Decreasing mortality rates for prostate cancer: possible role of hormonal therapy?

Mortality rates for prostate cancer have started to fall in some parts of the world. Is this because of better diagnostic methods and screening, earlier and more aggressive treatment, or an increase in early hormone therapy? This controversial subject is reviewed in this section. Another area of interest currently is the use of botulinum toxin in the lower urinary tract; its role in treating lower urinary tract pathology and the way that it can be used is reviewed. The reader will be able to assess its value and have a deeper insight into the relevant literature. The other two mini‐reviews describe the current thoughts on the use of minimally invasive therapies in renal cancer and cryosurgery in prostate cancer. Once again, two controversial areas of general interest in urological oncology. SUMMARY Within the last decade prostate cancer mortality rates have started to decrease in some countries. Although it is tempting to assume that these trends are a result of earlier diagnosis and aggressive therapeutic intervention, as a consequence of prostate‐specific antigen screening, definitive results from randomized trials of screening will not be available for several years. Moreover, there is mounting evidence that the effects of screening cannot be entirely responsible for this reduction in mortality rates. This review explores the possibility that other factors, particularly the increased uptake of early hormonal therapy, are contributing to the observed changes in mortality.