Book Review

Controversies in the Treatment of Prostate Cancer

N Engl J Med 2009; 360:311-312January 15, 2009

Article

Controversies in the Treatment of Prostate Cancer
(Frontiers of Radiation Therapy and Oncology. Vol. 41.) Edited by Lutz Moser, Martin Schostak, Kurt Miller, and Wolfgang Hinkelbein. 130 pp., illustrated. Basel, Switzerland, Karger, 2008. $126. ISBN: 978-3-8055-8524-8 (cloth); 978-3-8055-8525-5 (e-book).

The appropriate treatment of prostate cancer continues to challenge researchers and clinicians. During the past decade, intensive screening for prostate-specific antigen has resulted in a dramatic rise in the number of cases that are diagnosed in the United States and Canada. As a result of this screening, most men who are diagnosed with prostate cancer in North America present with disease that is localized to the prostate. Testing for prostate-specific antigen has also increased in Europe, but to a much lesser degree. Many European governments do not support screening for prostate cancer as a public health policy. As a consequence, men who have newly diagnosed prostate cancer in Europe often have more advanced disease than their North American counterparts.

Controversies in the Treatment of Prostate Cancer is an excellent summary of the dilemmas in prostate-cancer management from a European perspective. The book's chapters are divided into four major sections, which cover localized disease, node-positive disease, recurrence after primary surgery or radiation, and metastatic disease. Within each section, the editors have assembled a series of short, well-edited chapters that provide crisp reviews of key controversies and an extensive list of literature citations. Each chapter contains a one-paragraph abstract outlining the problem; a brief, well-edited discussion of the topic; and a concluding paragraph or two in which the primary arguments having to do with a treatment controversy are summarized. With the exception of three authors from Canada, all the authors hail from recognized centers in Europe.

The controversies surrounding the management of prostate cancer do not differ fundamentally on either side of the Atlantic, but there are subtle differences in emphasis and approach. For example, the opening chapter, “Prostate Cancer and Active Surveillance,” written by Per-Anders Abrahamsson, reflects the historical Scandinavian bias in favor of active surveillance. Abrahamsson encourages clinicians to consider more aggressive treatment for patients who are likely to have clinically significant disease. An American author would be likely to bring the opposite bias to the discussion and emphasize the problem of overdiagnosis and overtreatment that results from extensive prostate-cancer screening. The several chapters on controversies in the use of radiation therapy during different phases of the disease reflect the traditional support for this approach in many European centers. The last four chapters concern issues related to the treatment of hormone-refractory and metastatic prostate cancer — topics that are not covered as extensively as in similar monographs published in the United States.

This book is a welcome addition to any medical library, providing clinicians and students with a compact summary of contemporary treatment dilemmas in the management of prostate cancer. A few of the chapters have some awkward sentences and phrases, but these problems can be attributed to the fact that English is not the first language of many of the authors. Overall, the book is extremely well edited. Authors avoid excessive summaries of previously published data and extensive use of jargon. This book is ideal for patients who wish to explore primary medical literature on the topic, for urology residents who are learning how to manage this disease, and for clinicians who do not regularly treat prostate cancer. After a few hours spent reading the book, they will grasp the issues surrounding differing treatment recommendations. For experienced clinicians, the book provides a short summary of the key arguments related to the treatment of prostate cancer as well as an extensive list of contemporary references that have shaped this field. For American readers, Controversies in the Treatment of Prostate Cancer provides welcome new perspectives on many old problems.

Peter C. Albertsen, M.D.
University of Connecticut Health Center, Farmington, CT 06030