Prostate cancer is common and often is associated with pain. Currently, neoplasms of the prostate include 23% of all new cases of cancer in men, and these are second only to lung cancer as the cause of cancer death in men.' Black men have the highest incidence of prostate cancer in the world, estimated to be 123.4 per 100,000 (compared with 87.7 per 100,000 in white men),2 and prostate cancer may have caused more deaths than even lung cancer in black men in 1991 in the United state^.^ Estimates from surveys of cancer centers and oncology practices suggest that the prevalence of pain in patients with prostate cancer ranges from 55-100% (mean, 72Y0).~ Pain in prostate cancer may be caused by many factors (Table 1). In a busy oncologic practice, the management of pain complicating prostate cancer is a daily concern and usually revolves around the management of metastatic bone pain. Several recent reviews have emphasized new antitumor and analgesic treatments for the management of bone pain in cancer, and these will be discussed. In addition, the known pathophysiologic mechanisms of pain in prostate cancer and the assessment of pain complaints in the patient with prostate cancer will be reviewed.
Pain Syndromes in Prostate Cancer
Tumors of the prostate gland may produce: (1) local rectal, urethral, suprapubic, and penile pain as a result of expansion and inflammation of the prostate gland itself;
(2) pain referred to the back, lower extremities, and abdominal area resulting from tumor growth locally within the pelvis; and (3) distant bone pain with associated neurologic dysfunction associated with long bone, vertebral, and skull metastases. The urethral and