Prostate cancer: introduction

In Scotland, prostate cancer is the second most commonly diagnosed cancer in men, after non-melanoma skin cancer.  Currently, around 2550 men are diagnosed with prostate cancer in Scotland every year.  Survival from prostate cancer is moderately favourable with a 5-year relative survival of 70.2% in patients diagnosed between 1997 and 2001.  Nevertheless, because prostate cancer is relatively common, it is the third most common cause of death from cancer in men, after lung and colorectal cancer. 

The causes of prostate cancer are largely unestablished, but the main risk factors seem to be increasing age, family history, African descent, and various aspects of diet.

The age-standardised incidence rate of prostate cancer has been increasing for many years, with especially steep increases occurring during the 1990s.  While part of the increasing incidence of prostate cancer may reflect a genuine increase in risk, much of it seems likely to reflect increased detection of latent disease through increasing use of the prostate-specific antigen (PSA) test (Brewster et al, 2000). Variations in use of PSA testing make it difficult to interpret geographical variations in incidence and survival.

It is expected that the incidence of prostate cancer will continue to increase up to the period 2016-20, partly due to ageing of the population (Scottish Executive, 2004). 

As a potential screening test, PSA has limitations and, at present, there is no evidence that screening with PSA decreases the risk of dying from prostate cancer.  However, two large randomized trials of screening for prostate cancer are currently underway in Europe and the USA.