title: The epidemiology of high-risk prostate cancer.
abstract: OBJECTIVE
  Concern for over and under-treatment of men with prostate cancer has led to an increased focus on the identification and selective treatment of men with high-risk features. The purpose of this review is to summarize the epidemiology, risk factors, and treatment trends of men with high-risk prostate cancer.
  
  
  RESULTS
  Findings from recent trials on prostate-specific antigen-based screening suggest that screening has substantially reduced the incidence of high-risk prostate cancer. Men with high-risk disease tend to be older at diagnosis than those with low-risk disease. There is marked variation in the treatment of men with high-risk features; contemporary studies favor multimodal therapy, but high-risk disease is often under-treated with androgen deprivation alone, particularly among older men.
  
  
  CONCLUSIONS
  Variations in the incidence, mortality, and treatment of men with high-risk prostate cancer may reflect heterogeneity among studies in the definition of high-risk disease. Future research should attempt to standardize definitions of high-risk prostate cancer to allow better comparison between studies and provide a more homogeneous assessment of natural history.
authors.affiliation: Helen Diller Comprehensive Cancer Center, University of California, San Francisco, California, USA.
authors.forename: Sanoj
authors.initials: S
authors.lastname: Punnen
authors.forename: Matthew R
authors.initials: MR
authors.lastname: Cooperberg
mesh_terms: D000367:Age Factors; D055088:Early Detection of Cancer; D006801:Humans; D015994:Incidence; D007610:Kallikreins / Q000097:blood; D008297:Male; D008403:Mass Screening; D011237:Predictive Value of Tests; D015995:Prevalence; D017430:Prostate-Specific Antigen / Q000097:blood; D011471:Prostatic Neoplasms / Q000097:blood / Q000175:diagnosis / Q000453:epidemiology* / Q000235:genetics / Q000628:therapy; D018570:Risk Assessment; D012307:Risk Factors; D016896:Treatment Outcome
chemical_list: C549870:KLK3 protein, human; D007610:Kallikreins; D017430:Prostate-Specific Antigen