years preceding the widespread use of transurethral prostate surgery (1,3).

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