Adenocarcinoma of the prostate is the second leading cause of cancer death in men after lung cancer.<sup>45 Landis S.H., Murray T., Bolden S. , et al. Cancer statistics 1998 CA Cancer J Clin 1998 ;  48 : 6-30  [cross-ref]

Cliquez ici pour aller à la section Références</sup> In 1998, the American Cancer Society estimated that 184,500 men would be diagnosed with prostate cancer and 39,200 would die from the disease.<sup>45 Landis S.H., Murray T., Bolden S. , et al. Cancer statistics 1998 CA Cancer J Clin 1998 ;  48 : 6-30  [cross-ref]

Cliquez ici pour aller à la section Références</sup> Between 1988 and 1992, the incidence of prostate cancer increased dramatically. This phenomenon has been attributed to the introduction and application of serum prostate-specific antigen (PSA) in the screening and case finding for prostate cancer. Use of PSA led to an increase in both detection and earlier-stage detection of prostate cancer.<sup>53 Mettlin C., Jones G., Averette H. , et al. Defining and updating the American Cancer Society guidelines for the cancer-related checkup: Prostate and endometrial cancers CA Cancer J Clin 1993 ;  43 : 42-46  [cross-ref]

Cliquez ici pour aller à la section Références, 75 von Eschenbach A., Ho R., Murphy G.P. , et al. American Cancer Society guidelines for the early detection of prostate cancer: Update June 10, 1997 Cancer 1997 ;  80 : 1805-1807

Cliquez ici pour aller à la section Références, 83 Wingo P.A., Landis S., Ries L.A.G. An adjustment to the 1997 estimate for new prostate cancer cases CA Cancer Clin 1997 ;  47 : 239-242  [cross-ref]

Cliquez ici pour aller à la section Références</sup> Additionally the incidence of prostate cancer also increases with age; more than 75% of cancers diagnosed are in men older than age 65. Most prostate cancers run a protracted course with competing causes of death overwhelming the likelihood of cancer as the cause of death.<sup>55 Moon T.D. Prostate cancer in the elderly Comprehensive Geriatric Oncology Amsterdam: Harwood Academic Publishers (1998).  679-695

Cliquez ici pour aller à la section Références</sup> Thus, with a geriatric population (defined as men >70 years of age) that continues to expand, it is important to define which men should undergo prostate cancer screening, case finding, diagnosis, and active treatment. Quality-of-life issues and comorbidities help to guide treatment choices.<sup>2 Albertsen P.C., Fryback D.G., Storer B.E. , et al. The impact of co-morbidity on life expectancy among men with localized prostate cancer J Urol 1996 ;  156 : 127-132  [cross-ref]

Cliquez ici pour aller à la section Références, 17 Chodak G.W., Thisted R.A., Gerbere G.S. , et al. Results of conservative management of clinically localized prostate cancer N Engl J Med 1994 ;  330 : 242  [cross-ref]

Cliquez ici pour aller à la section Références, 71 Steinberg G.D., Bales G.T., Brendler C.B. An analysis of watchful waiting for clinically localized prostate cancer J Urol 1998 ;  159 : 1431-1436  [cross-ref]

Cliquez ici pour aller à la section Références</sup> The general controversy concerning the decision to screen and treat clinically localized prostate cancer is heightened for those in the geriatric population. With several treatment options available, comparison between them is difficult because most studies do not take into account patient comorbidities, which could affect patient survival and treatment efficacy. Albertsen et al<sup>3 Albertsen P.C., Hanley J.A., Gleason D.F. , et al. Competing risk analysis of men aged 55 to 74 years at diagnosis managed conservatively for clinically localized prostate cancer JAMA 1998 ;  280 : 975-980  [cross-ref]

Cliquez ici pour aller à la section Références</sup> analyzed men 55 to 75 years of age with localized prostate cancer and demonstrated that high tumor grade overwhelms comorbid conditions because it affects patient survival not only in younger men, but also those older than 70 years of age as well.