Prostate cancer in general is a disease of the elderly and screening has been a big topic of medical conversation and controversy forever even though a large European study has finally demonstrated a decrease in mortality.
Screening starts at the age of 50 in the general population and at 35-40 for high-risk individuals including African American men and men with a family history of prostate cancer or BRCA 1 positive mutation carriers.
Treatment is also a subject of controversy. It is known that approximately 90% of males at autopsy have evidence of prostate cancer. Not all prostate cancers have an aggressive behavior and therefore, would not need treatment.
Treatment for localized prostate cancer depends on how aggressive the tumor pathology is and the amount of tumor burden. For small tumors, with a low gleason score, observation is an option.
The local therapies range from surgery including robotic surgery, cryotherapy, seed implants, IMRT and proton TX and often time the selection of the modality depends on patient's age, co-morbidities and preference.
Larger and very aggressive tumors benefit from combined modality, antiandrogen therapy and radiation. For metastatic disease, first line therapy is androgen deprivation with a bisfosfanate in patients who develop osteoporosis. The options for androgen resistant patients used to be very limited until recently. In the last couple of years, new therapies have become available. A new antiandrogen that is very powerful called abiraterone. As far as chemotherapy, taxotere had been the only effective chemotherapy for years. Currently, we also have a new taxane, cabitaxel and also alimta, an antifolate agent. A couple of vaccines have been FDA approved as well. Even in prostate cancer, we have made strides and will continue to do so.