Book Review

Prostate Cancer

N Engl J Med 2002; 347:1988December 12, 2002

Article

Prostate Cancer
(American Cancer Society Atlas of Clinical Oncology.) Edited by Peter R. Carroll and Gary D. Grossfeld. 402 pp., illustrated, with CD-ROM. Hamilton, Ont., Canada, BC Decker, 2002. $159. ISBN: 1-55009-130-1

This book on prostate cancer is the latest in a series of books published on behalf of the American Cancer Society. It is a formidable task to provide a comprehensive overview of all aspects of prostate cancer in a single volume, and the authors, led by Dr. Peter Carroll of the Department of Urology at the University of California at San Francisco (UCSF), have made a valiant effort to do so in Prostate Cancer.

Most of the contributors are from UCSF. Working with local authors offers editors an advantage, because it gives them control over the timely delivery of manuscripts, the content of the chapters, and the overlap among chapters. It does not appear, however, that sufficient effort was made to avoid such overlap in this case. Similar topics are discussed in chapters 7, 8, and 10, which cover tumor markers, detection with systematic biopsies, and staging with initial risk assessment. In the coverage of treatment for various stages of prostate cancer, there is overlap between chapters on androgen-deprivation therapy (chapter 20) and on second-line hormonal therapy (chapter 21) and between chapters on chemotherapy in the treatment of hormone-refractory prostate cancer (chapter 22) and on novel systemic therapy for prostate cancer (chapter 23).

Another slightly distracting feature of the book is that many of the authors, perhaps understandably, spend considerable time describing their own experience — in other words, studies that have been conducted at UCSF. Although these studies are certainly worthy of discussion in the context of the topic, they may not, in all cases, be the most conclusive studies, the largest studies, or the most recent of the available publications. Although the book certainly attempts to cover all aspects of prostate cancer — epidemiology, pathology, molecular genetics, in vivo and in vitro models, serum markers, detection and staging, natural history, various forms of treatment, and the management of complications from treatment — it is noteworthy that the length of the individual chapters does not necessarily reflect the importance of the topic to the practitioner. For example, in chapter 18, Shinohara discusses new forms of focal therapy, many of which are still experimental, for more than 16 pages, whereas chemotherapy for hormone-refractory prostate cancer is covered in 6 pages and the entirety of androgen-deprivation therapy in 11 pages. There is insufficient discussion of the development of nomograms to predict the likelihood that disease is present, to determine the pathological stage on the basis of clinical information, and to predict tumor recurrence on the basis of surgical data, as well as of prediction made possible by the use of neural networks. In the coverage of prostate-specific antigen (PSA) and its subforms, the discussion of complex PSA, which has recently received considerable attention, is only cursory. By contrast, the discussion of imaging is lavishly illustrated, with wonderful examples showing all aspects of prostate imaging. The chapters on surgical treatment include one specifically dedicated to the laparoscopic radical prostatectomy, which is gaining popularity.

Although the book makes good use of graphs and tables, issues that are of great practical importance, such as the selection of patients for permanent implantation of radioactive seeds, are discussed in the text only. It has recently become evident that patients with a high level of urinary tract symptoms and a prostate volume in excess of 50 ml are not suitable candidates for such brachytherapy, and appropriate criteria have been set forth by the relevant professional organization. It would be advantageous to display criteria for brachytherapy in tabular format as a quick reference. Harris and Small discuss combined androgen blockade in chapter 20 and refer to the meta-analysis of 22 randomized trials that was performed by the Prostate Cancer Trialists' Collaborative Group, but they provide only one short paragraph on this important study, which, in the minds of many, invalidates the use of combined androgen ablation. I wish that Harris and Small had taken a firmer position on combined androgen ablation.

The last four chapters focus on complementary and alternative medicine and take a refreshing and open-minded approach. The same can be said for chapter 28, on palliative care — a topic that is often not treated in sufficient detail in other publications. Two chapters are dedicated to the evaluation and treatment of complications arising from the most commonly used forms of therapy — namely, surgery and radiation — which is another distinct advantage of this comprehensive book.

All in all, this book covers in a respectable manner all relevant issues concerning prostate cancer. Although there are some deficiencies, it takes an up-to-date and modern approach to the topic, and given the speed with which this field is developing, it must be considered one of the standard reference books for 2002. The included CD-ROM is a bonus.

Claus Roehrborn, M.D.
University of Texas Southwestern Medical Center, Dallas, TX 75390-9110
claus.roehrborn@utsouthwestern.edu