Does Prostate Cancer Represent More than One Cancer?

The increase in the incidence of prostate cancer in the United States has approached epidemic proportions. Clinical prostate cancer is clearly a disease of variable and generally unpredictable behavior, especially for the individual patient. Persistent pain usually implied metastatic disease, yet in many men with metastatic prostate cancer, they actually remained symptom free for extended periods of time, measured in years. Prostate carcinoma with all its significant prevalence is also quite heterogeneous in its clinical forms. Prostate cancer rarely causes symptoms early in its course because the malignancy arises in most patients posteriorly, in the peripheral portion of the gland, away from the prostatic urethra. The pathogenesis of prostate cancer reflects complex interactions among both environmental and genetic factors. Because of its genetic diversity, the cure for prostate cancer is unlikely to be any single agent or technological advancement, but will no doubt be identified through a multidisciplinary integrated approach spearheaded by a partnership of both clinicians and basic scientists working in concert.