Prostate cancer is the most common non-skin cancer in men in Canada and the third leading cause of male cancer mortality; 550 men die from it each year in BC and 3000 are diagnosed. If diagnosed early when localized, it can be treated with high cure rates. When advanced, it may cause significant morbidity and mortality, including fatigue, kidney failure, and bone pain. Early detection and treatment of prostate cancer aims to reduce the risks of suffering and death from advanced disease.

Prostate cancer is also a highly prevalent disease as approximately one in three men over the age of 50 years has histologic evidence of prostate cancer, with most of these tumours being clinically insignificant (i.e. not at risk of causing harm in a man’s lifetime). Despite this high prevalence, the lifetime risk of death from prostate cancer is only about 3%, highlighting its generally indolent course, and competing causes of death. Reduction in the risk of prostate cancer diagnosis may be possible by lifestyle modification including weight control, increased exercise, and decreased meat consumption, (level 3 evidence[1]).

Level 1 evidence supports the treatment of localized disease. Prostate cancer mortality is reduced in men younger than 65yrs with surgery[2] or those with a 10 year life expectancy with radiation[3]. However men with ‘low risk’ prostate cancer do not have reduced prostate cancer mortality (Level 1 evidence [4]), and these men should instead be offered active surveillance. Active surveillance involves monitoring patients diagnosed with low risk cancers, and providing radical intervention only if the cancer shows signs of significant growth.

The disparity between the high prevalence of prostate cancer and its relatively low risk of death highlights the importance of distinguishing those cancers that are destined to cause significant illness and premature death from those that are not. Currently there is no test, including PSA that reliably makes this distinction.