Advances in the diagnosis and treatment of prostate cancer.

Prostate cancer is currently diagnosed in more than 34,000 men every year and claims more than 10,000 lives per annum in the UK. Recently, prostate specific antigen (PSA) population screening has been evaluated in two major randomised, controlled studies. Even though the more mature European study confirmed that PSA screening is capable of reducing prostate cancer mortality, anxieties still persist, particularly surrounding the issue of overdiagnosis of clinically insignificant cancer. The recent identification of 29 genetic variants that predispose towards prostate cancer offers another, more targeted, opportunity to reduce mortality. It also raises the possibility of the identification of a sub-group of men who are especially susceptible to prostate cancer. In lower-risk patients with localised cancer active surveillance may be sufficient. In fitter men, with more clinically significant disease, eradication of the cancer by surgical removal of the gland is often involved. This is the only treatment which has been proven in a randomised controlled trial to reduce the rate of metastases and mortality compared with watchful waiting. Metastatic prostate cancer is associated with high mortality--approximately 70% within 5 years. Androgen deprivation, which has become the mainstay of treatment, effectively lowers intraprostatic DHT by more than 80%, resulting in reduced androgen receptor stimulation and increased prostate cancer apoptosis.