Epidemiology, Screening, Pathology and Pathogenesis

Prostate cancer (PCa) is the most common cancer affecting men in the Western world, and a less prominent cause of cancer death. Because PCa often grows so slowly that most men die of other causes before the disease becomes clinically advanced. Prostate specific antigen (PSA) testing revolutionized PCa screening and epidemiologic evidence supports the role of PSA screening in the stage and grade migration of prostate cancer, but to date the evidence for its role in changing mortality patterns is more equivocal. As a result, PCa screening has been a controversial issue because decisions were made about adopting PSA testing in the absence of efficacy data from randomized trials. There is currently no evidence for introducing widespread population-based screening programmes for early PCa detection in all men. Adenocarcinoma accounts for the vast majority of PCa. It is multifocal in more than 85 % of cases. The Gleason score is the most commonly used system for grading PCa. The factors that determine the risk of developing clinical PCa are not well known, although three well-established risk factors have been identified: increasing age, ethnic origin, and heredity. Exogenous factors affect the risk of progression from so-called latent PCa to clinical PCa. In the last 20 years, evidence that PCa may be caused by multiple genes, possibly interacting with endocrine and environmental factors, has continued to grow.