Chemotherapy Cytotoxic chemotherapy has been little used in the past, but is now increasing, with evidence for benefit accruing from clinical trials. It is generally believed that influences of therapeutic changes will be slight, and the relatively stable mortality rates experienced in most countries provide evidence that there has been little increase in the underlying burden of prostate cancer. An additional factor to consider is the effect of treatment morbidity and mortality. Although the published mortality rates following radical prostatectomy are unlikely to outweigh any survival benefit resulting from this procedure, the same may not apply to hormonal treatment. Effect of PSA screening on mortality has never been tested in Randomised Controlled Trials.
Ecological studies suggest some benefit.
In addition, we have considered plausible changes in prostate cancer in Scotland. The most likely origin of such changes is PSA use or even the introduction of a PSA screening programme. Present Trends are modified by plausible future changes based on current evidence Predicted numbers of prostate cancer cases and deaths are shown in Table 2 and corresponding age-standardised incidence and mortality rates for the actual predicted populations are plotted in Figure 1. The numbers of cases per year and deaths per year for 1995-9 can be compared to those actually observed for the earlier portion of this time period. This suggests that the model with temporal trends continuing is most likely.