Prostate cancer is the most commonly diagnosed visceral cancer in 2017 in USA. There are about 160,000 new prostate cancer diagnosed each year with more than 26,000 prostate cancer death. Worldwide, the incidence of prostate cancer is about 1,600,000 and more than 350,000 prostate cancer deaths. This makes it the seventh leading cause of male cancer death.
The lifetime risk of developing cancer is 16 percent, but the risk of dying of prostate cancer is only 3 percent. Most of male die of other causes before the disease becomes clinically significant. Survival of prostate cancer is mainly determined by the extent of the disease at diagnosis, with localised disease 5 year survival being 100%. The five year survival of metastatic prostate cancer is about 30%.
Serum Prostate Specific Antigen testing were introduced back in the early 1990s and subsequently professional societies issued guidelines supporting its routine use. The PSA testing led to an increase in the incidence of localised prostate cancer. As a result there was an increase in radical prostatectomy and radition therapy intended to cure these early-stage cancer.
With a low overall mortality rate, the screening detection of prostate cancer remain controversial for the general public. However, in well selective high risk cases, this has been proven to reduce cancer related morbidity and mortality. The European Randomized Study of Screening for Prostate Cancer (ERSPC) reported a small absolute survival benefit with PSA screening after nine years of follow-up; however, 48 additional patients would need to be diagnosed with prostate cancer to prevent one prostate cancer death. Although the report did not address quality of life outcomes, considerable data show the potential harms from aggressive treatments, including erectile dysfunction, urinary incontinence, and bowel problems. Further sustaining the uncertainty surrounding screening, the large randomized United States Prostate, Lung, Colorectal, and Ovarian (PLCO) Cancer Screening Trial found no prostate cancer mortality benefit even after 15 years of follow-up.