Early Detection of Prostate Cancer
P re f a c e E a r l y D e t e c t i o n o f P ro s t a t e Cancer
Stacy Loeb, MD, MSc
Matthew R. Cooperberg, MD, MPH Editors
modalities. This issue also reviews some of the most recent developments in this area. Finally, other articles in this issue highlight technical aspects of ultrasound-guided and MRIguided prostate biopsy, the management of elevated PSA after a negative biopsy, and a perspective on the emerging question of whether low-grade prostate cancer should in fact be called “cancer.” The authors of these articles include some of the best thought leaders in the world on these questions. We are thankful to them for their contributions to this issue and are extremely appreciative of the significant amount of time and insight that they have provided on this critically important topic. We hope and expect these articles will be of great interest to a diverse readership. Stacy Loeb, MD, MSc New York University and Manhattan Veterans Affairs Medical Center 550 1st Avenue, VZ30 (6th Floor, #612) New York, NY 10016, USA Matthew R. Cooperberg, MD, MPH Departments of Urology and Epidemiology and Biostatistics Helen Diller Family Chair in Urology University of California, San Francisco San Francisco, CA, USA E-mail addresses: [email protected] (S. Loeb) [email protected] (M.R. Cooperberg)
Urol Clin N Am 41 (2014) xiii http://dx.doi.org/10.1016/j.ucl.2014.03.001 0094-0143/14/$ – see front matter Ó 2014 Published by Elsevier Inc.
urologic.theclinics.com
Although prostate cancer remains the second leading cause of cancer death among men in the United States, in the era of prostate-specific antigen (PSA)-based early-detection efforts, ageadjusted prostate cancer mortality rates in this country have fallen nearly 50%. Despite this favorable epidemiological trend, prostate cancer early detection remains intensely controversial, due in part to highly prevalent overtreatment of low-risk, indolent tumors and to widespread misconceptions regarding the existing evidence supporting early-detection efforts. As guest editors of this issue of Urologic Clinics, it was our goal to provide readers a timely summary of some of the key controversies in prostate cancer early detection and how these issues might be resolved in the future. The first set of articles in this issue explores in detail the evidence for and against the mortality benefits associated with PSA testing, the evolving incorporation of this evidence into early-detection guidelines and shared decision-making models in the Unites States and abroad, and the political aspects of the PSA debate particularly as they relate to the US Preventive Services Task Force recommendation to end all PSA-based earlydetection efforts. In addition, there are many new biomarkers in the pipeline that hold the potential to improve early-detection efforts. These range from newly discovered germline genetic variants to PSA isoforms and related molecules, to better imaging
P re f a c e E a r l y D e t e c t i o n o f P ro s t a t e Cancer
Stacy Loeb, MD, MSc
Matthew R. Cooperberg, MD, MPH Editors
modalities. This issue also reviews some of the most recent developments in this area. Finally, other articles in this issue highlight technical aspects of ultrasound-guided and MRIguided prostate biopsy, the management of elevated PSA after a negative biopsy, and a perspective on the emerging question of whether low-grade prostate cancer should in fact be called “cancer.” The authors of these articles include some of the best thought leaders in the world on these questions. We are thankful to them for their contributions to this issue and are extremely appreciative of the significant amount of time and insight that they have provided on this critically important topic. We hope and expect these articles will be of great interest to a diverse readership. Stacy Loeb, MD, MSc New York University and Manhattan Veterans Affairs Medical Center 550 1st Avenue, VZ30 (6th Floor, #612) New York, NY 10016, USA Matthew R. Cooperberg, MD, MPH Departments of Urology and Epidemiology and Biostatistics Helen Diller Family Chair in Urology University of California, San Francisco San Francisco, CA, USA E-mail addresses: [email protected] (S. Loeb) [email protected] (M.R. Cooperberg)
Urol Clin N Am 41 (2014) xiii http://dx.doi.org/10.1016/j.ucl.2014.03.001 0094-0143/14/$ – see front matter Ó 2014 Published by Elsevier Inc.
urologic.theclinics.com
Although prostate cancer remains the second leading cause of cancer death among men in the United States, in the era of prostate-specific antigen (PSA)-based early-detection efforts, ageadjusted prostate cancer mortality rates in this country have fallen nearly 50%. Despite this favorable epidemiological trend, prostate cancer early detection remains intensely controversial, due in part to highly prevalent overtreatment of low-risk, indolent tumors and to widespread misconceptions regarding the existing evidence supporting early-detection efforts. As guest editors of this issue of Urologic Clinics, it was our goal to provide readers a timely summary of some of the key controversies in prostate cancer early detection and how these issues might be resolved in the future. The first set of articles in this issue explores in detail the evidence for and against the mortality benefits associated with PSA testing, the evolving incorporation of this evidence into early-detection guidelines and shared decision-making models in the Unites States and abroad, and the political aspects of the PSA debate particularly as they relate to the US Preventive Services Task Force recommendation to end all PSA-based earlydetection efforts. In addition, there are many new biomarkers in the pipeline that hold the potential to improve early-detection efforts. These range from newly discovered germline genetic variants to PSA isoforms and related molecules, to better imaging
