Recommendations of the first Michigan conference on prostate cancer

The following points were agreed on by participants during the conference: The high incidence of prostate cancer makes it an important target for cancer control measures. Increased use of PSA testing has led to a doubling of identified early stage prostate cancer cases since 1989. Both African-American men and men with a family history of prostate cancer are at particularly high risk for prostate cancer. Currently, there is insufficient evidence to evaluate if early detection decreases either mortality or morbidity rates associated with prostate cancer. If early detection proves to be clinically beneficial, the following groups are most likely to benefit: High-risk men: African-American men who are between 40-75 years of age and have a life expectancy of more than 10 years; Men with a family history of prostate cancer who are between 40-75 years of age and have a life expectancy of more than 10 years. All other men between 50-75 years of age who have a life expectancy of more than 10 years. PSA testing is currently the most reliable method for the early detection of prostate cancer. Before deciding to be tested for prostate cancer, every man needs to discuss with his healthcare provider the relevance of testing for himself, including the possible side effects of treatment and the implications for his quality of life if prostate cancer should be found. There currently is no standardized treatment regimen for prostate cancer patients. Thus, multidisciplinary studies are needed to provide objective comparative data (ie, efficacy, adverse effects, quality of life, and economic parameters) concerning therapeutic modalities. These studies must include the identification and use of uniform therapeutic end points (ie, defined measures of efficacy and toxicity). The dilemma for men and their physicians is that screening, treatment, failure to screen, and failure to treat each may have negative consequences for the individual. The former two are associated with the potentially adverse effects of therapeutic interventions, whereas the latter two are associated with the potential for disease progression. Research is needed to answer questions concerning: Effectiveness, costs, and complications in relation to the benefits of early-detection methods and of treatment alternatives, and effectiveness of various strategies for communicating information about prostate cancer to the general public, high- risk men, men diagnosed with prostate cancer, and health professionals.