Treating prostate cancer, Part I: The big picture

According to the American Cancer Society, about 186,320 Americans will be diagnosed with prostate cancer this year, and 28,660 will die from the disease. That makes prostate cancer the most common internal malignancy in American men, with a cancer death toll that trails only lung cancer (see "Malignancies in men in 2008" below). Researchers have made substantial progress in understanding the causes and basic biology of the disease, and clinicians have developed improved methods of diagnosis and therapy. Even so, basic questions remain unanswered; as a result, many important decisions about prostate cancer are not made by doctors but by patients.

Once a man is diagnosed with prostate cancer, his decisions take on a new urgency. In the case of most malignancies, news of the diagnosis is accompanied by a crisp and confident treatment plan. Not so with prostate cancer; instead, the doctor who announces the diagnosis is likely to ask the patient what treatment he wants. That means the shock of a diagnosis is followed by the shock of learning that, in many cases, doctors disagree about which treatment is best.