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Education And Debate

Current Issues in Cancer: Cancer of the prostate

BMJ 1994; 308 doi: (Published 19 March 1994) Cite this as: BMJ 1994;308:780

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  1. D P Dearnaley
  1. Institute of Cancer Research and The Royal Marsden Hospital Department of Radiotherapy and oncology, Sutton, Surrey SM2 5PT.

    Prostate cancer presents a growing health problem in Western societies as longevity increases. It is characteristically a disease of elderly men associated with the development of osteoblastic bone metastases and initial hormone responsiveness to androgen deprivation. Previously regarded as a Cinderella of cancers, there is currently more controversy concerning the detection and management of both localised and metastatic disease than for any other common malignancy. A balance needs to be drawn between the potential gains of more aggressive management and the disadvantages in terms of increased treatment side effects and cost, taking into account both the natural course of the disease and the life expectancy of patients.

    This is the second in a series of articles examining developments in cancer and updating what we know about the disease

    In England and Wales in 1987 there were 10 837 new cases of prostate cancer. In 1991 prostate cancer ranked second to lung cancer in mortality from malignant disease in men, with 8570 prostate cancer deaths. This pattern of increasing incidence is common to other Western countries. In the United States prostate cancer is now the most frequently diagnosed male malignancy, with 132 000 cases per year1 and a lifetime risk of 9-11% of developing the disease.2

    Although prostate cancer predominantly affects the aging male population, it has been calculated that men dying of the disease lose on average nine years of life.3 In the United Kingdom morbidity and mortality from prostate cancer can be expected to rise as the longevity of the population increases. Currently some 50-60% of men present with metastatic disease,4 but as prostate awareness and programmes of early detection become more widespread there will be an increasing incidence of patients diagnosed with early disease, as is happening in North America.

    Epidemiology and aetiology

    Worldwide there seems to …

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