What is the risk posed by prostate cancer?

Prostate cancer carries an extraordinarily varied prognosis. Previously, most men presented with clinical symptoms often succumbed to their disease several years following treatment with hormonal manipulation. With the advent of prostate-specific antigen (PSA) testing, most men are now diagnosed with localized, well- to moderately differentiated disease. The most powerful predictor of long-term outcome is the Gleason score, followed by tumor volume. Over the past two decades, changes in the interpretation of Gleason patterns have resulted in the reclassification of many well-differentiated tumors as higher grade tumors. Men with well-differentiated disease have an excellent prognosis and often survive 10-20 years without intervention. Conversely, men with poorly differentiated disease often succumb to their cancer within a decade. PSA can estimate tumor volume, but poorly differentiated disease may not produce much PSA. We are unable to predict accurately the risk posed by a specific prostate cancer.