Includes Index

The practice of medicine is a commitment to lifetime learning applied in the
service of patients. For any of us who practice, the simple truths that we
learned in medical school have been found no longer simple and no longer
true. The advances in oncologic analysis, imaging, and treatment options
with respect to prostate cancer have shown great expansion in the last 40
years, and the authors have taken pains to make the details of these advances
accessible to generalists and specialists of all stripes.
Initially, the identification of prostate cancer was limited by the ability of
the probing finger to feel that part of the prostate that was accessible. Often
the first identification of the cancer was the appearance of the spread to bone
at a time that the rectal examination was still normal. The development of the
PSA test helped identify patients that required more aggressive investigation,
but the variety of benign conditions producing PSA elevations resulted in
often unnecessary invasive biopsies. Early imaging was crude and the inherent errors did not dissuade the urologist from pursuing biopsy or help him in
guiding the biopsy in the areas of greatest likelihood of malignant disease.
The improvement of imaging techniques with power Doppler ultrasound,
sonographic elastography, high-resolution MRI, and the organization of these
techniques into a multimodal approach has dramatically changed the field of
prostate cancer diagnosis. No longer is every PSA elevation an obligation to
biopsy nor are the appropriate biopsies blindly directed. Judgments of the
severity of disease allow many patients to be followed expectantly, confident
that changes in the underlying condition will be identified soon enough to
change course. Furthermore, when those changes are identified, the biopsy
can be directed to the specific area of concern.
These improvements in diagnostic techniques have been paralleled by the
development of more focused modalities of treatment. Therapeutic ultrasound, laser, and photodynamic therapies are being actively investigated to
ascertain their roles in the spectrum of prostate malignancies. We are at an
exciting time in the development of knowledge in the identification and treatment of prostate cancer, and the authors are leaders in these fields and this
volume brings the reader up to speed on these developments.