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Detection, Diagnosis, and Prognosis of Prostate Cancer

  • Authors: Authors: H. Ballentine Carter, MD; Angelo DeMarzo, MD, PhD; Hans Lilja, MD, PhD
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Target Audience and Goal Statement

This activity is intended for urologists, medical oncologists, radiation oncologists, and other healthcare professionals who treat patients with prostate cancer.

The goal of this activity is to educate physicians regarding the latest research in the diagnosis, treatment, and prevention of prostate cancer.

Upon completion of this activity, participants will be able to:

  1. Describe the controversies surrounding prostate-specific antigen (PSA) measurement in men at risk for prostate cancer.
  2. Identify emerging imaging strategies for the diagnosis of prostate cancer.
  3. Detail the accepted approaches toward staging and grading prostate tumors.
  4. Evaluate emerging factors for risk stratification and outcomes prediction in patients with prostate cancer.


Medscape requires Authors to disclose any relevant financial relationship within the past 12 months with the manufacturer of any product that may relate to the subject matter of the educational activity, whether or not the activity is commercially supported.

Medscape asks Authors to identify, at first mention, investigational products regulated by the US Food and Drug Administration.


  • H. Ballentine Carter, MD

    Professor of Urology and Oncology, Johns Hopkins University School of Medicine; Director, Division of Adult Urology, Brady Urological Institute, Johns Hopkins Hospital, Baltimore, Maryland


    Disclosure: H. Ballentine Carter, MD, has no significant financial interests or relationships to disclose. Dr. Carter may discuss investigational or unlabeled uses of commercial products in this activity.

  • Angelo DeMarzo, MD, PhD

    Associate Professor of Pathology, Oncology, and Urology; Director, Tissue Microarray Core Facility, Sidney Kimmel Comprehensive Cancer Center at Johns Hopkins, Baltimore, Maryland


    Disclosure: Angelo DeMarzo, MD, PhD, has no significant financial interests or relationships to disclose. Dr. DeMarzo may discuss investigational or unlabeled uses of commercial products in this activity.

  • Hans Lilja, MD, PhD

    Attending Research Clinical Chemist, Departments of Clinical Laboratories, Urology, and Medicine, Memorial Sloan-Kettering Cancer Center, New York, NY


    Disclosure: Hans Lilja, MD, PhD, has disclosed that he has served as a data evaluator for Ferring Pharmaceuticals, as a consultant or advisor to GenSpera, Inc., and on the prostate cancer steering committee for Sanofi-Synthelabo, and is a patent holder for free PSA assay and hK2 assay. Dr. Lilja may discuss investigational or unlabeled uses of commercial products in this activity.

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Detection, Diagnosis, and Prognosis of Prostate Cancer

Authors: Authors: H. Ballentine Carter, MD; Angelo DeMarzo, MD, PhD; Hans Lilja, MD, PhDFaculty and Disclosures



Prostate cancer is the most common non-skin cancer in men in the United States, and is second only to lung cancer as a cause of cancer deaths in men. An estimated 230,000 men will be diagnosed with prostate cancer in 2004, and nearly 30,000 will die of the disease.[1] Nevertheless, the fact that the vast majority of tumors are now detected either localized to the prostate or regionally spread, while only a small percentage are detected at the metastatic stage,[1] has highlighted the importance of earlier detection and diagnosis of the disease. The use of prostate-specific antigen (PSA) testing has allowed physicians to detect tumors at much earlier stages of disease, and the recognition of finer points of disease pathology has enabled physicians to establish more comprehensive and detailed staging criteria.

The downstaging of disease due to the widespread use of PSA in the general population, coupled with the lack of definitive cutpoints for determining the presence of disease, has spawned a new class of patients: those with biochemical and pathologic evidence of disease but no clinical signs or symptoms of disease. With this population, physicians and patients are forced to carefully weigh the benefits of therapy vs watchful waiting, and to consider the myriad of risk factors that have been studied as possibly predisposing a patient to more aggressive disease. Validation of surrogate endpoints for prostate cancer mortality also plays a key role in this population, as these endpoints can help identify patients who are in greater need for immediate therapy and who will likely need systemic therapy in addition to primary therapy.[2,3]

Current research in the areas of detection, diagnosis, and prognosis are primarily focusing on four main areas: identification of risk factors for disease in the general public that warrant regular screening; identification of risk factors in patients diagnosed with prostate cancer that warrant immediate therapeutic intervention; identification of biologic markers and imaging strategies to detect disease and disease progression; and use of these markers and imaging strategies in predicting outcomes in different patient populations.

This chapter of the Report to the Nation on Prostate Cancer will review the latest data in these areas, and will discuss some of the obstacles yet remaining as urologists, medical oncologists, and radiation oncologists attempt to increase detection of clinically meaningful tumors and accurately predict outcomes in patients diagnosed with prostate cancer.