The 1996–1997 fiscal year has been a watershed year in regard to prostate cancer for the American Cancer Society. Several major decisions were made that give long-term direction to programs of the Society. One such decision was to update the prostate cancer detection guideline, as reported in this issue.1 Other decisions include the designation of prostate cancer as an ACS core priority to be included in programs in all divisions and units and the launching of a targeted research effort in prostate cancer. These decisions have several implications.
Evidence is developing that supports early prostate cancer detection as the factor that has resulted in a rapid change in prostate cancer incidence and mortality. All experts agree that yearly prostate-specific antigen testing and digital rectal examination applied during routine examination have resulted in a shift in the stage of prostate cancer at diagnosis. Now, instead of two-thirds of the disease detected being locally advanced and distant, in nearly two-thirds of men disease is locally confined, thus allowing for curative treatment.
Most primary care practitioners in the nation are performing such tests, and this activity may well explain the rise and subsequent fall in prostate cancer incidence. The resulting curative treatment may explain the recently documented decline in prostate cancer mortality rates.2 Certainly, additional research on these points is needed. The Society's guideline clearly stresses the need for informed decision making in prostate cancer early detection.
As a core priority for the ACS, prostate cancer will be the focus of substantial attention. The effort will encompass better education for the public about prostate cancer early detection and appropriateness for treatment selection; it also will include group support activities through the Society's Man to Man program, which is rapidly spreading across the nation. Also, as the Society increases its grassroots advocacy activities, its divisions and units will garner additional support for prostate cancer legislative issues, including early detection, treatment, and research.
The Society is altering the course of its research activities in part by adding directed research into specific target areas. Prostate cancer was selected as the first such area in which 7 million to 8 million dollars per year for 3 years will be set aside for requests for applications (RFAs) evaluating novel ideas, outcomes and policy research, and behavioral research. Preliminary assessment of this target has been positive, and many quality research applications have been received. Should this effort be successful, additional target areas in research may be established.
Finally, the Society is beginning to build toward the long-term goal of a 50% reduction in age-adjusted mortality by the year 2015. Clearly, substantial effort will be required in all major cancers, including prostate cancer, to achieve this outcome. This goal is starting to drive the Society's decisions in shaping programs for community cancer control, advocacy, information delivery, and research. The additional prostate cancer articles published in this issue of CA provide some insight into the understanding of this complex disease and its detection and management.3–6