title: Prostate cancer: an evolving paradigm.
abstract: Since at least the early 1990s, stage and risk migration have been seen in patients with prostate cancer, likely corresponding to the institution of prostate specific antigen (PSA) screening in health systems. Preoperative risk factors, including PSA level and clinical stage, have decreased significantly. These improved prognostic variables have led to a larger portion of men being stratified with low-risk disease, as per the classification of D'Amico and associates. This, in turn, has corresponded with more favorable postoperative variables, including decreased extraprostatic tumor extension and prolonged biochemical-free recurrence rates. The advent of focal therapy is bolstered by findings of increased unilateral disease with decreased tumor volume. Increasingly, targeted or delayed therapies may be possible within the current era of lower risk disease.
authors.affiliation: Division of Urologic Surgery and Duke Prostate Center (DPC), Department of Surgery, Duke University Medical Center, Durham, North Carolina 27710, USA.
authors.forename: Jorge R
authors.initials: JR
authors.lastname: Caso
authors.forename: Vladimir
authors.initials: V
authors.lastname: Mouraviev
authors.forename: Matvey
authors.initials: M
authors.lastname: Tsivian
authors.forename: Thomas J
authors.initials: TJ
authors.lastname: Polascik
authors.forename: Judd W
authors.initials: JW
authors.lastname: Moul
mesh_terms: D014408:Biomarkers, Tumor / Q000032:analysis*; D006801:Humans; D008297:Male; D009367:Neoplasm Staging; D017430:Prostate-Specific Antigen / Q000032:analysis*; D011471:Prostatic Neoplasms / Q000175:diagnosis* / Q000628:therapy*; D018570:Risk Assessment; D012307:Risk Factors
chemical_list: D014408:Biomarkers, Tumor; D017430:Prostate-Specific Antigen