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The tumor marker prostate-specific antigen (PSA) has changed the way we think about and manage carcinoma of the prostate to a degree unprecedented in human oncology. Elevated serum concentrations can occur in men with benign prostatic hyperplasia but are more frequent and higher in those with cancer. Serum PSA measurements have become indispensable for monitoring disease, but their use for screening is controversial and highlights the paradoxes of this neoplasm. See also p 289. What confuses us about prostate cancer is that it usually grows slowly and is predominately a malady of aging. Among men older than 70 years who die of something else, 30% also have "autopsy" cancer of the prostate, usually with cancer volumes less than 0.2 cm3and low-grade cell types.1Yet prostate cancer is the second leading cause of male cancer death. Clinical cancer of the prostate can only be cured if localized, and

The field of prostate cancer is important, changing, and confusing. Prostate cancer is the most frequent cancer and the second most common cause of cancer death among US men. Yet autopsy studies show that many men without clinical prostate cancer have some cancer in their prostates, albeit in small volumes. This, plus the fact that prostate cancer occurs in aging men and often grows slowly, means that many more men die with prostate cancer than of it. In the past, early diagnosis was advocated by periodic digital rectal examinations (DREs), treatments for curative intent consisted of radical prostatectomy and/or radiation therapy, and significant palliation as afforded by androgen ablation therapies. Yet the mortality from prostate cancer has not altered in decades. 1 Today, concepts about prostatic cancer treatment are changing rapidly, principally because of the availability of spring-loaded biopsy guns and transrectal ultrasonography (which make prostate biopsies safer, easier, and

Using electrohydraulic lithotripsy, we removed branched or staghorn calculi from four patients via a percutaneous nephrostomy tract with local anesthesia. There were no serious complications, and the patients were able to resume their preadmission activities immediately after discharge from the hospital. Our experience suggests that, eventually, all upper urinary tract calculi may be treatable by a percutaneous approach. ( JAMA 1983;250:73-75)